Bariatric surgery reliably induces weight loss, but the effect of bariatric surgery on long-term survival is not clear. Maciejewski and colleagues examined the association of bariatric surgery with all-cause mortality in a cohort of predominantly male and older patients with high rates of obesity-related comorbid conditions who received care at Veterans Affairs medical centers. The authors compared the men who underwent bariatric surgery with those who did not, and in propensity score–adjusted analyses, they found that bariatric surgery was not associated with decreased mortality over a mean 6.7 years of follow-up.
In an analysis of data from the National Practitioner Data Bank, Bishop and colleagues Article assessed trends in malpractice claims paid by setting (inpatient and outpatient), characteristics of claims, and factors associated with payment amount. The authors report that in 2009 the numbers of paid malpractice claims for events in outpatient and inpatient settings were similar and that major injury and death accounted for almost two-thirds of paid outpatient claims. In an editorial, Zuccotti and Sato Article discuss factors associated with the increasing and often unrecognized problem of malpractice risk in ambulatory settings.
Elevated levels of the phosphate-regulating hormone fibroblast growth factor 23 (FGF-23) are associated with increased mortality among patients with end-stage renal disease. In a prospective study of racially and ethnically diverse patients with chronic kidney disease stages 2 through 4, Isakova and colleagues examined the association of the level of FGF-23 with all-cause mortality and disease progression. The authors found that elevated FGF-23 was an independent risk factor for mortality and was associated with an increased risk of end-stage renal disease among patients with relatively preserved kidney function at baseline assessment.
Ambulance diversion—temporary closure of emergency departments to ambulance traffic—could be problematic for patients with time-sensitive conditions. In an analysis of 2000-2005 Medicare claims data from patients with acute myocardial infarction (AMI) who resided in 4 California counties, Shen and Hsia examined whether temporary closure of the nearest emergency department on the day a patient experienced an AMI was associated with increased mortality. The authors found that compared with no diversion hours, exposure to 12 or more hours of diversion was associated with increased mortality at 30 and 90 days, 9 months, and 1 year.
Television viewing is a prevalent sedentary behavior that has been associated with unhealthy eating and possibly increased risks of morbidity and mortality. In a systematic review and meta-analysis of 8 prospective cohort studies, Grøntved and Hu found that prolonged television viewing is consistently associated with higher risks of type 2 diabetes, fatal and nonfatal cardiovascular disease, and all-cause mortality.
“They told me about the scores of doctors who had pronounced [Marcus’] days on earth numbered, and how the family had completely lost confidence in ‘high and mighty’ physicians. This made me nervous.” From “Cyanosis.”
For the first time, guidelines are available on the prevention and treatment of hypertension in individuals aged 65 years or older.
Improving outcomes in patients with heart failure
Changing concepts of Alzheimer disease
Addressing elder abuse
Surveillance bias in outcomes reporting
Superficial corneal growth
The extraordinary Dr Biggs
How would you manage a 15-year-old athlete who experienced a sports-related concussion? Go to www.jama.com to read the case. Submit your response by July 3 for possible online posting.
For your patients: Information about ovarian cancer.
This Week in JAMA . JAMA. 2011;305(23):2379. doi:10.1001/jama.2011.837