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 of 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, July 9, 2007)
HEART ATTACK DEATH RATES APPEAR LOWER AT ‘AMERICA’S BEST HOSPITALS’
STUDY IDENTIFIES CHARACTERISTICS OF CLINICIANS LIKELY TO ORDER INAPPROPRIATE PROSTATE SCREENINGS
ARCHIVES OF NEUROLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, July 9, 2007)
SMOKING ASSOCIATED WITH LOWER PARKINSON’S DISEASE RISK
ARCHIVES OF OPHTHALMOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, July 9, 2007)
VISUAL IMPAIRMENT ASSOCIATED WITH INCREASED MORTALITY RISK
MANY NURSING HOME RESIDENTS MAY NOT GET REGULAR EYE EXAMINATIONS
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, July 9, 2007
Media Advisory: To contact corresponding author Harlan M. Krumholz, M.D., S.M., call Karen Peart at 203-432-1326.
HEART ATTACK DEATH RATES APPEAR LOWER AT ‘AMERICA’S BEST HOSPITALS’
CHICAGO—Individuals admitted for heart attack to a hospital ranked as one of “America’s Best” by U.S. News & World Report are less likely to die within 30 days than those admitted to a non-ranked hospital, according to a report in the July 9 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. Using a methodology that is similar to the recently released mortality measures that are publicly reported by the Centers for Medicare and Medicaid Services (CMS), the study found that ranked hospitals were also more likely to have lower-than-expected death rates—however, many unranked hospitals did as well.
“Among the increasing number of academic, industry and governmental profiling systems that evaluate and compare hospitals, U.S. News & World Report’s annual issue of ‘America’s Best Hospitals’ for specialty and overall care is one of the most well known,” the authors write as background information in the article. “Despite their prominent role in the public arena, the ability of the U.S. News & World Report rankings to identify hospitals with excellent survival rates for common cardiovascular conditions is not known.”
Oliver J. Wang, M.D., of Yale University School of Medicine, New Haven, Conn., and colleagues assessed 30-day death rates among 13,662 patients admitted to 50 hospitals ranked on the U.S. News list as the best in “Heart and Heart Surgery” and among 254,907 patients admitted to 3,813 unranked hospitals in 2003. The researchers also compared the hospitals’ standardized mortality ratios, where a ratio of greater than one indicates that the hospital had more deaths than expected and a ratio of less than one means there were fewer deaths than expected.
After the researchers factored in patient characteristics, the 30-day death rates were, on average, lower in ranked hospitals vs. non-ranked hospitals (16 percent vs. 17.9 percent). When the hospitals were divided into four groups based on these rates, 35 ranked hospitals (70 percent) were in the group with the fewest deaths, 11 (22 percent) were in the middle two groups and four (8 percent) were in the worst-performing group.
Eleven ranked hospitals (22 percent) and 28 non-ranked hospitals (0.73 percent) had standardized mortality ratios significantly less than one, meaning that although ranked hospitals were more likely to have lower-than-expected death rates, non-ranked hospitals with favorable ratios outnumbered ranked hospitals with similar performance by nearly three to one. “As a result, the U.S. News & World Report ranking list does not include many hospitals that have outstanding performances for the care of patients with acute myocardial infarction,” or heart attack, the authors write.
One reason for this may be the reputation component of the rankings, which accounts for one-third of the overall ranking score and is based on cardiologists’ opinions of hospitals that provide the best treatment, the authors speculate. “Citations by cardiologists likely favor tertiary centers with strong subspecialty care for the most critically ill patients while not necessarily reflecting the perceived care for the overwhelming majority of admissions for more common diagnoses, which in turn have a more substantial impact on overall hospital outcomes,” they continue.
“The U.S. News & World Report ranking, which includes many of the nation’s most prestigious hospitals, did identify a group of hospitals that was much more likely than non-ranked hospitals to have superb performance on 30-day mortality after acute myocardial infarction,” the authors conclude. “However, our study also revealed that not all ranked hospitals had outstanding performance and that many non-ranked hospitals performed well. Consequently, although the U.S. News & World Report rankings provide some guidance about the performance on outcomes, they fall short of identifying all the top hospitals with respect to 30-day survival after admission for acute myocardial infarction and include a few hospitals that are actually in the lowest quartile of performance.”
(Arch Intern Med. 2007;167(13):1345-1351. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: RANKINGS SHOULD DRIVE QUALITY CARE
Although hospital rankings are now published by a wide variety of governmental and non-governmental organizations, it is unclear how useful they are to patients, write Sean Michael O’Brien, Ph.D., and Eric D. Peterson, M.D., of Duke University, Durham, N.C, in an accompanying editorial.
