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This Week in JAMA
JAMA. 2006;296:2519.
Pharmacy Care Program and Medication Adherence
Strategies to improve medication adherence among elderly patients are needed. Lee and colleagues (SEE ARTICLE) assessed the efficacy of a comprehensive pharmacy care program, which involved medication education, regular follow-up by pharmacists, and medications dispensed in time-specific packs vs usual care to improve medication adherence, medication persistence, and 2 clinical outcomes—blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) levels—in elderly patients taking a mean (SD) of 9 (3) chronic medications. The authors found that compared with baseline measures, the pharmacy care program led to significant improvements in medication adherence, medication persistence, and reductions in BP. Discontinuation of the program was associated with decreased adherence to medication and persistence. In an editorial, Simpson (SEE ARTICLE) discusses interventions to improve medication adherence among elderly patients and the design of research trials to test intervention efficacy.
Effect of Pioglitazone vs Glimepiride on CIMT
Results of several small and short-duration investigations have suggested that for patients with type 2 diabetes mellitus (DM), thiazolidinediones, such as pioglitazone, might reduce the progression of carotid artery intima-media thickness (CIMT) and possibly cardiovascular event risk. Mazzone and colleagues report results of a randomized trial that compared the effects of pioglitazone with glimepiride on progression of CIMT in a multiracial/ethnic cohort of patients with DM. During an 18-month treatment period, the authors found that patients randomly assigned to receive pioglitazone had less progression of CIMT than patients assigned to receive glimepiride.
(SEE ARTICLE)
Mental Disorders in New Parents
Most studies of postpartum mental disorders focus on the mother and the initial weeks after childbirth. Munk-Olsen and colleagues (SEE ARTICLE) report results of a population-based cohort study from Denmark in which they assessed the risk of new-onset mental disorders that required psychiatric hospital admission or outpatient contact among first-time parents during the 12 months after childbirth. The authors found that mothers, but not fathers, had an increased risk of postpartum mental disorders, particularly within the first 3 months after childbirth. In an editorial, Wisner and colleagues (SEE ARTICLE) discuss the epidemiology of postpartum depression and the value of universal screening.
Cancer Staging With PET/CT Colonography
Scanners that combine positron emission tomography with computed tomography (PET/CT) provide both functional and morphological data for tumor staging in 1 procedure. In a preliminary study involving 47 patients with colorectal cancer, Veit-Haibach and colleagues assessed the staging accuracy of whole-body PET/CT colonography vs conventional CT staging alone or CT followed by PET (CT + PET). The authors found that PET/CT colonography was at least equivalent to CT + PET in the staging of patients with colorectal cancer.
(SEE ARTICLE)
A Piece of My Mind
"Jostled about for three hours by strangers' hands lifting, pushing, probing, and inserting needles and tubes, [my mother] ended her life in a swirl of blaming voices, conflicting commands, frenetic activity, alarms, and mechanical devices." From "An Unquiet Death."
(SEE ARTICLE)
Medical News & Perspectives
Scientists are working on the development of hormonal and nonhormonal male contraceptives and predict that men may have new options for contraception within the next decade.
(SEE ARTICLE)
CLINICIAN'S CORNER
Osteopenia
Clinical Crossroads
Ms Q is a 55-year-old woman who has had a gradual loss of bone mineral density over more than 5 years. Cummings discusses bone mineral density, the significance of osteopenia, risk factors for fractures, and pharmacologic treatment.
(SEE ARTICLE)
Improving Population Health
Kindig discusses the challenges and potential benefits of a pay-for-population health performance system.
(SEE ARTICLE)
Author in the Room
Teleconference
Join Louise C. Walter, MD, on December 20, 2006, from 2 to 3 PM eastern time to discuss PSA screening among elderly men with limited life expectancy. To register, go to http://www.ihi.org/AuthorintheRoom.
JAMA Patient Page
For your patients: Information about osteopenia.
(SEE ARTICLE)
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