Neuropsychiatric symptoms accompany dementia and also mild cognitive
impairment (MCI), a cognitive condition in elderly persons of insufficient
severity to qualify for a diagnosis of dementia. To estimate the prevalence
of neuropsychiatric symptoms among persons with dementia and MCI, Lyketsos
and colleagues evaluated participants with dementia or MCI enrolled in the
Cardiovascular Health Study using ratings from the Neuropsychiatric Inventory.
Three quarters of participants with dementia exhibited a neuropsychiatric
symptom in the previous month, with apathy, depression, and agitation/aggression
being the most common. Among participants with MCI, 43% exhibited a neuropsychiatric
symptom in the previous month, most commonly depression, apathy, and irritability.
Public disclosure of data on health care quality by health maintenance
organizations (HMOs) is voluntary. McCormick and colleagues linked data for
1997, 1998, and 1999 from the National Committee for Quality Assurance annual
Quality Compass databases to determine if withdrawal from public disclosure
of Health Plan Employer Data and Information Set (HEDIS) quality scores was
related to an HMO's HEDIS performance 1 year earlier. Health plans in the
lowest tertile of HEDIS scores for overall quality of care were significantly
more likely to withdraw from public disclosure in 1998 and 1999 than were
health plans in the highest tertile. In an editorial, Berwick suggests ways
to implement public reporting of health care performance by health plans,
hospitals, and large medical group practices and clinics.
The Losartan Intervention For Endpoint reduction (LIFE) study, a randomized
controlled trial, compared the long-term effects of losartan-based vs atenolol-based
antihypertensive therapy in patients with hypertension and electrocardiographically
documented left ventricular hypertrophy on the incidence of cardiovascular
morbidity and mortality. In this subgroup analysis of patients with isolated
systolic hypertension, Kjeldsen and colleagues found that risk of the composite
end point of cardiovascular death, stroke, or myocardial infarction was lower
in the losartan group. Risk of cardiovascular mortality and stroke was reduced
in the losartan group as was incidence of new-onset diabetes and total mortality.
Anemia is a common problem among critically ill patients but optimal
management of anemia in this patient population is not clearly defined. In
this prospective observational survey of critically ill patients hospitalized
in intensive care units (ICUs), Vincent and colleagues found that blood loss
through blood drawing averaged 41 mL per day. Almost one third of patients
had an admitting hemoglobin level less than 10 g/dL, and 37% received a red
blood cell transfusion while in the ICU. In an analysis using a matching strategy
based on propensity to receive a transfusion, 28-day mortality was higher
among patients who received red blood cell transfusions than among patients
who did not receive transfusions. In an editorial, Hébert and Fergusson
emphasize the need for randomized clinical trials to assess red blood cell
transfusions and blood-conserving strategies in critically ill patients.
Since being involved in a third motor vehicle collision within 2½
years, Mr M has had nightmares about driving, difficulty sleeping, trouble
concentrating, and diffuse fear and anxiety. His primary care physician is
considering a diagnosis of posttraumatic stress disorder (PTSD). Stein discusses
the definition and epidemiology of PTSD, risk factors for PTSD, and diagnosis
and management of PTSD in primary care.
"I cannot recall exactly when I found out that our doctor was something
other than a physician." From "A Man of His Words."
Preventing physician burnout.
Two groups of researchers in Boston are each performing experiments
seeking to validate their separate hypotheses that immune cells—or maybe
mast cells—are responsible for rheumatoid arthritis.
A comprehensive review of the research portfolio of the US Department
of Health and Human Services, including the National Institutes of Health,
found that only 21 of 45 022 research abstracts in the portfolio addressed
behavioral or emotional issues in children and adolescents, and only 11 of
the 21 examined these issues in the context of primary care.
For your patients: Information about mental retardation.
This Week in JAMA. JAMA. 2002;288(12):1439. doi:10.1001/jama.288.12.1439