Medication use is common among adults aged 65 years and older; in a
recent nationwide survey, more than one third of older noninstitutionalized
adults used 5 or more different medications per week. Gurwitz and colleaguesArticle
conducted a study of Medicare enrollees to evaluate the incidence and preventability
of adverse drug events among older persons cared for in the ambulatory setting.
In a cohort of Medicare enrollees (30 397 person-years of observation),
1523 adverse drug events were identified (50.1 per 1000 person-years), 27.6%
of which were considered preventable (13.8 per 1000 person-years). In an editorial,
ClassenArticle underscores the risk that medications pose to patients and emphasizes
the need for strategies to reduce it.
In the Trial of Invasive versus Medical therapy in Elderly patients
(TIME) study, functional outcomes of patients aged 75 years or older with
coronary artery disease (CAD) who received invasive therapy were significantly
better at 6 months than in the optimal medical management group, but early
mortality was slightly higher. In this study of 1-year outcomes, Pfisterer
and colleaguesArticle found that improvements in angina and quality of life compared
with baseline persisted in both treatment groups, but there were no significant
between-group differences in symptoms, quality of life, or rates of death
or nonfatal myocardial infarction. Rates of hospitalization for uncontrolled
symptoms and of late revascularization during the 1-year follow-up were significantly
higher in the medical therapy group. In an editorial, PetersonArticle discusses how
to approach treatment decisions for symptomatic elderly patients with CAD.
Bronchopulmonary dysplasia, brain injury, and severe retinopathy of
prematurity are known risk factors for poor long-term outcomes of very preterm
infants, but the individual and combined prognostic value of these common
neonatal morbidities is uncertain. In this analysis of data from extremely
low-birth-weight (LBW) infants enrolled in the international Trial of Indomethacin
Prophylaxis in Preterms who survived to a postmenstrual age of 36 weeks, Schmidt
and colleagues found that each of the 3 neonatal morbidities was independently
associated with death or neurosensory impairment at 18 months. The rate of
a poor outcome at 18 months increased from 18% in children with none of the
neonatal morbidities to 88% with all 3 neonatal morbidities.
Stem cell transplantation and immunosuppression alone are both effective
treatments for aplastic anemia, but late complications of immunosuppression
have included high rates of relapse and evolution to other hematologic diseases.
In a cohort of 122 patients with severe aplastic anemia treated with antithymocyte
globulin and cyclosporine, Rosenfeld and colleagues found that overall actuarial
survival at 7 years was 55%. Survival was associated with early satisfaction
of response criteria and with the quality of the blood cell count response
at 3 months. Relapse (defined as the requirement for further immunosuppressive
therapy) was common, but severe pancytopenia usually did not recur. Thirteen
patients had evolution to other hematologic diseases.
New guidelines for colorectal cancer screening stress the importance
of initial screenings for people aged 50 years or older.
Results of this preliminary randomized placebo-controlled trial suggest
that inhaled nitric oxide may be beneficial for the treatment of acute vaso-occlusive
crisis in patients with sickle cell disease.
Cohen discusses why affirmative action policies are critically important
in medical school admissions.
Acute pericarditis: current concepts and clinical management.
Health care coverage in the United States.
(Go to MSJAMA)
For your patients: Information about pericarditis.
This Week in JAMA. JAMA. 2003;289(9):1077. doi:10.1001/jama.289.9.1077