“A growing literature of methodological studies presents a sobering picture for patients who would like to use available quality information to identify hospitals with the best outcomes for a particular condition,” they write. “Most systems seem to do a reasonable job at identifying groups of hospitals that perform well on average, yet there is considerable uncertainty regarding the true performance of a particular hospital. As noted, some truly exceptional hospitals will be improperly rated as poor whereas some mediocre hospitals will be rated as excellent.”
However, that does not mean that assessing hospital quality has no role in medicine, they write. Hospitals ranked poorly should take action, and those ranked highly should not boast or become complacent. “They need to understand the potential inconsistency and fallibility of quality-ranking systems. And they need to realize that regardless of their true rank, their goal should not be to merely beat their peers in the ratings but to strive for optimum performance. In this type of quality competition, the real winners are the patients,” Drs. O’Brien and Peterson conclude.
(Arch Intern Med. 2007;167(13):1342-1344. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, July 9, 2007
Media Advisory: To contact B. Price Kerfoot, M.D., Ed.M., call Diane Keefe at 857-203-5879.
STUDY IDENTIFIES CHARACTERISTICS OF CLINICIANS LIKELY TO ORDER INAPPROPRIATE PROSTATE SCREENINGS
CHICAGO— Prostate-specific antigen (PSA) tests to screen for prostate cancer are frequently performed among patients for whom the PSA test is not shown to be beneficial, and clinicians with certain characteristics are more likely to order such inappropriate screening tests, according to a report in the July 9 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Most guidelines for clinical practice do not recommend routine PSA screening for men younger than 40, older than 75 or who are expected to live less than 10 years, according to background information in the article. “To our knowledge, there is currently no solid evidence that PSA screening provides any health benefits for these patient populations,” the authors write. “Rather, it imposes substantial psychological and financial costs and may lead to diagnostic and therapeutic procedures of questionable benefit.” Because the ultimate decision to perform PSA testing rests with the clinician, it is likely that demographic and other characteristics of physicians, nurses and physician assistants may influence inappropriate screening behaviors.
B. Price Kerfoot, M.D., Ed.M., of the Veterans Affairs Boston Healthcare System and Harvard Medical School, Boston, and colleagues analyzed data from 105,765 male patients who were treated at Veterans Health Affairs (VHA) facilities in New England from 1997 to 2004. Information about the patients and the 1,552 health care clinicians who ordered PSA tests was gathered from VHA databases. Inappropriate screening was defined as PSA testing in patients older than 75 or younger than 40 who had not been diagnosed with prostate cancer, were not taking prostate cancer–specific medications or had not undergone related procedures.
Of the 232,302 PSA tests ordered during the study period, 37,483 (16.1 percent) were considered inappropriate, with 35,612 (15.3 percent) performed in patients older than 75 years and 1,871 (0.8 percent) in patients younger than 40 years. Of the health care clinicians who ordered inappropriate tests, 51.3 percent were male, 79.4 percent were physicians, 53.4 percent were trainee physicians and 8.2 percent were urologists. “Practitioners who were urology specialists, male, infrequent PSA tests orderers and affiliated with specific hospitals had significantly higher levels of inappropriate PSA screening. Compared with attending physicians, nurses and physician assistants had significantly lower levels of inappropriate screening,” the authors write.
“The percentage of inappropriate PSA screening increased significantly with the age of male health care providers,” they continue. “The cause of these sex and age differences is not clear. It is possible that, as they age, male health care providers increasingly empathize with their older male patients over prostate cancer concerns. Their ‘prostatemphathy’ may then lead to more aggressive screening in these older male patients.”
Patient education and systems-level changes, such as a computerized system that could alert clinicians when they attempt to order an inappropriate PSA test, could help reduce the level of PSA screening misuse, the authors conclude.
(Arch Intern Med. 2007;167(13):1367-1372. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by the Research Career Development Award Program and research grants from the Veterans Affairs Health Services Research & Development Service, the American Urological Association Foundation, Astellas Pharma U.S. Inc., Wyeth Inc. and the National Institutes of Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, July 9, 2007
Media Advisory: To contact Beate Ritz, M.D., Ph.D., call Mark Wheeler at 310-794-2265.
