Peripheral arterial disease (PAD) is associated with an increased risk
of cardiovascular ischemic events and death and decreased quality of life.
Hirsch and colleaguesArticle conducted a screening of older adult patients in a nationwide
sample of primary care clinics using Doppler ankle-brachial index measurement
to detect PAD. The prevalence of PAD was 29%, and 55% of patients with PAD
alone and 35% of patients with PAD and cardiovascular disease were newly diagnosed
during the survey. In an editorial, OurielArticle encourages physicians to perform
an ankle-brachial index measurement when examining patients at risk for atherosclerosis.
In a previously published trial, quality improvement (QI) interventions
for treatment of depression implemented in diverse managed primary care practices
improved clinical outcomes compared with usual care. In this cost-effectiveness
analysis of the quality improvement efforts, Schoenbaum and colleagues found
that over a 2-year period, the incremental costs per quality-adjusted life-year
relative to usual care were within the range of accepted medical interventions.
Patients in the QI groups had fewer days with depression and were employed
more days during the study period.
Prior studies have shown that sibutramine hydrochloride is efficacious
for the treatment of obesity. In this randomized trial, Wirth and Krause found
that mean weight loss was not significantly different among patients assigned
to receive continuous sibutramine therapy compared with patients who received
intermittent sibutramine therapy. Weight loss in both sibutramine groups was
significantly greater than in the placebo group.
Shortened cervical length has been consistently associated with preterm
birth. To determine when in gestation this risk factor becomes apparent, Owen
and colleagues performed endovaginal sonography of the cervix at 2-week intervals
in women with singleton gestations who had previously experienced a spontaneous
birth before 32 weeks of gestation. Cervical length of less than 25 mm on
the initial sonogram at 16 to 18 weeks of gestation was a significant predictor
of spontaneous preterm birth before 35 weeks of gestation. Using the shortest
ever observed cervical length on serial evaluations improved the prediction
of preterm birth.
Expenditures for Medicare beneficiaries in the last year of life have
been shown in several previous studies to decrease with increasing age. In
this analysis of Medicare data for beneficiaries aged 65 years or older from
Massachusetts and California who died in 1996, Levinsky and colleagues found
a similar pattern of decreasing expenditures with increasing age for medical
care of the elderly in the last year of life. This pattern appears to result
largely from a decrease in the use of aggressive care with increasing age.
"I am more aware than ever how human beings are spiritual beings—whether
or not they are religious—concerned with meaning, hope, relationship
and love, suffering, and life's mystery." From "Toward Meaning."
Native American students who participate in Harvard Medical School's
Four Directions Summer Research Program are helped toward their goal of becoming
physicians and biomedical researchers.
Thrombolysis in Myocardial Infarction (TIMI) Risk Score, a bedside risk
assessment tool for patients with ST-elevation myocardial infarction, demonstrated
strong prognostic performance in a community-based population of patients
with ST-elevation acute coronary syndromes who had been treated with reperfusion
Cognitive behavioral therapy and graded exercise therapy showed the
most beneficial effect in controlled trials of treatments for patients with
chronic fatigue syndromeArticle. But overall, the evidence base was limited—a
challenge to the chronic fatigue syndrome research communityArticle.
Approaches to the care of bereaved patients are illustrated by the experience
of Mrs A, a 77-year-old woman widowed for 2 years.
For your patients: Information about peripheral arterial disease.
This Week in JAMA. JAMA. 2001;286(11):1277. doi:10.1001/jama.286.11.1277