This Week in JAMA
Care Coordination Among Medicare Beneficiaries
In 2002, the Centers for Medicare & Medicaid Services funded 15 independent clinical trials that compared the effects of care coordination with usual care for Medicare beneficiaries with serious chronic illnesses. Trial outcomes included hospitalization rates, expenditures, and quality of care. Peikes and colleagues (ARTICLE) performed an independent evaluation of the results. Among their findings were that only 2 of the care coordination programs reduced hospitalizations and none of the programs generated net savings. In an editorial, Ayanian (ARTICLE) discusses the project design and how the results of the trials may inform future Medicare policy on care coordination.
Muscle Reinnervation for Control of Artificial Arms
In a study involving 5 patients with shoulder disarticulation or transhumeral amputation and 5 control participants, Kuiken and colleagues (ARTICLE) assessed the outcome of a new surgical technique—targeted muscle reinnervation (TMR), which transfers residual nerves to alternative muscles—on the patients' ability to control a virtual prosthetic arm and operate advanced arm prosthesis prototypes. The authors report that patients who had undergone TMR were able to repeatedly perform the virtual arm movements and that contraction of the reinnervated muscles produced sufficient electromyogram signal to control advanced artificial arms. In an editorial, Loeb (ARTICLE) discusses challenges in the design and implementation of prosthetic arms with complex functional capabilities.
Food Additives and Hyperphosphatemia
Patients with renal disease have an impaired ability to excrete phosphorus, so they are advised to limit their intake of foods naturally high in this mineral. An additional source of dietary phosphorus is food additives, and Sullivan and colleagues assessed the effect of limiting the intake of phosphorus-containing food additives on serum phosphorus levels in a randomized trial of patients with end-stage renal disease. The authors report that at a 3-month assessment, patients who received an educational intervention to avoid foods with phosphorus additives experienced a modest decline in serum phosphorus compared with patients receiving usual care.
Maternal Weight and Risk of Congenital Anomalies
In a systematic review and meta-analysis, Stothard and colleagues assessed the association between maternal overweight and maternal obesity and the risk of congenital anomalies. The authors found that maternal obesity is associated with an increased risk of a range of structural congenital anomalies—including those of the nervous system and cardiovascular system and orofacial clefts—although the absolute increase in risk relative to recommended body mass index is likely to be small.
CLINICIAN'S CORNER
High-Quality Palliative Care
Perspectives on Care at the Close of Life
Teno and Connor use the case of Mr K, a 49-year-old man with severe cancer-related pain, to discuss concerns primary care physicians may have when considering referral of a patient to a hospital-based palliative care service. The authors review factors that differentiate hospital-based palliative care from hospice and highlight components associated with quality palliative care programs.
A Piece of My Mind
“A young intern glanced at the nurse who brought my daughter into the recovery room and said, ‘Is this the lung?’” From “Person, Place, or Thing.”
Medical News
& Perspectives
Scientists are attempting to develop electronic “noses,” sensors they hope one day may be used to help diagnose a variety of conditions, from pneumonia to lung cancer.
200 Years After Darwin
From the Archives Journals
Two hundred years after Darwin's birth, Rosenberg discusses recent findings in the genetics of neurological diseases.
Politicization of professional practice guidelines
Author in the Room
Teleconference
Join Mary M. McDermott, MD, February 18 from 2 to 3 PM eastern time to discuss treadmill exercise vs resistance training for patients with peripheral arterial disease. To register, go tohttp://www.ihi.org/AuthorintheRoom.
Readers Respond
How would you manage a 76-year-old patient with multiple medical problems and recurrent Clostridium difficile colitis? Go to www.jama.com to read the case and submit your response, which may be selected for online publication. Submission deadline is February 25.