SMOKING ASSOCIATED WITH LOWER PARKINSON’S DISEASE RISK
CHICAGO—A pooled analysis of data from previous studies suggests that cigarette smoking appears to be associated with a reduced risk for developing Parkinson’s disease, with long-term and current smokers at the lowest risk, according to a report in the July issue of Archives of Neurology, one of the JAMA/Archives journals.
Several studies have suggested that patients with Parkinson’s disease are less likely to be smokers, according to background information in the article. “Recent studies also suggested that Parkinson’s disease risk is particularly low in active smokers with a long history of intense smoking; some even suggested dose-related risk reductions with increasing pack-years of smoking,” the authors write. “This prompted speculation as to whether and how these observations might inform Parkinson’s disease treatment and prevention.” However, the number of participants in most Parkinson’s disease studies is too small to answer important questions about the role of smoking.
Beate Ritz, M.D., Ph.D., of the UCLA School of Public Health, Los Angeles, and colleagues pooled data from 11,809 individuals (2,816 individuals with Parkinson’s disease and 8,993 controls of the same age and sex but without Parkinson’s disease) involved in 11 studies conducted between 1960 and 2004.
“Our analyses confirmed prior reports of an inverse association between cigarette smoking and Parkinson’s disease similar in size to those reported in a recent meta-analysis,” the authors write. “We also showed that associations did not differ by sex or educational status. Although we found that current smokers and those who had continued to smoke to within five years of Parkinson’s disease diagnosis exhibited the lowest risk, a decrease in risk (13 percent to 32 percent) was also observed in those who had quit smoking up to 25 years prior to Parkinson’s disease diagnosis.” Other tobacco products also appeared to be protective—men who smoked pipes or cigars had a 54 percent lower risk. The number of chewing tobacco users was small, but there was a suggestion of reduced risk associated with this product.
The researchers found no association between smoking and Parkinson’s disease risk in individuals older than 75. In addition, while the association was strong in white and Asian-American individuals, no association was observed in Hispanic or African-American participants. This could be because these groups have more undiagnosed cases of Parkinson’s disease than others, or because of genetic characteristics and their interaction with the environment.
“The biochemical basis for possible preventative effects of smoking, or of a substance delivered through cigarette smoke, is not well understood, but animal studies have indicated two possible mechanisms: chemical or biochemical processes may exist by which substances contained in cigarette smoke such as nicotine or carbon monoxide exert a protective effect and promote survival of dopaminergic neurons; or cigarette smoke alters the activity of metabolic enzymes or competes with other substrates for these enzymes and thereby alters the production of toxic endogenous (dopamine quinones) or exogenous (MPP+) metabolites,” the authors write.
“Ultimately, only randomized intervention trials can confirm that some components in tobacco are truly neuroprotective, negating the possibility that a premorbid personality influences smoking behavior among those who later develop Parkinson’s disease,” they conclude. “In the meantime, there is more to learn from epidemiologic studies with enough statistical power to examine Parkinson’s disease associations in sub-groups such as users of chewing tobacco or nicotine gums and patches, people exposed to second-hand smoke or groups that metabolize nicotine or other tobacco constituents at different rates.”
(Arch Neurol. 2007;64(7):990-997.
Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, July 9, 2007
Media Advisory: To contact corresponding author Jie Jin Wang, M.Med., Ph.D., e-mail: jiejin_wang{at}wmi.usyd.edu.au.
VISUAL IMPAIRMENT ASSOCIATED WITH INCREASED MORTALITY RISK
CHICAGO—Individuals age 49 and older with cataract and those age 49 to 74 years with age-related macular degeneration appear to have higher mortality rates over an 11-year period than those without such visual impairments, according to a report in the July issue of Archives of Ophthalmology, one of the JAMA/Archives journals.
Several studies have shown associations between visual problems and the risk of death in older individuals, according to background information in the article. “The mechanisms for higher mortality associated with visual impairment remain unclear,” the authors write. “It could be attributed to age-related ocular conditions, such as age-related macular degeneration (ARMD) or cataract, which can be markers of biological aging. Alternatively, visual impairment and its related ocular conditions could share a similar pathogenesis with other conditions associated with increased mortality.”
Sudha Cugati, M.S., of the University of Sydney, Australia, and colleagues assessed 3,654 individuals age 49 and older who were part of the Blue Mountains Eye Study, an ongoing examination of visual disorders in the Blue Mountains area west of Sydney. When the participants enrolled in the study, between 1992 and 1994, they were assessed for overall visual impairment and its two main causes: cataract, a disease in which the eye’s lens is covered by a film that reduces sight, and ARMD, which occurs when the macula, the area at the back of the retina that produces the sharpest vision, deteriorates over time.
