Older adults, particularly those who are poor, often fail to receive health care that meets recommended standards. Counsell and colleagues Article designed a primary care and home-based geriatrics care management program and assessed the quality of care received, acute care utilization, health-related quality of life, and independence in activities of daily living among low-income seniors who were randomly assigned to home-based care management vs usual care. During the 2-year follow-up, the authors found that compared with patients who received usual care, patients in the home-based care management program received higher-quality medical care, reported improvements in health-related quality of life, and had fewer emergency department visits. There were no differences between the intervention and usual care patients in measures of physical function. In an editorial, Reuben Article discusses principles of optimal health care delivery for older persons with chronic health conditions.
Evidence from clinical trials has suggested an increased risk of adverse cardiovascular outcomes among patients taking thiazolidinediones (TZDs). To assess this association in a population-based sample of older adults (mean age, 74.7 years) with diabetes and to compare outcomes among patients taking TZDs vs other oral hypoglycemic agents, Lipscombe and colleagues analyzed data from health databases in Ontario, Canada, in a nested case-control study. In analyses adjusted for baseline cardiovascular risk and diabetes duration, the authors found that patients treated with TZDs had significantly higher risks of congestive heart failure, acute myocardial infarction, and all-cause mortality than patients who were treated with other combination oral hypoglycemic therapies.
Lorazepam is recommended for sedation of patients receiving mechanical ventilation in the intensive care unit, but its use is associated with increased risks of delirium and coma. Pilot data have suggested that dexmedetomidine, a sedative that acts at different central nervous system receptors than lorazepam, is associated with reduced rates of delirium. In a randomized controlled trial that enrolled 106 adults receiving mechanical ventilation in the intensive care unit, Pandharipande and colleagues compared sedation adequacy and duration of delirium and coma in patients receiving dexmedetomidine vs lorazepam. The authors report that patients who were randomly assigned to receive dexmedetomidine had more days alive without delirium or coma and more time at the targeted level of sedation than did patients who received lorazepam.
Willi and colleagues Article report results of a systematic literature review and meta-analysis of data from 25 prospective cohort studies that assessed the association between smoking and the incidence of type 2 diabetes. The authors found that compared with never smokers, current and past smokers had significantly increased risks of type 2 diabetes. In an editorial, Ding and Hu Article discuss the evidence linking smoking and diabetes risk, the approximate burden of diabetes attributable to smoking, and implications for patient care and public health interventions.
Join Ian G. Williamson, MD, January 16, 2008, from 2 to 3 PM eastern time to discuss the use of antibiotics and topical nasal steroids for treatment of acute maxillary sinusitis. To register, go to http://www.ihi.org/AuthorintheRoom.
Researchers at the American College of Chest Physicians' annual meeting reported findings on improper use of inhalers by patients with airway disease, potential prophylactic care for rescue workers, and care of student athletes with asthma.
Application of magnetic resonance imaging to visualize anatomical structures in dry human mummies.
Market forces erode professionalism
Sharing the risk of genetics
Authors are invited to submit manuscripts for an upcoming theme issue.
How would you manage a 39-year-old man with erythema and swelling of a finger? Read about his case and submit your response by December 26, which may be selected for online publication.
For your patients: Information about smoking cessation.
This Week in JAMA . JAMA. 2007;298(22):2587. doi:10.1001/jama.298.22.2587