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This Week in JAMA
August 11, 2010

This Week in JAMA

JAMA. 2010;304(6):607. doi:10.1001/jama.2010.1132

To assess changes in rates of health care–associated invasive methicillin-resistant Staphylococcus aureus (MRSA) infections, Kallen and colleagues Article analyzed 2005-2008 data reported by facilities participating in a Centers for Disease Control and Prevention population-based emerging infections surveillance system. The authors found that from 2005 through 2008, health care–associated invasive MRSA infections decreased 17% among patients with infections that began in the community and 28% among patients with hospital-onset disease in these 9 geographically diverse metropolitan areas. In an editorial, Perencevich and Diekema Article discuss potential reasons for the decrease in health care–associated invasive MRSA infections and the importance of ongoing infection surveillance and prevention research programs.

Zhang and colleagues analyzed data from the 2005-2008 National Health and Nutrition Examination Survey to determine the prevalence of and risk factors associated with diabetic retinopathy among adults aged 40 years or older. The authors estimate that among US adults with diabetes, the prevalence of diabetic retinopathy and vision-threatening diabetic retinopathy was 28.5% (95% confidence interval [CI], 24.9%-32.5%) and 4.4% (95% CI, 3.5%-5.7%), respectively. Risk factors included racial/ethnic minority status, male sex, higher hemoglobin A1c level, use of insulin, longer duration of diabetes, and higher systolic blood pressure.

Esophagitis is a known adverse effect of oral bisphosphonate use, and several small case series of esophageal cancer among patients using bisphosphonates have been reported. To more fully assess whether bisphosphonates increase esophageal cancer risk, Cardwell and colleagues analyzed data from the UK General Practice Research Database—representing approximately 6% of the UK population—and found no increased risk of incident esophageal or gastric cancer among users of bisphosphonates compared with nonusers.

Emergency departments (EDs) are often the health care provider of last resort for uninsured and underinsured persons. In an analysis of nationally representative ED visit data from 1997 through 2007, Tang and colleagues Article assessed changes in adult and pediatric ED visits by sociodemographic group. Among the authors' findings were that total ED visits increased significantly, particularly among adults with Medicaid, and the number of EDs qualifying as safety net—providing a disproportionate share of services to Medicaid and uninsured persons—increased 46% between 1997 and 2007. In a commentary, Katz Article discusses the future of the health care safety net—including public hospitals and clinics, community health centers, and private hospitals and physicians who provide uncompensated care—under health reform.

Ms R is a 29-year-old woman who sought care from her primary care physician after several days of a nonproductive cough, diffuse headache, myalgia, and fatigue, which did not respond to over-the-counter remedies. On physical examination she was afebrile with nonlabored respirations and normal vital signs; she had clear nasal discharge and a mildly erythematous pharynx. Barry discusses the diagnosis, treatment, and prevention of influenza.

“The thousands of patients with fixable problems shaped me collectively, but these individual persons influenced me distinctively.” From “Maintenance.”

There are many questions and few definitive answers about potential health risks resulting from the unprecedented oil leak in the Gulf of Mexico.

Dietary guidelines in the 21st century

Evaluation of comparative treatment trials

Electronic medical records and clinical trial data

Join Patricia Goode, MD, Wednesday, August 18, from 2 to 3 PM eastern time to discuss caring for aging patients with urinary incontinence. To register, go to http://www.ihi.org/AuthorintheRoom.

Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

For your patients: Information about cancer of the esophagus