Providing hospitals with feedback on their achievement of patient care
“quality indicators” is a popular quality improvement strategy.
To investigate whether this strategy is effective, Beck and colleaguesArticle conducted a randomized trial where hospitals were
assigned to receive either immediate or delayed (14 months after randomization)
one-time feedback based on administrative data on processes of care and outcomes
for patients with acute myocardial infarction. The authors found no differences
between the rapid and delayed group hospitals in terms of medication prescriptions
filled, mortality, length of stay, waiting times for procedures, and readmissions
for cardiac complications. In an editorial, PetersonArticle discusses
the importance of rigorous evaluation of quality improvement strategies.
Little is known about the health and functional status of school-aged
children born extremely low-birth-weight (ELBW, <1000 g). In a study of
219 children born ELBW from 1992 to 1995 who received care at a tertiary perinatal
center and survived to follow-up at age 8 years, Hack and colleaguesArticle found that ELBW children have more chronic health
conditions and functional limitations, have a greater dependence on compensatory
aids, and have a greater need for educational and medical services compared
with normal-birth-weight controls. In an editorial, Tyson and SaigalArticle discuss the need for more follow-up studies of infants
born ELBW to better understand the benefits and risks of treatment and the
children’s long-term prognoses and needs.
A variety of lipid biomarkers and their ratios are recommended for predicting
risk of future cardiovascular disease (CVD) events, but their clinical utility
has not been directly compared. In a cohort of women participants in a clinical
trial with 10 years of follow-up for first cardiovascular event, Ridker and
colleaguesArticle evaluated baseline levels of total
cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein
cholesterol (HDL-C), non–HDL-C, apolipoproteins A-I and B100,
high-sensitivity C-reactive protein, and several ratios of these measurements
as predictors of future CVD events. They found that non–HDL-C and the
ratio of total cholesterol to HDL-C were as good or better than apolipoprotein
fractions to predict future CVD events.
Diabetes and obesity are established risk factors for congestive heart
failure (CHF) and are associated with insulin resistance, but whether insulin
resistance predicts CHF is not known. Ingelsson and colleaguesArticle analyzed
data from a longitudinal study of elderly men in Sweden who were free of CHF
at baseline to explore the association of insulin resistance with subsequent
CHF. In analyses adjusted for established risk factors for CHF including diabetes,
insulin resistance predicted first hospitalization for CHF.
Renal dysfunction is a possible adverse outcome following coronary artery
bypass graft (CABG) surgery performed with cardiopulmonary bypass (CBP). Burns
and colleaguesArticle hypothesized that N-acetylcysteine, which has antioxidant and vasodilator effects, might
prevent postoperative renal dysfunction. They randomly assigned patients undergoing
CABG surgery with CPB to receive either perioperative intravenous N-acetylcysteine or placebo and found that N-acetylcysteine
was no better than placebo in preventing renal dysfunction.
Accumulating evidence that certain synthetic and plant-derived compounds
have hormonelike effects is heightening concerns that exposure to these substances,
especially early in life, might pose long-term health risks.
A current understanding of nutrient requirements and interactions supports
consumption of essential nutrients from a varied diet rather than dietary
Perspectives on Care at the Close of LifeAdvance
care planning can be complicated by diagnostic uncertainty, lack of trust,
and the loss of hope; helping the patient to focus on goals for care rather
than specific treatments can be beneficial.
Expanding off-label use of patent foramen ovale closure devices and
the absence of data supporting long-term safety and efficacy compels the need
for evidence-based evaluation.
For your patients: Information about premature infants.
This Week in JAMA . JAMA. 2005;294(3):281. doi:10.1001/jama.294.3.281