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This Week in JAMA
JAMA. 2004;292:1655.
Length of Stay and Rehabilitation Outcomes
Length of stay (LOS) for inpatient rehabilitation has declined, but whether this affects patient outcomes is not clear. To assess this question, Ottenbacher and colleagues (SEE ARTICLE) reviewed national patient data on rehabilitation LOS, postdischarge living setting, and change in functional status and mortality. They found that median LOS decreased 8 days during the study period without evidence of decline in patients’ functional status or changes in living setting. However, mortality in the 6 months after discharge increased significantly. In an editorial, Esselman (SEE ARTICLE) discusses these findings in light of evolving expectations and reimbursement for rehabilitation services.
Vaccine Policy and Epidemiology of Poliomyelitis
To eliminate vaccine-associated paralytic poliomyelitis (VAPP), national vaccination policy transitioned from reliance on oral poliovirus vaccine (OPV) to exclusive use of inactivated poliovirus vaccine (IPV). Alexander and colleagues (SEE ARTICLE) used national surveillance data from 1990 through 2003 to review the epidemiology of poliomyelitis and to document the impact of the vaccine schedule changes on VAPP. They found VAPP declined significantly during the transition. No cases of VAPP were reported with the sequential IPV-OPV schedule or when IPV was used exclusively. In an editorial, Modlin (SEE ARTICLE) discusses polio eradication in the United States and the dangers of not achieving similar goals worldwide.
Safety of Pneumococcal Conjugate Vaccine
Prior to licensure, almost 19 000 infants and children enrolled in randomized trials received the 7-valent pneumococcal conjugate vaccine (PCV) and a favorable safety profile was demonstrated. However, some vaccine risks may not emerge until larger populations are exposed. Using data from the Vaccine Adverse Event Reporting System, Wise and colleagues analyzed events reported during the initial 2 years of PCV use. They found the majority of reports describe mild signs and symptoms identified in the prelicensure clinical trials. Adequate assessment of any association of PCV with rare but potentially serious events requires continued surveillance and analysis.
(SEE ARTICLE)
Literacy and Diabetes Management
Patients with low literacy may have difficulty understanding and managing their disease, but whether interventions that address literacy deficiencies can improve outcomes is not known. Rothman and colleagues report results of a randomized trial of patients with poorly controlled type 2 diabetes. The intervention group received frequent one-to-one communication designed to enhance disease management comprehension. The authors found that intervention group patients with low literacy were more likely to reach target hemoglobin A1c (HbA1c) levels and to achieve reductions in systolic blood pressure than control patients of similar literacy level. Outcomes for patients with high literacy did not differ by randomization group.
(SEE ARTICLE)
Medical News & Perspectives
A new study suggests that elective full-body computed tomography scans for asymptomatic people—a controversial practice because of questions about the procedure’s ability to detect hidden disease and extend life—might increase risk of a potentially fatal radiation-linked cancer.
(SEE ARTICLE)
Patient Travel With Regionalized Care
Regionalization of percutaneous transluminal coronary angioplasty would not increase the travel distance for most patients.
(SEE ARTICLE)
Bariatric Surgery
Obesity comorbidities resolve or improve in patients having bariatric surgery.
(SEE ARTICLE)
CLINICIAN’S CORNER
Urgent Care Decisions
Perspectives on Care at the Close of Life
Factors to consider when a patient’s disease suddenly worsens and a shift from life-prolonging to palliative treatment is imminent.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about polio and polio vaccination.
(SEE ARTICLE)
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