In 2000, Jencks and colleaguesArticle reported national- and state-level performance
data on Medicare Quality Improvement Organization indicators of the quality
of care delivered to fee-for-service Medicare beneficiaries in 1998-1999.
The indicators measure delivery of services that evidence has shown to be
effective in preventing or treating breast cancer, diabetes, myocardial infarction,
heart failure, pneumonia, and stroke. In this report of follow-up data on
care given in 2000-2001, Jencks and colleagues found that the performance
of the median state and the weighted national average improved on 20 of 22
indicators. The percentage of patients receiving appropriate care on the median
indicator in the median state increased from 69.5% to 73.4%, but performance
continued to vary widely across states and by indicator. Relative rankings
among states changed little. In an editorial, HsiaArticle discusses opportunities
suggested by the quality literature to improve the quality of health care.
Helical computed tomography (CT) scanning to screen for lung cancer
is being promoted to physicians and patients despite the lack of evidence
supporting its use. In this decision and cost-effectiveness analysis of lung
cancer screening with helical CT in a hypothetical cohort of 60-year-old adults
who are current, quitting, and former heavy smokers, Mahadevia and colleaguesArticle
concluded that lung cancer screening with helical CT is unlikely to be highly
cost-effective for most heavy smokers without substantial reductions in lung
cancer mortality, high rates of adherence, lower rates of overdiagnosis, and
lower costs per screening test. In an editorial, Grann and NeugutArticle discuss
limitations of cost-effectiveness analysis but still advise caution about
accepting the use of helical CT scanning to screen for lung cancer until more
data are available.
Irwin and colleagues examined the effects of a moderate-intensity exercise
intervention on total and intra-abdominal body fat in overweight, sedentary,
postmenopausal women using data from the Physical Activity for Total Health
study, a randomized trial assessing the effects of exercise on breast cancer
biomarkers. After 12 months, reductions in body weight and total, intra-abdominal,
and subcutaneous abdominal body fat were greater in the exercise group than
in the stretching control group. Body fat loss increased significantly with
increasing duration of exercise.
Effective acute stroke therapy depends in large part on prompt recognition
of stroke symptoms and rapid access to emergency medical care. In this population-based
survey of adults in the greater Cincinnati region, a follow-up to a similar
survey conducted in 1995, Schneider and colleagues found that public knowledge
of stroke warning signs improved significantly from 1995 to 2000, but knowledge
of stroke risk factors did not improve. Groups of individuals at highest risk
of stroke were the least knowledgeable about warning signs and risk factors.
"She had been his cardiologist. Now she was his doctor." From "Convictions."
Guidance is now available from several sources for physicians faced
with providing prophylaxis for patients, other than health care workers, who
have been potentially exposed to HIV.
A systematic review of
studies on the efficacy and safety of low-molecular-weight heparins compared
with unfractionated heparin for the management of acute coronary syndromes
(ACS) and as an adjunct to percutaneous coronary intervention.
The Rational Clinical Examination
Assessment of the precision and accuracy of the clinical examination for diagnosing Parkinson
For your patients: Information about lung cancer.
This Week in JAMA. JAMA. 2003;289(3):263. doi:10.1001/jama.289.3.263