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 14, 2008)
JOINT REPLACEMENT ASSOCIATED WITH SYMPTOM RELIEF, IMPROVED FUNCTION IN OLDER ADULTS WITH OSTEOARTHRITIS
FORMULA PREDICTS EMERGENCY ADMISSIONS IN ADULTS OLDER THAN 40
OLDER ADULTS WHO BRING COMPANIONS TO MEDICAL VISITS MAY BE MORE SATISFIED WITH MEDICAL CARE
ARCHIVES OF OPHTHALMOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, July 14, 2008)
VISUAL IMPAIRMENT MAY BE ASSOCIATED WITH HIGHER SUICIDE RISK
MANY HISPANICS WITH DIABETES UNAWARE OF POTENTIAL EYE DISEASE, DO NOT RECEIVE EYE EXAMS
ARCHIVES OF NEUROLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, July 14, 2008)
NEW CRITERION MAY IMPROVE IDENTIFICATION OF DEMENTIA RISK IN HIGHLY EDUCATED OLDER ADULTS
STUDY EXAMINES ANTI-CLOTTING THERAPY FOLLOWING CARDIOEMBOLIC STROKE
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, July 14, 2008
Media Advisory: To contact Mary Beth Hamel, M.D., M.P.H., call Bonnie Prescott at 617-667-7306.
JOINT REPLACEMENT ASSOCIATED WITH SYMPTOM RELIEF, IMPROVED FUNCTION IN OLDER ADULTS WITH OSTEOARTHRITIS
CHICAGO—Older adults who have hip or knee replacement surgery for severe osteoarthritis may take several weeks to recover but appear to have excellent long-term outcomes, according to a report in the July 14 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
As the U.S. population ages, the number of older adults with osteoarthritis is increasing, according to background information in the article. The disease causes debilitating pain and often restricts older adults’ mobility. Non-invasive treatments such as medications and physical therapy appear to be of limited value for the advanced stages of osteoarthritis. However, surgery may be associated with risks and discomfort.
Mary Beth Hamel, M.D., M.P.H., and colleagues at Beth Israel Deaconess Medical Center, Boston, studied medical decision-making and treatment outcomes in 174 patients age 65 and older (average age 75.2) who had severe osteoarthritis of the hip or knee. Participants’ arthritis symptoms and functional status were assessed at the beginning of the study, between 2001 and 2004, and again 12 months later. Patients who chose to have joint replacement surgery were assessed six weeks, six months and 12 months after the procedure.
During 12 months of follow-up, 51 patients (29 percent) had joint replacement surgery, including 30 knee and 21 hip replacements. None of these patients died, 17 percent had postoperative complications and 38 percent had pain lasting more than four weeks following surgery. Patients age 75 and older took about the same amount of time to return to regular activities as those age 65 to 74, with most patients requiring assistance with activities such as shopping and household chores for more than a month.
At the 12-month mark, scores on scales measuring osteoarthritis symptoms improved more significantly in patients who had surgery than in patients who did not have surgery. Close to half (45 percent) of patients who did not have surgery reported that surgery was not offered to them as a potential treatment. Participants who did not have surgery tended to be older, have lower incomes and be more worried about surgical complications and a long recovery than those who did have surgery.
“Our findings of excellent outcomes from joint replacement surgery in elderly patients with severe hip or knee osteoarthritis corroborate and extend the findings of previous studies,” the authors conclude. “These data should help inform discussion about joint replacement surgery and allow patients to consider the risks and benefits of surgery as well as the expected postoperative recovery experience.”
(Arch Intern Med. 2008;168[13]:1430-1440. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by the Paul Beeson Physician Faculty Scholars in Aging Research Program. 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 14, 2008
Media Advisory: To contact Peter T. Donnan, Ph.D., e-mail
p.t.donnan{at}chs.dundee.ac.uk.
