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This Week in JAMA
October 8, 2003

This Week in JAMA

JAMA. 2003;290(14):1817. doi:10.1001/jama.290.14.1817
Air Pollution and Asthma Exacerbations in Children

Exposure to high levels of air pollution has been shown to increase the risk of respiratory symptoms in children with asthma. Gent and colleaguesArticle conducted a prospective study of children with asthma in southern New England during spring and summer 2001 to assess the simultaneous effects of exposure to ozone and fine particles on asthma severity. In copollutant models, exposure to ozone, often at levels below Environmental Protection Agency air quality standards, was significantly associated with increased respiratory symptoms and rescue medication use among children using maintenance asthma medication, but exposure to fine particles was not. In an editorial, Thurston and BatesArticle urge greater recognition that exposure to air pollution is an important factor in asthma exacerbations and describe ways for patients with asthma to avoid the potentially adverse effects of air pollution.

Medical Injuries and Length of Stay, Charges, Mortality

Patient Safety Indicators (PSIs), developed by the US Agency for Healthcare Research and Quality, are tools designed to screen administrative data for potential patient safety problems. Using PSIs to identify medical injuries in hospital discharge abstracts from a sample of approximately 20% of US hospitals, Zhan and MillerArticle found that for 18 types of medical injuries, the excess length of stay attributable to medical injuries ranged from 0 days to 10.89 days, excess charges ranged from $0 to $57 727, and excess mortality ranged from 0% to 21.96%. In an editorial, Weingart and IezzoniArticle discuss limitations of current measurement tools, including administrative data–based algorithms, for capturing patient safety information.

Methotrexate for Autoimmune Inner Ear Disease

Methotrexate has been proposed for long-term therapy to maintain the hearing improvement achieved by high-dose prednisone in patients with rapidly progressive, bilateral sensorineural hearing loss (autoimmune inner ear disease [AIED]). In this randomized controlled trial, however, Harris and colleagues found that among patients with AIED whose hearing improved after 1 month of high-dose prednisone, methotrexate was no more effective than placebo in maintaining the initial hearing improvement after prednisone therapy was tapered.

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Lifetime Risk of Diabetes Mellitus in the United States

Using data from the National Health Interview Surveys (1984-2000) and the US Census Bureau, Narayan and colleagues estimated the lifetime risk of developing diabetes from birth to 80 years for the US population born in 2000. The estimated lifetime risk of developing diabetes was 32.8% for males and 38.5% for females. Life-years and quality-adjusted life-years lost due to diabetes were substantial at all ages, including among individuals diagnosed as having diabetes at older ages.

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Reperfusion When Thrombolysis Is Contraindicated

Thrombolytic therapy is the most widely used method of achieving coronary artery reperfusion in patients with acute ST-segment elevation myocardial infarction (STEMI), but management of patients with STEMI who have contraindications to thrombolytic therapy is unclear. In this propensity analysis using data from the National Registry of Myocardial Infarction 2, 3, and 4 databases, Grzybowski and colleagues found that immediate mechanical reperfusion (percutaneous coronary intervention or coronary artery bypass graft surgery) in patients with STEMI who have contraindications to thrombolytic therapy was associated with a significantly reduced risk of in-hospital mortality.

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Medical News & Perspectives

Cardiologists are exploring whether anemia causes or worsens congestive heart failure.

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Quality of Care of Patients in Isolation

Patients in isolation for infection control precautions were twice as likely as control patients to experience adverse events during their hospitalization, expressed greater dissatisfaction with their care, and had less documented care.

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Clinician's corner

Acute hemodynamic consequences of obstructive sleep apnea and abnormalities associated with obstructive sleep apnea that may contribute to the initiation and progression of cardiovascular disease (CVD).

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JAMA Patient Page

For your patients: Information about health effects of ozone.

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