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Statewide System for Coronary Reperfusion
Prompt restoration of coronary perfusion benefits patients with ST-segment elevation myocardial infarction (STEMI), but many patients do not receive timely treatment. Jollis and colleagues report results of the Reperfusion of Myocardial Infarction in North Carolina Emergency Departments study, a quality improvement study that examined reperfusion times and rates before and after implementation of a statewide, regional system for STEMI reperfusion. The investigators found that compared with baseline, median reperfusion times significantly improved and nonreperfusion rates declined in intervention hospitals with established, 24-hour, 7 days per week percutaneous coronary intervention (PCI) capabilities. Transfer times from non-PCI to PCI hospitals improved, as did door-to-needle times for patients receiving fibrinolysis in non-PCI hospitals.
High-Trauma Fractures and Bone Mineral Density
To examine the widely held assumptions that high-trauma fractures in older women and men are not associated with low bone mineral density (BMD) or subsequent fracture risk, Mackey and colleagues Article analyzed data from 2 large prospective cohorts—the Study of Osteoporotic Fractures and the Osteoporotic Fractures in Men Study—in which hip and spine BMD were assessed and incident fractures confirmed by radiographic report. The authors report that similar to low-trauma nonspine fractures, high-trauma nonspine fractures are associated with low BMD and an increased risk of subsequent fracture. In an editorial, Khosla Article discusses the implications of these findings for patient care and future research.
Predicting Postmenopausal Hip Fracture
Prevention of hip fractures might be enhanced by improved identification of persons at risk. In an analysis of data from the observational component of the Women's Health Initiative (WHI), Robbins and colleagues developed an algorithm that included 11 clinical variables that predicted the 5-year risk of hip fracture in postmenopausal women. Validation of the algorithm in a cohort of women drawn from the hormone, dietary, and calcium-plus-cholecalciferol (vitamin D) components of the WHI clinical trial is described.
Glucose-Insulin-Potassium Therapy in STEMI
Whether glucose-insulin-potassium (GIK) infusion benefits or harms patients with ST-segment elevation myocardial infarction (STEMI) is unclear. In an analysis of data from 2 clinical trials of GIK therapy in acute STEMI, with a combined enrollment of nearly 23 000 patients, Díaz and colleagues assessed mortality rates at 6 months and changes in glucose, potassium, and net fluid gain postinfusion. The authors found that GIK infusion provided no clinical benefit and may be associated with an increased risk of death in the first 3 days after STEMI. In analyses adjusted for multiple confounders, patients who received GIK experienced increased levels of glucose, potassium, and net fluid gain, which were associated with increased mortality risk.
Most patients with dementia receive medical care in primary care settings, where screening to detect early stage dementia has been advocated. Brayne and colleagues discuss the lack of evidence that population screening for dementia will benefit patients, patient caregivers, or society.
A Piece of My Mind
“After three years sober and finally getting on the liver transplant list, with one swallow he threw it all away.” From “It's Simple, Really.”
Medical News & Perspectives
Scientists are investigating therapeutic strategies aimed at keeping cancer cells in senescence, a nondividing state.
Mortality After Bariatric Surgery
An article in the October Archives of Surgery reported death rates and causes of death after bariatric surgery. Livingston discusses obesity-related mortality and perioperative mortality associated with bariatric surgery.
Reemerging HIV/AIDS epidemic
Asymmetric paternalism and health
Call for Research
Organizers of the Sixth International Congress on Peer Review and Biomedical Publication invite abstracts describing original research on peer review, scientific publication, and information exchange.
Author in the Room Teleconference
Join Dena Bravata, MD, MS, 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.
JAMA Patient Page
For your patients: Information about hip fractures.
This Week in JAMA . JAMA. 2007;298(20):2345. doi:10.1001/jama.298.20.2345
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