FORMULA PREDICTS EMERGENCY ADMISSIONS IN ADULTS OLDER THAN 40
CHICAGO—Using data from clinical encounters and drug prescriptions over three years, researchers have devised a model to predict emergency hospital admissions in the following year in individuals age 40 and older, according to a report in the July 14 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Stratifying individuals by risk to target health care may help reverse the trend of increasing emergency hospital admissions, according to background information in the article. Several models have been previously developed to identify those at risk. However, most have focused on those older than 65 years or those who have already experienced multiple emergency admissions. “These algorithms clearly leave out of consideration the important group of people at high risk who are younger than 65 years and those who have never experienced an emergency admission but are likely to experience an emergency admission in the future,” the authors write.
Peter T. Donnan, Ph.D., of the University of Dundee, Scotland, and colleagues studied 90,522 residents of Tayside, Scotland, where each individual who visits a general practitioner is given a 10-digit identifier. Participants were at least 40 years old when they entered the study between 1996 and 2004, had at least three years of data available on hospital use and drug prescribing and were followed for at least one year.
A total of 6,793 (7.5 percent) of the participants experienced an emergency hospital admission within one year of enrolling in the study. Those who were hospitalized tended to:
- Be older and male
- Live in an area with high social deprivation
- Have received more respiratory medications
- Have had previous emergency admissions, with average total days in the hospital six times greater than those who were not admitted on an emergency basis
- Have been prescribed analgesics (pain medications), antibacterials, nitrates and diuretics
The researchers identified 35 such parameters that were used to derive the probability of emergency admission within the next year, expressed as a percentage. “As an example, consider a man aged 72 years and is from a highly deprived area; has previous emergency admissions, eight previous admissions and 106 total bed-days in the previous three years; and is in receipt of hypertension and heart failure drugs, nitrates and calcium channel blockers, respiratory drugs, anxiolytics, antidepressants, analgesics and antibacterials: the absolute risk of admission in the next year is 52.8 percent,” the authors write. On the other hand, a 50-year-old woman from an affluent area with no previous emergency admissions and one previous hospital admission with a one-day stay who takes ulcer-healing drugs, diuretics and antibiotics would have a 2.4 percent risk of emergency admission in the next year.
The model “provides a useful tool for the individual clinician in face-to-face consultation as well as the general practice as a whole, and for health insurers, policy makers and planners at the health board level faced with the increasing prevalence of hospital use,” the authors conclude. “This work has immediate relevance to developing policy and service reorganization, as well as informing future intervention studies of different models of case management.”
(Arch Intern Med. 2008;168[13]:1416-1422. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was funded by an unrestricted grant from NHS Tayside. 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 14, 2008
Media Advisory: To contact Jennifer L. Wolff, Ph.D., call Tim Parsons at 410-955-7619.
OLDER ADULTS WHO BRING COMPANIONS TO MEDICAL VISITS MAY BE MORE SATISFIED WITH MEDICAL CARE
CHICAGO—More than one-third of Medicare beneficiaries appear to be accompanied by family members or companions during medical encounters, according to a report in the July 14 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. Such medical visit companions may be associated with improved patient satisfaction, especially among beneficiaries in poor health.
Families are increasingly understood to be relevant to patient care, according to background information in the article. However, little is known about which specific attributes of their involvement are most helpful to patients or result in the greatest improvements in quality of care.
Jennifer L. Wolff, Ph.D., and Debra L. Roter, Dr. P.H., M.P.H., of the Johns Hopkins Bloomberg School of Public Health, Baltimore, and colleagues studied a sample of 12,018 Medicare beneficiaries 65 years or older who participated in a 2004 survey. These older adults were representative of approximately 30 million Medicare beneficiaries living in the community.
