In a prospective study of 1984 older adults, hearing loss was independently associated with accelerated cognitive decline and incident cognitive impairment. The magnitude of these associations is clinically significant, with individuals with hearing loss having a 30% to 40% accelerated rate of cognitive decline over a 6-year period compared with individuals with normal hearing. On average, individuals with hearing loss required 7.7 years to decline by 5 points on the Modified Mini-Mental State Examination (a commonly accepted level of change indicative of cognitive impairment) vs 10.9 years in those with normal hearing.
With the new Institute of Medicine report, along with the American Board of Internal Medicine Foundation's “Choosing Wisely” campaign, and JAMA Internal Medicine’s “Less Is More” series, the topic of health care value and cost awareness is currently of great interest to community-based and academic internists and subspecialists. Residency programs are now tasked with integrating these concepts into training; however, most lack curricula to address this need. In this article, Moriates et al describe the implementation of a unique, multifaceted cost awareness curriculum for medicine residents, sharing keys to success and defining guiding principles.
Gross et al conducted a randomized clinical trial of human immunodeficiency virus (HIV) medication adherence intervention derived from problem solving theory. The intervention consisted of 4 face-to-face meetings over 3 months with intervening telephone calls with a trained interventionist as well as feedback of adherence measured using microelectronic monitors on the medication bottles. The authors enrolled 180 HIV-infected individuals to the experimental (n = 91) and control (n = 89) arms, and participants were followed for the outcomes of adherence and HIV RNA suppression quarterly over 1 year. The intervention resulted in both increased medication adherence and a higher rate of HIV RNA suppression.
In a 3-arm, cluster-randomized trial among 33 primary care practices, 2 different approaches to providing decision support for evaluation and treatment of acute cough illness in adolescents and adults were equally effective at reducing antibiotic use for acute bronchitis. Both active intervention groups received patient and clinician education about appropriate antibiotic use for acute cough illness. Practices receiving decision support provided through examination room posters showed a decrease in antibiotic prescription rates for acute bronchitis from 80% to 68%; practices receiving decision support through the electronic medical record showed a decrease from 74% to 61%; and the control group practices showed a slight increase in prescription rates between the baseline and study periods. Changes in total acute respiratory tract infection visits, proportion diagnosed as acute bronchitis, and 30-day return visit rates were similar between study groups.
Whether regular aspirin use is associated with age-related macular degeneration is unclear. Liew et al examined a population-based cohort of 2389 participants followed up for 15 years. After adjustment for age, sex, smoking, history of cardiovascular disease, systolic blood pressure, and body mass index, persons who were regular aspirin users had higher risk of developing neovascular age-related macular degeneration (odds ratio, 2.46; 95% CI, 1.25-4.83). Aspirin use may be associated with higher risk of incident age-related macular degeneration.
Left eye retinal photograph of a participant with regular aspirin use who developed neovascular age-related macular degeneration with an extensive subretinal fibrous scar.
In This Issue of JAMA Internal Medicine. JAMA Intern Med. 2013;173(4):256. doi:10.1001/jamainternmed.2013.2698