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This Week in JAMA
JAMA. 2003;290:1817.
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 colleagues (SEE ARTICLE) 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 Bates (SEE ARTICLE) 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 Miller (SEE ARTICLE) 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 Iezzoni (SEE ARTICLE) 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.
(SEE ARTICLE)
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.
(SEE ARTICLE)
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.
(SEE ARTICLE)
Medical News & Perspectives
Cardiologists are exploring whether anemia causes or worsens congestive heart failure.
(SEE ARTICLE)
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.
(SEE ARTICLE)
CLINICIAN'S CORNER
Obstructive Sleep Apnea and CVD: Clinical Cardiology
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).
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about health effects of ozone.
(SEE ARTICLE)
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