By Dec. 31, 2003—an average of 11 years of follow-up—1,051 participants (28.9 percent) died. Rates of death were higher among those with any visual impairment than among those without (54 percent vs. 34 percent), among those with ARMD than those without (45.8 percent vs. 33.7 percent) and among those with cataract than those without (39.2 percent vs. 29.5 percent).
“After adjusting for factors that predict mortality, neither visual impairment nor ARMD was significantly associated with all-cause mortality in all ages,” the authors write. “Among persons younger than 75 years, however, ARMD predicted higher all-cause mortality.” Among participants of all ages, having cataract also was associated with a higher risk of death from any cause.
It remains unclear whether there is a direct or indirect link between visual impairment and death or if another factor not measured in this study affected the results, the authors note. “The implications of these findings also remain uncertain: whether such an association indicates that visual impairment, age-related eye disease or both are markers of aging and frailty or whether these ocular conditions accelerate aging, thus leading to relatively earlier death in older persons,” they conclude. “If a direct or indirect causal effect from visual impairment on earlier death is confirmed, regular assessment of vision in older persons may lead to early detection, facilitating treatments that could reduce the impact of visual impairment.”
(Arch Ophthalmol. 2007;125(7):917-924. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by grants from the Australian National Health and Medical Research Council. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, July 9, 2007
Media Advisory: To contact Cynthia Owsley, Ph.D., M.S.P.H., call Bob Shepard at 205-934-8934.
MANY NURSING HOME RESIDENTS MAY NOT GET REGULAR EYE EXAMINATIONS
CHICAGO—In a study of Alabama nursing home residents, more than half were visually impaired yet two-thirds had no record of or reference to an eye examination in their medical charts, according to a report in the July issue of Archives of Ophthalmology, one of the JAMA/Archives journals.
Previous studies have estimated that nursing home residents have visual impairment rates anywhere from three to 15 times higher than adults of the same age living in the community, according to background information in the article. “Reasons for these high vision impairment rates among nursing home residents are not fully understood,” the authors write. “A variety of factors may contribute, including that persons with vision impairment may be more likely to be admitted to nursing homes, nursing home residents may have limited accessibility to doctors’ offices because of lack of transportation and escort availability, residents may not wear spectacles even though they have them, family and health care professionals may believe that cognitively impaired persons do not personally benefit from treatments to improve vision and there is a shortage of eye care professionals who routinely serve clientele living in nursing homes.”
Cynthia Owsley, Ph.D., M.S.P.H., and colleagues at the University of Alabama at Birmingham assessed 380 individuals age 55 or older living at 17 nursing homes in the Birmingham area for visual impairment. Each resident and a family member or guardian was interviewed about the use of eyeglasses and eye care. “Medical records provided information on demographics, chronic medical conditions, date of last eye examination, duration of residence in the nursing home and health insurance,” the authors write. All 17 facilities had licensed optometrists who regularly visited the facility to provide eye care services.
A total of 57 percent of the residents were visually impaired, defined as having visual acuity of worse than 20/40 in the better eye. This compares with rates of approximately 10 percent to 20 percent among adults 60 or older living in the community nationwide. Three-fourths of the participants had abnormal binocular contrast sensitivity, or the ability to detect boundaries between objects and changes in brightness, which is important for mobility and reading.
“It appears that routine eye care may not be taking place for a substantial segment of the nursing home residents in our sample, as implied by our data in several ways,” the authors write. Although 90 percent of the residents had some form of health insurance, 66 percent of them had no reference to eye examinations in their medical records. When asked about their most recent eye exam, 28 percent said it was in the previous year, 20 percent indicated that it was more than two years ago or used words indicating that it was a very long time ago, and one-third did not know.
“Information about the extent to which this visual impairment is remediable was unavailable to the study, so whether high visual impairment rates can be interpreted as underutilization of routine eye care may be questionable. Yet some credence is lent to this possibility based on a previous study estimating that 37 percent of the visual impairment and 20 percent of the blindness among nursing home residents is remediable by refractive error correction,” the authors conclude. “These findings underscore the need to better understand the causes of high visual impairment rates in nursing home residents and to evaluate interventions to improve the visual status of this population.”
(Arch Ophthalmol. 2007;125(7):925-930. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This research was supported by the Retirement Research Foundation, the EyeSight Foundation of Alabama, the Pearle Vision Foundation, a National Institutes of Health grant and Research to Prevent Blindness, Inc. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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