The researchers found that:
- 38.6 percent of participants reported regularly being accompanied to medical visits
- Companions included spouses (53.3 percent); adult children (31.9 percent); other relatives (6.8 percent); roommates, friends or neighbors (5.2 percent); non-relatives (2.8 percent); or nurses, nurse aides or legal or financial officers (less than 1 percent)
- 63.8 percent of companions helped with communication, including 44.1 percent who recorded physician comments and instructions, 41.5 percent who communicated information about the patient’s medical condition to the physician, 41 percent who asked questions, 29.7 percent who explained physician’s instructions and 3.3 percent who translated the English language
- 28.4 percent of companions were reported to be present for company and moral support, 52.3 percent to assist with transportation, 16.6 percent to help schedule appointments and 8.4 percent to provide physical assistance
Beneficiaries with regular companions were more highly satisfied with their physician’s technical skills, information-giving and interpersonal skills. Those whose companions more actively helped with communication rated their physicians’ information-giving and interpersonal skills more favorably. This relationship was stronger among patients who reported themselves to be in worse health.
“Findings establish that visit companions, most often spouses and adult children, are commonly present in older adults’ routine medical encounters, actively engaged in the exchange of health information between patients and their physicians and influential in patients’ perceptions of physician interpersonal rapport and information giving,” the authors write. “Moreover, visit companions tend to accompany patients who are especially vulnerable; in this study, accompanied patients were older, less educated and in worse health than their unaccompanied counterparts.”
“Results presented in this article suggest that patients’ visit companions, hidden, but in plain sight, are a valuable quality of care resource whose efforts, if further optimized, could enhance the experience of care for millions of vulnerable Americans,” they conclude.
(Arch Intern Med. 2008;168[13]:1409-1415. 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 14, 2008
Media Advisory: To contact Byron L. Lam, M.D., call Marla Bercuson at 305-326-6190.
VISUAL IMPAIRMENT MAY BE ASSOCIATED WITH HIGHER SUICIDE RISK
CHICAGO—Visual impairment may be associated with an increased risk of suicide through its indirect negative effect on health, according to a report in the July issue of Archives of Ophthalmology, one of the JAMA/Archives journals.
Eye conditions that lead to visual impairment often have psychosocial and health consequences including impaired activities of daily living, social isolation, mental impairment, increased dependency on others, increased motor vehicle crashes, falls and fractures, depression and poor self-rated health, according to background information in the article. “Increased mortality risks also have been noted in adults with visual impairment and disabling eye disease.”
Byron L. Lam, M.D., of Bascom Palmer Eye Institute, University of Miami School of Medicine, and colleagues reviewed data from national health surveys of 137,479 participants conducted between 1986 and 1996. Participants reported demographic information along with details about visual impairment and other health conditions. Researchers then verified deaths of participants up until 2002 through the National Death Index.
During an average 11 years of follow-up, 200 suicide deaths were identified. “After controlling for survey design, age, sex, race, marital status, number of non-ocular health conditions and self-rated health, the direct effect of visual impairment on death from suicide was elevated (increased by 50 percent) but not significant,” the authors write. The indirect effect of visual impairment on suicide through poor self-rated health or number of non-ocular health conditions was considerable (5 percent and 12 percent, respectively). “The combined indirect effects of reported visual impairment operating jointly through poorer self-rated health and a higher number of reported non-ocular conditions increased the risk of suicide significantly by 18 percent.”
“In summary, we observed that reported visual impairment increased suicide risk, particularly indirectly via reported health status and health conditions,” the authors conclude. “Our results suggest improved treatments of visual impairment and factors causing poor health could potentially reduce suicide risk.”
(Arch Ophthalmol. 2008;126[7]:975-980. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by a grant from the National Eye Institute and a grant from the National Institute on Occupational Safety and 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 14, 2008
Media Advisory: To contact Beatriz Muñoz, M.Sc., call John Lazarou at 410-502-8902.
MANY HISPANICS WITH DIABETES UNAWARE OF POTENTIAL EYE DISEASE, DO NOT RECEIVE EYE EXAMS
CHICAGO—Hispanic patients with diabetes appear to have less frequent eye examinations than the national average for Hispanic individuals, and many are not aware of the potential ocular complications of diabetes, according to a report in the July issue of Archives of Ophthalmology, one of the JAMA/Archives journals.
