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This Week in JAMA
JAMA. 2002;288:413.
Adherence to Statin Therapy in Elderly Patients
In clinical trials, long-term therapy with statins has been shown to reduce morbidity and mortality in patients with coronary artery disease. Two articles in this issue of THE JOURNAL assess adherence to statin therapy in elderly patients. In an analysis of data from patients aged 65 years and older enrolled in the New Jersey Medicaid or Pharmaceutical Assistance to the Aged and Disabled program, Benner and colleagues (SEE ARTICLE) found that persistence in use of statin therapy decreased substantially over time, especially during the first 6 months of treatment. Jackevicius and colleagues (SEE ARTICLE) , using data from several population-based administrative databases in Ontario for patients aged 66 years or older, found that 2-year adherence to statin therapy, defined as a statin being dispensed at least every 120 days after the index prescription, was 40.1% for patients with acute coronary syndrome, 36.1% for patients with chronic coronary artery disease, and 25.4% for patients without coronary artery disease in a primary prevention cohort. In an editorial, Applegate (SEE ARTICLE) considers ways to improve adherence to statin therapy, which is necessary to achieve the clinical benefit observed in clinical trials, and to monitor adherence in clinical practice.
Bupropion for Smoking Cessation in African Americans
Patterns of smoking and quitting in African Americans are different from those in whites, but few smoking cessation trials have been conducted among African Americans. Ahluwalia and colleagues (SEE ARTICLE) conducted a clinical trial comparing 7 weeks of treatment with a sustained-release form of bupropion hydrochloride (bupropion SR) with placebo for smoking cessation among African Americans. Abstinence rates were significantly higher in the bupropion SR group than in the placebo group at 6 and 26 weeks after the quit day. In an editorial, Benowitz (SEE ARTICLE) discusses why results of smoking cessation trials might yield different results in African Americans and other racial and ethnic minority groups compared with whites.
Health Literacy and Outcomes in Patients With Diabetes
Poor health literacy has been associated with poor self-rated health and higher use of health services, but little is known about the effects of poor health literacy on clinical outcomes. In this cross-sectional study of adult patients with type 2 diabetes in 2 primary care clinics of a university-affiliated public hospital, Schillinger and colleagues found that patients with inadequate health literacy as assessed by the short-form Test of Functional Health Literacy in Adults were less likely than patients with adequate health literacy to achieve tight glycemic control (HbA1c level of 7.2% or less) and were more likely to have poor glycemic control (HbA1c level of 9.5% or more) and to report having retinopathy.
(SEE ARTICLE)
Aircraft Air Recirculation and Postflight URI Symptoms
New commercial aircraft are designed to recirculate approximately 50% of cabin air to increase fuel efficiency. To assess whether air recirculation predicts postflight upper respiratory tract infections (URIs), Zitter and colleagues followed up passengers 5 to 7 days after flying from the San Francisco Bay area to Denver, Colo, on aircraft that used either 100% fresh air for ventilation or recirculated air. Rates of new URI symptoms within 1 week of the flight reported by passengers who traveled in aircraft that recirculated air were not significantly different from rates reported by passengers who traveled in aircraft that used fresh air.
(SEE ARTICLE)
CLINICIAN'S CORNER
A Woman With Chronic Illness, Strong Religious Beliefs
Clinical Crossroads
Mrs A is an 83-year old woman who copes with chronic progressive pain and weakness through prayer and her religious beliefs. Koenig discusses the role of spirituality in helping patients cope with serious medical illness, spiritual history taking, and professional boundaries between physicians and chaplains.
(SEE ARTICLE)
A Piece of My Mind
"She was a foreign national without a green card to prove resident alien status. She couldn't qualify for a transplant without the green card." From "A Perfect Match."
(SEE ARTICLE)
Contempo Updates
Update on telemedicine and remote patient monitoring.
(SEE ARTICLE)
Medical News & Perspectives
Perhaps the greatest challenge in caring for patients with mental retardation is effectively diagnosing and treating those who also have mental illness. Experts discuss the problems clinicians face and new research that may yield treatment advances.
(SEE ARTICLE)
Controversies: Patient Safety
Making Health Care Safer: A Critical Analysis of Patient Safety Practices, a report commissioned by the Agency for Healthcare Research and Quality, evaluated evidence supporting patient safety practices using standards of evidence-based medicine. Leape and coauthors (SEE ARTICLE) critique the report, asserting that "rigorous proof of efficacy . . . is neither necessary nor, in many cases, sufficient for recommending widespread use of a safety practice." Shojania and colleagues (SEE ARTICLE) , authors of the report, defend the evidence-based approach to patient safety.
JAMA Patient Page
For your patients: Information about quitting smoking.
(SEE ARTICLE)
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