In clinical trials, long-term therapy with statins has been shown to
reduce morbidity and mortality in patients with coronary artery disease. Two
articles in this issue of THE JOURNAL assess adherence to statin therapy in
elderly patients. In an analysis of data from patients aged 65 years and older
enrolled in the New Jersey Medicaid or Pharmaceutical Assistance to the Aged
and Disabled program, Benner and colleaguesArticle found that persistence in use of statin therapy decreased substantially over time, especially during the
first 6 months of treatment. Jackevicius and colleaguesArticle, using data from several
population-based administrative databases in Ontario for patients aged 66
years or older, found that 2-year adherence to statin therapy, defined as
a statin being dispensed at least every 120 days after the index prescription,
was 40.1% for patients with acute coronary syndrome, 36.1% for patients with
chronic coronary artery disease, and 25.4% for patients without coronary artery
disease in a primary prevention cohort. In an editorial, ApplegateArticle considers
ways to improve adherence to statin therapy, which is necessary to achieve
the clinical benefit observed in clinical trials, and to monitor adherence
in clinical practice.
Patterns of smoking and quitting in African Americans are different
from those in whites, but few smoking cessation trials have been conducted
among African Americans. Ahluwalia and colleaguesArticle conducted a clinical trial
comparing 7 weeks of treatment with a sustained-release form of bupropion
hydrochloride (bupropion SR) with placebo for smoking cessation among African
Americans. Abstinence rates were significantly higher in the bupropion SR
group than in the placebo group at 6 and 26 weeks after the quit day. In an
editorial, BenowitzArticle discusses why results of smoking cessation trials might
yield different results in African Americans and other racial and ethnic minority
groups compared with whites.
Poor health literacy has been associated with poor self-rated health
and higher use of health services, but little is known about the effects of
poor health literacy on clinical outcomes. In this cross-sectional study of
adult patients with type 2 diabetes in 2 primary care clinics of a university-affiliated
public hospital, Schillinger and colleagues found that patients with inadequate
health literacy as assessed by the short-form Test of Functional Health Literacy
in Adults were less likely than patients with adequate health literacy to
achieve tight glycemic control (HbA1c level of 7.2% or less) and
were more likely to have poor glycemic control (HbA1c level of
9.5% or more) and to report having retinopathy.
New commercial aircraft are designed to recirculate approximately 50%
of cabin air to increase fuel efficiency. To assess whether air recirculation
predicts postflight upper respiratory tract infections (URIs), Zitter and
colleagues followed up passengers 5 to 7 days after flying from the San Francisco
Bay area to Denver, Colo, on aircraft that used either 100% fresh air for
ventilation or recirculated air. Rates of new URI symptoms within 1 week of
the flight reported by passengers who traveled in aircraft that recirculated
air were not significantly different from rates reported by passengers who
traveled in aircraft that used fresh air.
Mrs A is an 83-year old woman who copes with chronic progressive pain
and weakness through prayer and her religious beliefs. Koenig discusses the
role of spirituality in helping patients cope with serious medical illness,
spiritual history taking, and professional boundaries between physicians and
"She was a foreign national without a green card to prove resident alien
status. She couldn't qualify for a transplant without the green card." From
"A Perfect Match."
Update on telemedicine and remote patient monitoring.
Perhaps the greatest challenge in caring for patients with mental retardation
is effectively diagnosing and treating those who also have mental illness.
Experts discuss the problems clinicians face and new research that may yield
Making Health Care Safer: A Critical Analysis of Patient
Safety Practices, a report commissioned by the Agency for Healthcare
Research and Quality, evaluated evidence supporting patient safety practices
using standards of evidence-based medicine. Leape and coauthorsArticle critique the
report, asserting that "rigorous proof of efficacy . . . is neither necessary
nor, in many cases, sufficient for recommending widespread use of a safety
practice." Shojania and colleaguesArticle, authors of the report, defend the evidence-based
approach to patient safety.
For your patients: Information about quitting smoking.
This Week in JAMA. JAMA. 2002;288(4):413. doi:10.1001/jama.288.4.413