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The extent of conflicts of interest in cardiology guideline production has not been well studied. Mendelson et al examined 17 recent American College of Cardiology/American Heart Association guidelines. Using disclosure lists, the authors cataloged conflicts of interest (COIs) for each individual writer and reviewer of the guidelines and the companies involved in each episode of COI. Among the 498 individuals, 56% reported a COI. Consultant/advisory board was the most common type. The percentage of episodes involving a COI varied between guidelines (13% to 87%), as did the number of companies involved per guideline (2 to 242, average 38). While COIs are prevalent in cardiology guidelines, there appears to be a significant number of experienced experts without COIs.
Yamin et al evaluated the adoption and use of a personal health record (PHR) in an integrated delivery system. Blacks and Hispanics were less likely to adopt the PHR than whites. Patients with 2 or more chronic conditions were more likely to adopt than those without. Intensity of use was correlated with increasing number of comorbidities, followed by race (whites over blacks and Hispanics) and insurance status. Despite increasing Internet availability, minority patients adopted a PHR less frequently than white patients, and patients with the lowest income adopted less often. Among adopters, however, income did not have an effect on PHR use.
A multimedia patient education program with health professional support reduced falls among cognitively intact hospital inpatients (4.01 falls per 1000 days in the intervention group compared with 8.72 falls per 1000 days in the control group). This evidence shows that a single intervention strategy can reduce falls in hospitals. Cognitively impaired patients did not benefit from the intervention, and a multimedia education program that did not include health professional support was ineffective.
Older adults having difficulties to perform concurrent motor or cognitive tasks are more likely to fall. Little is known about effective approaches to improve gait under such dual-task situations. Trombetti et al evaluated the efficacy of a music-based multitask exercise program in 134 community-dwelling older adults 65 years or older and at high risk of falling, using a randomized controlled trial design with gait variability as primary outcome measure. The authors found that 6 months of once-weekly exercise classes benefited the gait performance under dual-task condition. These findings provide evidence for the reversibility of increased gait variability (ie, a strong risk factor for falls) while walking and simultaneously performing a cognitive interference task. Also, balance and functional performances improved with the exercise program. These changes translated into a reduction in falls and numbers of fallers.
Modern thrombolytic strategies, including the use of routine invasive evaluation after thrombolytic therapy (TT), may affect the previously documented mortality benefit of primary percutaneous coronary intervention (PPCI) over TT. This study prospectively assessed in-hospital mortality in 5295 unselected patients with ST-segment elevation myocardial infarction treated with PPCI (86%) or with TT (14%) during the period 2007 through 2009 in 73 Belgian hospitals. After adjustment for differences in baseline risk profile, a significant mortality benefit was only present in the high-risk groups: 23.7% for PPCI vs 30.6% for TT. For non–high-risk patients (81% of the study population), the mortality difference was marginal, with in-hospital mortality rates of less than 5% irrespective of reperfusion therapy. Subgroup analysis revealed that mortality benefit of PPCI over early TT (door-to-needle time, <30 minutes) was offset if the door-to-balloon time exceeded 60 minutes.
Adjusted mortality odds ratios (ORs).
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2011;171(6):486. doi:10.1001/archinternmed.2011.43