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Rapid Response Teams in Pediatric Hospitals
Some data suggest that among adult inpatients, rapid response teams (RRTs) reduce the rates of mortality and cardiopulmonary arrest outside the intensive care unit (ICU), but whether RRTs offer benefits for pediatric inpatients is not clear. Sharek and colleaguesArticle determined hospital-wide mortality rates and code rates outside the ICU before and after implementation of an RRT at an academic children's hospital. The authors found that compared with the 56 months before implementation, in the 15 months after RRT implementation, the mean monthly mortality rate decreased 18% and the mean monthly code rate decreased 72%. In an editorial, Nowak and BrilliArticle discuss current data on pediatric RRTs and directions for future investigation.
Obesity, Hemodilution, and PSA Levels
Recent studies have found that obese men have lower circulating levels of prostate-specific antigen (PSA) than nonobese men. In a large retrospective cohort study of men who had radical prostatectomy for prostate cancer, Bañez and colleagues assessed whether a larger plasma volume in men with higher body mass index (BMI) was associated with lower PSA concentrations. The authors found that men with higher BMI had higher plasma volume and lower PSA concentrations, suggesting a hemodilution effect.
Employers' Use of Value-Based Purchasing
Value-based purchasing, which includes quality measurement, reporting, and pay-for-performance, has been portrayed as a key element in health system improvement. In a survey of employers from 41 randomly selected and nationally representative health care markets, Rosenthal and colleagues examined the degree to which value-based purchasing and related strategies are used in decisions about employer-sponsored health benefits. The authors found that a majority of employers examined health plan quality data. However, few examined data on physician quality, shared plan, or physician data with employees or offered pay-for-performance rewards to health plan physicians.
Posttherapy PET and Cervical Cancer Survival
Positron emission tomography (PET) with F-18 fluorodeoxyglucose (FDG) can be used to assess tumor cell glucose uptake—a reflection of viable tumor cell volume and response to therapy—and is recommended in the pretreatment and posttherapy evaluation of several cancers. In a prospective study of 92 women with cervical cancer who were treated with chemoradiation therapy, Schwarz and colleagues validated a previous finding that FDG uptake on PET 3 months after completion of treatment predicts survival. The authors report that among women with FDG-PET results suggesting a complete or partial treatment response or progressive disease, 3-year progression-free survival was 78%, 33%, and 0%, respectively.
In a systematic literature review to assess the association of pedometer use with physical activity and health outcomes among adults, Bravata and colleagues found that pedometer use—particularly with a daily step goal—was associated with significant increases in physical activity and significant decreases in body mass index and blood pressure.
A Piece of My Mind
“These patients constantly told me that they envisioned psychiatrists to be, well, older and, preferably, bearded.” From “Perceptions.”
Medical News & Perspectives
Studies suggest deep brain stimulation may help patients with certain types of refractory mental illness and improve function in select individuals in a minimally conscious state.
Radiofrequency identification technology in health care
Author in the Room Teleconference
Join Dena Bravata, MD, December 19 from 2 to 3 PM eastern time to discuss use of pedometers to increase physical activity. 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.
How would you manage a 93-year-old man with advanced dementia and eating problems? Go to www.jama.com, read the case, and submit your response. Your response may be selected for online publication. Submission deadline is November 28.
JAMA Patient Page
For your patients: Information about carcinoma of the cervix.
This Week in JAMA . JAMA. 2007;298(19):2231. doi:10.1001/jama.298.19.2231
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