One in five Hispanic individuals older than 40 years currently has diabetes, and almost half have diabetic retinopathy, a related eye disease, according to background information in the article. “The limited use of health care services in minority groups may make them more susceptible to the complications of uncontrolled diabetes,” the authors write. “In addition, a substantial proportion of those with diabetes are unaware of their condition, although already presenting signs of moderate to severe diabetic retinopathy. The importance of appropriate and timely care for diabetic retinopathy or macular edema [swelling in the retina] is paramount, as it is the leading cause of visual loss among working-age Hispanic individuals.”
Beatriz Muñoz, M.Sc., of the Wilmer Eye Institute, Johns Hopkins University, Baltimore, and colleagues interviewed 349 randomly selected Hispanic individuals without diabetes and a group of 204 Hispanic individuals with diabetes. Participants answered questions about demographic information, health care habits and knowledge of diabetes and diabetic retinopathy.
The researchers found that:
- Less than 10 percent of participants preferred reading in English
- 50 percent reported language barriers to health care
- Knowledge of eye disease as a consequence of diabetes was reported by 18 percent of non-diabetics with no family history of diabetes, 29 percent of non-diabetics with a family history of diabetes, 36 percent of those newly diagnosed with diabetes and 52 percent diagnosed with diabetes more than a year prior
- 16 percent of non-diabetics with no family history, 28 percent of non-diabetes with a family history, 13 percent of those newly diagnosed with diabetes and 34 percent diagnosed more than a year prior know that strict control of diabetes could prevent eye problems; 33 percent, 51 percent, 31 percent and 48 percent, respectively, knew dilated eye examinations were important
- Less than one-third (30 percent) of diabetic participants had had an eye examination in the previous year, compared with 70 to 75 percent in national samples of Hispanics
- Almost half of those with diabetes for more than one year and 79 percent of those diagnosed in the previous year had never had a dilated eye exam
“The lack of correct information about diabetes and diabetic eye disease in this population of Hispanic individuals should be of great concern,” the authors conclude. “The frequency of dilated eye examinations among people with diabetes was unacceptable, and places this population at risk of visual loss. These deficiencies need to be rectified with a culturally appropriate health education campaign, and with innovative ways to reduce barriers to health care.”
(Arch Ophthalmol. 2008;126[7]:968-974. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This project was supported by a grant from the National Eye Institute. 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 14, 2008
Media Advisory: To contact Sid E. O’Bryant, Ph.D., call Suzanna Cisneros Martinez at 806-252-4153.
NEW CRITERION MAY IMPROVE IDENTIFICATION OF DEMENTIA RISK IN HIGHLY EDUCATED OLDER ADULTS
CHICAGO—A different cutoff point on an existing mental function assessment may more effectively assess the risk of dementia in highly educated older adults, according to a report in the July issue of Archives of Neurology, one of the JAMA/Archives journals.
The most commonly administered screening test of cognitive (thinking, learning and memory) function is known as the mini-mental state examination (MMSE), according to background information in the article. “The MMSE is used to screen patients for cognitive impairment, track changes in cognitive functioning over time and often to assess the effects of therapeutic agents on cognitive function,” the authors write. “Performance on the MMSE is moderated by demographic variables, with scores decreasing with advanced age and less education.” The maximum MMSE score is 30; a score of 24 or less is typically used to detect individuals with cognitive dysfunction.
Sid E. O’Bryant, Ph.D., of the Texas Tech University Health Sciences Center, and colleagues reviewed the MMSE scores of 1,141 participants (93 percent white, average age 75.9 years) in the Mayo Clinic Alzheimer Disease Research Center and Alzheimer Disease Patient Registry who reported having 16 or more years of education. These included 307 patients with dementia, 176 patients with mild cognitive impairment and 658 control patients without dementia.
With the traditional cut score of 24 on the MMSE, 89 percent of the participants were accurately classified by dementia status. This score had a sensitivity of 66 percent and a specificity of 99 percent for the detection of dementia, meaning that an individual with a score of 23 or lower would be correctly identified as having dementia 66 percent of the time and an individual with score of 24 or higher would be correctly diagnosed as not having dementia 99 percent of the time. Raising the cut score to 27 changed the sensitivity to 89 percent and the specificity to 78 percent, correctly classifying 90 percent of the participants.
