JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENTS
ARCHIVES OF INTERNAL MEDICINE NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, June 23, 2003)
WALKING ASSOCIATED WITH DECREASED MORTALITY IN ADULTS
CARE FOR ACUTE MYOCARDIAL INFARCTION FOR MEDICARE PATIENTS HAS IMPROVED BUT MANY THERAPIES REMAIN UNDERUSED
MEDICATION ERRORS IN HOSPITALIZED CARDIOVASCULAR PATIENTS
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, JUNE 23, 2003
To contact Edward W. Gregg, Ph.D., call Mary Kay Sones at (770) 488-5131. To contact editorialist Frank B. Hu, M.D., Ph.D., call Kevin Myron at (617) 432-3952.
WALKING ASSOCIATED WITH DECREASED MORTALITY IN ADULTS
CHICAGO—Walking appears to be linked with lower death rates among adults with diabetes, according to an article in the June 23 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.
Regular physical activity has been associated with reduced risk for cardiovascular disease (CVD), diabetes and death in the general population, according to the article. Additionally, walking and other forms of physical exercise were key components of lifestyle changes shown to prevent progression to diabetes among people with impaired glucose tolerance (those at risk for developing diabetes). Physical activity has also been shown to improve insulin sensitivity, glycemic control and CVD risk factors on people who already have diabetes.
Edward W. Gregg, Ph.D., of the Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, and colleagues investigated the association between walking and the risk for all causes of death, and death due to CVD among people with diabetes.
The researchers examined data on 2,896 adults aged 18 years and older (average age, 58.7 years) with diabetes (average time since diagnosis of diabetes, 11 years) who participated in the 1990 and 1991 National Health Interview Survey. Of the participants, 39.2 percent also were considered overweight (body mass index, or BMI 25-29) and 32.4 percent were obese (BMI of 30 or higher).
The researchers found that compared with inactive adults, those who walked at least 2 hours per week had a 39 percent lower all-cause death rate (2.8 percent vs. 4.4 percent per year) and a 34 percent lower CVD death rate (1.4 percent vs. 2.1 percent per year). The mortality rates were lowest for people who walked 3 to 4 hours per week and for those who reported that their walking included moderate increases in heart rate and breathing rate.
"Walking was associated with lower mortality [death rates] across a diverse spectrum of adults with diabetes," write the authors. "One death per year may be preventable for every 61 people who could be persuaded to walk at least 2 hours per week."
(Arch Intern Med. 2003;163:1440-1447. Available post-embargo at archinternmed.com)
EDITORIAL: WALKING: THE BEST MEDICINE FOR DIABETES?
In an accompanying editorial, Frank B. Hu, M.D., Ph.D., of Harvard School of Public Health, Boston, writes "Persuasive evidence from epidemiologic studies and clinical trials demonstrates substantial benefits of exercise, especially walking, in the prevention and treatment of type 2 diabetes mellitus. Because walking is accessible, is relatively safe, and can easily be incorporated into a daily routine, it is a form of exercise that is practical and suitable for most individuals, especially women, diabetic patients, and the elderly," writes Dr. Hu.
"Because of the high prevalence of underlying ischemic heart disease and the augmented risk of joint-related injuries, adoption of a moderate, rather than vigorous, activity program may be more suitable for diabetic patients. For the vast majority of the population, the benefits of walking are enormous, with little or no harm. So far, the 'best medicine' for both prevention and treatment of diabetes mellitus," Dr. Hu concludes.
(Arch Intern Med.. 2003;163:1397-1398). Available post-embargo at archinternmed.com)
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail jamaarchmedia{at}ama-assn.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, JUNE 23, 2003
To contact JoAnne Micale Foody, M.D., call Karen Peart at (203) 432-1326. To contact editorialist Paula Seth, M.D., call Michael Cohen at (508) 856-2000.
CARE FOR ACUTE MYOCARDIAL INFARCTION FOR MEDICARE PATIENTS HAS IMPROVED BUT MANY THERAPIES REMAIN UNDERUSED
CHICAGO—Care for Medicare patients who have acute myocardial infarction (AMI, or heart attack), has improved in recent years, but room for further improvement remains, according to an article in the June 23 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.
According to information in the article, therapies to treat AMI, including aspirin therapy and beta-blockers remain underused, leaving substantial opportunity for improvement in the care of patients with AMI. Quality care for AMI has been a major focus of the Medicare Health Care Quality Improvement Program since 1992, and is an ongoing initiative by the Centers for Medicare & Medicaid Services (CMS).
JoAnne Micale Foody, M.D., of Yale University School of Medicine, New Haven, Conn., and colleagues determined state and national trends in quality of care for Medicare patients hospitalized with AMI between 1994-1995 (n=234,754 discharges) and 1998-1999 (n=35,713 discharges) as part of the Centers for Medicare & Medicaid Services (CMS) National AMI Project. AMI was clinically confirmed in 204,501 cases (87 percent) in the 1994-1995 group and 31,331 cases (88 percent) in the 1998-1999 group.
