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JAMA. 2005;294:281.

Administrative Data Feedback to Improve Cardiac Care
Providing hospitals with feedback on their achievement of patient care "quality indicators" is a popular quality improvement strategy. To investigate whether this strategy is effective, Beck and colleagues (SEE ARTICLE) conducted a randomized trial where hospitals were assigned to receive either immediate or delayed (14 months after randomization) one-time feedback based on administrative data on processes of care and outcomes for patients with acute myocardial infarction. The authors found no differences between the rapid and delayed group hospitals in terms of medication prescriptions filled, mortality, length of stay, waiting times for procedures, and readmissions for cardiac complications. In an editorial, Peterson (SEE ARTICLE) discusses the importance of rigorous evaluation of quality improvement strategies.

Health Outcomes of Children Born ELBW
Little is known about the health and functional status of school-aged children born extremely low-birth-weight (ELBW, <1000 g). In a study of 219 children born ELBW from 1992 to 1995 who received care at a tertiary perinatal center and survived to follow-up at age 8 years, Hack and colleagues (SEE ARTICLE) found that ELBW children have more chronic health conditions and functional limitations, have a greater dependence on compensatory aids, and have a greater need for educational and medical services compared with normal-birth-weight controls. In an editorial, Tyson and Saigal (SEE ARTICLE) discuss the need for more follow-up studies of infants born ELBW to better understand the benefits and risks of treatment and the children’s long-term prognoses and needs.

Measuring CVD Risk in Women
A variety of lipid biomarkers and their ratios are recommended for predicting risk of future cardiovascular disease (CVD) events, but their clinical utility has not been directly compared. In a cohort of women participants in a clinical trial with 10 years of follow-up for first cardiovascular event, Ridker and colleagues (SEE ARTICLE) evaluated baseline levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL-C), non–HDL-C, apolipoproteins A-I and B₁₀₀, high-sensitivity C-reactive protein, and several ratios of these measurements as predictors of future CVD events. They found that non–HDL-C and the ratio of total cholesterol to HDL-C were as good or better than apolipoprotein fractions to predict future CVD events.

Insulin Resistance and Heart Failure Risk
Diabetes and obesity are established risk factors for congestive heart failure (CHF) and are associated with insulin resistance, but whether insulin resistance predicts CHF is not known. Ingelsson and colleagues (SEE ARTICLE) analyzed data from a longitudinal study of elderly men in Sweden who were free of CHF at baseline to explore the association of insulin resistance with subsequent CHF. In analyses adjusted for established risk factors for CHF including diabetes, insulin resistance predicted first hospitalization for CHF.

Preventing Renal Dysfunction in CABG Patients
Renal dysfunction is a possible adverse outcome following coronary artery bypass graft (CABG) surgery performed with cardiopulmonary bypass (CBP). Burns and colleagues (SEE ARTICLE) hypothesized that N-acetylcysteine, which has antioxidant and vasodilator effects, might prevent postoperative renal dysfunction. They randomly assigned patients undergoing CABG surgery with CPB to receive either perioperative intravenous N-acetylcysteine or placebo and found that N-acetylcysteine was no better than placebo in preventing renal dysfunction.

Medical News & Perspectives
Accumulating evidence that certain synthetic and plant-derived compounds have hormonelike effects is heightening concerns that exposure to these substances, especially early in life, might pose long-term health risks.

(SEE ARTICLE)

Achieving a Healthy Diet
A current understanding of nutrient requirements and interactions supports consumption of essential nutrients from a varied diet rather than dietary supplements.

(SEE ARTICLE)

CLINICIAN’S CORNER
Beyond Advance Directives
Perspectives on Care at the Close of Life
Advance care planning can be complicated by diagnostic uncertainty, lack of trust, and the loss of hope; helping the patient to focus on goals for care rather than specific treatments can be beneficial.

(SEE ARTICLE)

Foramen Ovale Closure Devices
Expanding off-label use of patent foramen ovale closure devices and the absence of data supporting long-term safety and efficacy compels the need for evidence-based evaluation.

(SEE ARTICLE)

JAMA Patient Page
For your patients: Information about premature infants.

(SEE ARTICLE)

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