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In This Issue of JAMA Internal Medicine
June 10, 2013

In This Issue of JAMA Internal Medicine

JAMA Intern Med. 2013;173(11):946. doi:10.1001/jamainternmed.2013.63

The MACE service is a novel model of care designed to deliver specialized interdisciplinary care to hospitalized older adults to improve patient outcomes. To evaluate the impact of the MACE service, Hung et al conducted a prospective, matched cohort study of patients 75 years or older admitted to a tertiary hospital for an acute illness to either the MACE service or medicine service. Admission to the MACE service was associated with lower rates of adverse events (9.5% vs 17.0%), shorter hospital length of stay by 0.8 days, and better satisfaction.

Doshi challenges the basic assumptions of officials and professional societies to treat influenza as a major public health threat for which the annual vaccine offers a safe and effective solution, showing that there is no good evidence that vaccines reduce serious complications of influenza. Promotional messages conflate “influenza” (disease caused by influenza viruses) with “flu” (a syndrome with many causes, of which influenza viruses appear to be a minor contributor). This lack of precision causes physicians and potential vaccine recipients to have unrealistic assumptions about the vaccine's potential benefit and impedes dissemination of the evidence on nonpharmaceutical interventions against respiratory diseases. Also, unexpected and serious adverse effects of influenza vaccines have occurred. The decisions surrounding influenza vaccines need to include a discussion of these risks and benefits.

Puetz et al conducted a systematic review of randomized clinical trials to summarize the effect of exposure to creative arts therapies (CAT) on psychological symptoms and quality of life (QoL) among patients with cancer during treatment and follow-up. Twenty-seven investigations that included both randomization to either a CAT or control condition and a measure of anxiety, depression, pain, fatigue, and/or QoL were selected. Meta-regression analyses examined whether the effects varied according to patient characteristics and modifiable features of CAT and clinical settings. Findings indicated that exposure to CAT reduced anxiety, depression, and pain and increased QoL during cancer treatment; fatigue was not significantly reduced. Exposure to CAT only significantly reduced pain during follow-up.

To assess the impact of the interdisciplinary Acute Care for Elders (ACE) model on costs, Flood et al conducted a retrospective cohort study of hospitalist patients 70 years or older spending the entirety of their hospitalization in either the ACE or usual care (UC) unit. Variable direct cost was chosen as the primary outcome because it represents the cost stemming directly from daily patient care. The authors found significantly reduced mean (SD) variable direct cost per patient for ACE compared with UC ($2109 [$1870] vs 2480 [$2113]; P = .009). Adjusted cost ratios revealed significant cost savings for patients with low (0.82; 95% CI, 0.72-0.94) and moderate (0.74; 95% CI, 0.62-0.89) case-mix index scores; care was cost neutral for patients with high case-mix index scores (1.13; 95% CI, 0.93-1.37). Significantly fewer ACE patients were readmitted within 30 days of discharge compared with UC (7.9% vs 12.8%; P = .02).

Hirsch et al performed a comprehensive, systematic analysis of oncology clinical trials registered with ClinicalTrials.gov between October 2007 and September 2010 to better understand the strengths and weaknesses of ongoing cancer research. Of 40 970 interventional studies registered during that time frame, 22% focused on oncology. Oncology trials were more likely to be single arm, open label, and nonrandomized compared with trials in other diseases. One-third of trials were conducted completely outside the United States, and there was only moderate correlation between the number of trials focused on a specific cancer type and the respective incidence or mortality. These and other results highlight the crucial need to better understand the trials being performed and to develop metrics with which to guide trial design to ensure that reliable, relevant data are generated to inform clinical care.

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