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Primary vs Specialist Care of Patients With OSA
Many patients report symptoms suggestive of obstructive sleep apnea (OSA), which has increased demand for sleep specialist consultation as well as interest in primary care models for diagnosis and treatment. Chai-Coetzer and colleagues assessed the clinical efficacy of primary care vs specialist care treatment in a randomized trial that enrolled 155 patients with OSA identified by screening questionnaire and home oximetry. The authors report that compared with care in a university-based sleep medicine center, OSA treatment under a primary care model—led by a primary care physician and community-based nurse—did not result in worse sleepiness scores.
Effects of Breastfeeding on Adiposity and IGF-1
To examine long-term effects of breastfeeding duration and exclusivity on child growth and obesity regulation, Martin and colleagues assessed measures of adiposity in a follow-up study of 13 879 Belarusian children whose mothers had initiated breastfeeding and were randomly assigned to either an intervention to improve the duration and exclusivity of breastfeeding or usual care. The authors report that although the intervention increased breastfeeding duration and exclusivity, it did not prevent child overweight or obesity or affect levels of insulin-like growth factor (IGF)-1 at age 11.5 years.
Smoking Cessation, Weight Change, and CVD
Smoking cessation reduces the risks of cardiovascular disease (CVD); however, whether weight gain, which is common after quitting smoking, attenuates the CVD risk reduction is not known. In an analysis of data from 3251 participants in a prospective cohort study, Clair and colleagues found that smoking cessation was associated with a lower risk of CVD events among individuals without diabetes and that weight gain following smoking cessation was not associated with a reduction in this favorable effect. In an editorial, Fiore and Baker discuss benefits of smoking cessation for every patient who smokes.
Bleeding and Mortality Following PCI
Bleeding is the most common complication following percutaneous coronary intervention (PCI). In an analysis of registry data from nearly 3.4 million PCI procedures, Chhatriwalla and colleagues assessed the association between bleeding events and in-hospital mortality following PCI. The authors report the incidence of major bleeding complications following PCI was 1.7%. Postprocedural bleeding events were associated with increased risk of in-hospital mortality, with an estimated 12.1% of these deaths related to bleeding complications.
CLINICIAN'S CORNER JAMA Clinical Challenge
A 55-year-old man who has hypertension and hyperlipidemia and whose mother died of complications of scleroderma is admitted to the hospital with a 1-month history of progressive dyspnea and exertional angina. He undergoes coronary angiography. What would you do next?
Medical News & Perspectives
A new guideline aims to reduce the high mortality rate associated with sepsis by setting targets for early and aggressive treatment.
Caring amid chaos
Health information technology: a path to success
Improving the electronic health record
Helping smokers quit before surgery
See Viewpoint and Article
A Piece of My Mind
“Snow's genius was his uncanny ability to connect the dots, so to speak, of disease causation.” From “Happy Birthday, Dr Snow.”
Thank you—JAMA peer reviewers and authors
Editor's Audio Summary
Dr Bauchner summarizes and comments on this week's issue. See www.jama.com.
Author in the Room Teleconference
Join Daniel J. Buysse, MD, March 20, 2013, from 2 to 3 PM eastern time to discuss insomnia. To register, go to http://www.ihi.org/AuthorintheRoom.
JAMA Patient Page
For your patients: Information about trigeminal neuralgia.
This Week in JAMA. JAMA. 2013;309(10):951. doi:10.1001/jama.2012.145287
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