The researchers found that beta-blocker prescriptions given at discharge increased from 50.3 percent to 70.7 percent; early administration of beta-blocker increased from 51.1 percent to 68.4 percent; and prescriptions for angiotensin-converting enzyme inhibitors given at discharge increased from 62.8 percent to 70.8 percent.
The researchers also found that early administration of aspirin increased by 6.6 percentage points (from 76.4 percent to 82.9 percent) and aspirin prescribed at discharge increased by 5.6 percentage points (from 77.3 percent to 82.9 percent).
Smoking cessation counseling decreased by 3.6 percentage points (from 40.8 percent to 37.2 percent). Additionally, the time from hospital arrival to initiation of thrombolytic therapy (drugs to help dissolve blood clots) decreased by 7 minutes, and the time from arrival to initiation of primary percutaneous transluminal coronary angioplasty (define) decreased by 12 minutes.
"Our analysis focuses on a 4-year period during which a number of national and state-level events or interventions occurred that improved AMI care, and therefore provides important feedback on the progress to date and direction for future efforts," write the authors. "From 1994-1995 to 1998-1999, major improvements were achieved nationally in the use of beta-blockers, while more moderate improvement occurred in the use of ACE inhibitors and aspirin for Medicare patients with AMI."
"These data extend the results from a recently published national and state profile by demonstrating that improvement has been achieved, including major gains in some indicators and states, but also ample opportunities for improvement remain," the authors write.
(Arch Intern Med. 2003;163:1430-1439. Available post-embargo at archinternmed.com)
Editor's Note: All funding for this project was provided by the CMS, Baltimore, Md., formerly known as the HCFA. Some of this work was performed under a contract sponsored by the HCFA.
EDITORIAL: TREATMENT OF ACUTE MYOCARDIAL INFARCTION
In an accompanying editorial, Paula Seth, M.D., of University of Massachusetts Medical Center, Worcester, Mass., writes, "The rate of decline in mortality has decreased throughout the decades, as noted by the only 13 percent decline in mortality found by Burwen et al vs. up to 50 percent in decades past. These slowdowns in the rate of decline of heart disease deaths may mean that further progress in death reduction is in jeopardy."
"Early and late treatment with beta-blockers, ACE inhibitors, and aspirin continues to need improvement. Moreover, there needs to be a stronger policy on encouraging all Americans to modify their lifestyles and undergo tobacco cessation counseling," Dr. Seth writes.
(Arch Intern Med. 2003;163:1392-1393). Available post-embargo at archinternmed.com)
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail jamaarchmedia{at}ama-assn.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, JUNE 23, 2003
To contact Nancy M. Allen LaPointe, Pharm.D., call Richard Merritt at (919) 684-4148.
MEDICATION ERRORS IN HOSPITALIZED CARDIOVASCULAR PATIENTS
CHICAGO—Better knowledge of a patient's outpatient medication regimens, and improved education and support of new interns during their first months of hospital training may reduce the number of medication errors involving patients treated on cardiology wards, according to a study in the June 23 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.
According to information in the article, cardiovascular drugs are associated with severe adverse reactions. In addition, pharmacist participation in patient rounds may help reduce medication errors.
Nancy M. Allen LaPointe, Pharm.D., and James G. Jollins, M.D., of Duke University Medical Center, Durham, N.C., reviewed the experience of a clinical pharmacist on the cardiology wards at Duke University Hospital between September 1, 1995 and February 18, 2000. The pharmacist was trained in cardiovascular medicine and participated in patient care with physicians and nurses in the cardiology units. The researchers identified and classified medication errors according to the type of error, medications involved, personnel involved, stage of drug administration involved, and time of year in which the errors occurred.
During the study period, 24,538 patients were admitted to cardiology wards and there were 4,768 pharmacist interventions that were related to medication errors (which were corrected), or 24 medication errors per 100 admissions. The most common errors included wrong drug (36 percent) or wrong dose (35.3 percent), and cardiovascular medications were involved in 41.2 percent of the errors recorded. The researchers also found that the prescribers were associated with most of the errors and the transition from outpatient to inpatient was the most common point in the system for a medication error to occur. More errors were also noted during the transition period of house staff, and there were more errors recorded in the summer months (when interns start their hospital trainining).
"Three notable medication error trends were identified in our study, including: (1) a high number of errors attributed to lack of knowledge of the patient's drug therapy before admission, (2) an increase in errors during periods of house staff transition, and (3) a gradual increase in the number of medication errors during the study period," write the authors. "These findings confirm the potential for pharmacist participation in physician rounds to identify and markedly decrease medication errors," the authors conclude.
The researchers describe two techniques for helping to reduce errors, "The first is the development of a system that provides health care providers with accurate, up-to-date medication information at the point of care. The second is more focused education and backup for new interns during their initial months of training. The large and increasing numbers of potential ADEs [adverse drug events] identified through routine review by a clinical pharmacist strongly support the role of pharmacists in assuring patient safety," write the authors.
(Arch Intern Med. 2003;163:1461-1466. Available post-embargo at archinternmed.com)
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail jamaarchmedia{at}ama-assn.org.
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