Length of stay (LOS) for inpatient rehabilitation has declined, but
whether this affects patient outcomes is not clear. To assess this question,
Ottenbacher and colleaguesArticle reviewed national patient
data on rehabilitation LOS, postdischarge living setting, and change in functional
status and mortality. They found that median LOS decreased 8 days during the
study period without evidence of decline in patients’ functional status
or changes in living setting. However, mortality in the 6 months after discharge
increased significantly. In an editorial, EsselmanArticle
discusses these findings in light of evolving expectations and reimbursement
for rehabilitation services.
To eliminate vaccine-associated paralytic poliomyelitis (VAPP), national
vaccination policy transitioned from reliance on oral poliovirus vaccine (OPV)
to exclusive use of inactivated poliovirus vaccine (IPV). Alexander and colleaguesArticle
used national surveillance data from 1990 through 2003 to
review the epidemiology of poliomyelitis and to document the impact of the
vaccine schedule changes on VAPP. They found VAPP declined significantly during
the transition. No cases of VAPP were reported with the sequential IPV-OPV
schedule or when IPV was used exclusively. In an editorial, ModlinArticle
discusses polio eradication in the United States and the dangers of not achieving
similar goals worldwide.
Prior to licensure, almost 19 000 infants and children enrolled
in randomized trials received the 7-valent pneumococcal conjugate vaccine
(PCV) and a favorable safety profile was demonstrated. However, some vaccine
risks may not emerge until larger populations are exposed. Using data from
the Vaccine Adverse Event Reporting System, Wise and colleagues analyzed events
reported during the initial 2 years of PCV use. They found the majority of
reports describe mild signs and symptoms identified in the prelicensure clinical
trials. Adequate assessment of any association of PCV with rare but potentially
serious events requires continued surveillance and analysis.
Patients with low literacy may have difficulty understanding and managing
their disease, but whether interventions that address literacy deficiencies
can improve outcomes is not known. Rothman and colleagues report results of
a randomized trial of patients with poorly controlled type 2 diabetes. The
intervention group received frequent one-to-one communication designed to
enhance disease management comprehension. The authors found that intervention
group patients with low literacy were more likely to reach target hemoglobin
A1c (HbA1c) levels and to achieve reductions in systolic blood
pressure than control patients of similar literacy level. Outcomes for patients
with high literacy did not differ by randomization group.
A new study suggests that elective full-body computed tomography scans
for asymptomatic people—a controversial practice because of questions
about the procedure’s ability to detect hidden disease and extend life—might
increase risk of a potentially fatal radiation-linked cancer.
Regionalization of percutaneous transluminal coronary angioplasty would
not increase the travel distance for most patients.
Obesity comorbidities resolve or improve in patients having bariatric
Factors to consider when a patient’s disease suddenly worsens
and a shift from life-prolonging to palliative treatment is imminent.
For your patients: Information about polio and polio vaccination.
This Week in JAMA. JAMA. 2004;292(14):1655. doi:10.1001/jama.292.14.1655