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In This Issue of JAMA Internal Medicine
April 22, 2013

In This Issue of JAMA Internal Medicine

JAMA Intern Med. 2013;173(8):609. doi:10.1001/jamainternmed.2013.45

Freiberg et al examined the association between human immunodeficiency virus (HIV) and acute myocardial infarction (AMI) among 82 459 participants in the Veterans Aging Cohort Study Virtual Cohort. During a median follow-up of 5.9 years, there were 871 AMI events. After adjusting for Framingham risk factors, comorbidities, and substance use, HIV-infected veterans had an increased risk of AMI (hazard ratio, 1.48; 95% CI, 1.27-1.72) compared with uninfected veterans. An excess risk remained among HIV-infected veterans with HIV-1 RNA levels lower than 500 copies/mL compared with uninfected veterans in time-updated analyses.

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In this cohort study of more than 10 000 medical admissions, 879 (8.2%) were followed by a potentially avoidable 30-day readmission. A risk score using data readily available before discharge was derived and validated in this cohort. Referred to as “HOSPITAL,” the risk score includes the following: h emoglobin at discharge, discharge from an o ncology service, s odium level at discharge, p rocedure during the index admission, i ndex t ype of admission, number of a dmissions during the last 12 months, and l ength of stay. The score had good calibration and fair discriminatory power and has potential to easily identify patients who may need more intensive transitional care interventions.

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Tzoulaki et al examined 56 meta-analyses of emerging cardiovascular biomarkers and evaluated whether there is evidence for biases favoring statistically significant results. In 29 meta-analyses (52%) there was a significant excess of studies with statistically significant results. Only 13 of the statistically significant meta-analyses had more than 1000 cases, no hints of very large heterogeneity, small-study effects, or excess significance. These included the associations of glomerular filtration rate and albumin to creatinine ratio in general and high-risk populations with cardiovascular disease mortality and of non–high-density lipoprotein cholesterol, serum albumin, Chlamydia pneumoniae IgG, glycosylated hemoglobin, nonfasting insulin, apolipoprotein B/AI ratio, erythrocyte sedimentation rate, and lipoprotein-associated phospholipase mass or activity with coronary heart disease. These findings suggest that most of the proposed associations of these biomarkers may be inflated.

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In 2010, 50 061 of 66 901 Ontario long-term care residents (75%) received a new antibiotic treatment course, and 45% of these treatment courses were prolonged beyond 7 days. Among 699 high-volume antibiotic prescribers, there was much more variability in the use of prolonged treatment courses than would be expected by random chance or differences in the characteristics of treated patients. If long-duration and average-duration prescribers adopted the prescribing habits of short-duration prescribers, overall antibiotic days in long-term care would drop by 19%. Future trials should evaluate antibiotic stewardship interventions targeting prescriber preferences to systematically reduce average treatment durations and thereby reduce the complications, cost, and resistance associated with antibiotic overuse.

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Xiao et al examined dietary and supplemental calcium intake in relation to cardiovascular mortality in the National Institutes of Health–AARP Diet and Health Study, a large prospective cohort of nearly half a million men and women. The authors' findings suggest that high intake of supplemental calcium is associated with an excess risk of cardiovascular deaths in men but not in women. Dietary intake of calcium was not associated with increased cardiovascular mortality. Given the extensive use of calcium supplement in the population, it is important to assess the impact of supplemental calcium use beyond bone health.

Nonparametric regression curve for men showing adjusted multivariate relative risks (RRs) and 95% CIs for the association between total calcium intake and total cardiovascular disease mortality.

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