“The current findings are not intended to encourage the diagnosis of cognitive impairment or dementia based on total MMSE scores alone,” the authors write. “Instead, these results provide practitioners with revised criteria for appropriate management of highly educated older white patients. Specifically, older patients who present with memory complaints (reported by themselves or others) who have attained a college degree or higher level of education and who score below 27 on the MMSE are at increased risk of cognitive dysfunction and dementia and should be referred for a comprehensive evaluation, including formal neuropsychological studies.”
The authors suggest that use of this new cut point may help facilitate early detection of dementia in highly educated individuals. Timely treatment may be particularly important in this population, since individuals with more education tend to decline and die more quickly after they are diagnosed with Alzheimer’s disease, the authors note.
(Arch Neurol. 2008;65[7]:963-967. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by grants from the National Institute on Aging, and by the Robert and Clarice Smith and Abigail Van Buren Alzheimer’s Disease Research Program. 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 14, 2008
Media Advisory: To contact Hen Hallevi, M.D., call Deborah Mann Lake at 713-500-3030.
STUDY EXAMINES ANTI-CLOTTING THERAPY FOLLOWING CARDIOEMBOLIC STROKE
CHICAGO—The common practice of administering heparin soon after cardioembolic stroke is associated with an increased risk for serious bleeding, according to an article posted online today that will appear in the September 2008 print issue of Archives of Neurology, one of the JAMA/Archives journals. However, it appears that anticoagulation with warfarin therapy may safely begin shortly after stroke.
Cardioembolic stroke, in which blood flow to the brain is interrupted by a clot or other substance originating within the heart, account for 20 percent of strokes involving reduced blood flow to an area of the brain (ischemic strokes), according to background information in the article. Current guidelines do not recommend giving anticoagulation (anti-clotting) therapy to patients shortly after cardioembolic stroke. However, most patients who have this type of stroke eventually need anticoagulation therapy, and there is no consensus regarding the best way to begin this treatment. Warfarin sodium, commonly prescribed for this purpose, takes several days to reach therapeutic levels and so is often combined (bridged) with other therapies.
Hen Hallevi, M.D., of the University of Texas Health Science Center at Houston, and colleagues retrospectively studied 204 patients who had been admitted with cardioembolic stroke between 2004 and 2006. Of these, eight received no anti-clotting therapy; 88 received aspirin only; 35 were given aspirin and warfarin; 44 received intravenous heparin and warfarin; and 29 were treated with a full dose of enoxaparin, a low-molecular-weight-heparin, followed by warfarin. All patients who did not receive full doses of heparin or enoxaparin took low doses of enoxaparin to prevent deep vein thrombosis (blood clots in the thigh or legs).
Recurrent strokes occurred in two patients (1 percent). The most common serious adverse event was a progressive stroke, in which the patient’s neurological condition continues to deteriorate following the acute phase of the stroke, seen in 11 patients (5 percent). All except one of these cases occurred in the aspirin-only group. Patients receiving only aspirin therapy were 12.5 times as likely to experience stroke progression compared with patients who received other anticoagulation therapies, and patients with progressive strokes were 18 times more likely to have a poor outcome.
Hemorrhagic transformation, which involves bleeding into brain tissue affected by the ischemic stroke, was observed in 23 cases (11 percent) but only three (1 percent) were symptomatic. All three of these cases occurred in patients taking full-dose enoxaparin. Systemic bleeding occurred in two patients (1 percent), both taking heparin.
“Our data may provide guidance as to the mode of starting long-term anticoagulation therapy in patients with cardioembolic stroke,” the authors write. “Warfarin treatment appears to be safe and can be started at any point during the hospital stay along with deep vein thrombosis prophylaxis. Bridging with a full dose of enoxaparin or heparin may carry a high risk of intracranial and systemic bleeding. However, it may be considered in special circumstances.”
(Arch Neurol. 2008;65[9]:(doi:10.1001/archneur.65.9.noc70105). Available to the media pre-embargo at www.jamamedia.org)
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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