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 CONTENT
JAMA NEWS RELEASES
(Embargoed for Release: 3:00 p.m. CT, Tuesday, June 24, 2008)
JAMA NEWS RELEASES
HOME BLOOD PRESSURE MONITORING COMBINED WITH WEB-BASED PHARMACY CARE HELPS IMPROVE BLOOD PRESSURE CONTROL
ELECTROMAGNETIC INTERFERENCE FROM SOME RADIO FREQUENCY IDENTIFICATION DEVICES MAY POSE HAZARDS TO MEDICAL EQUIPMENT
USE OF DRUG-RELEASING STENTS ASSOCIATED WITH DECREASE IN REPEAT PROCEDURES TO UNBLOCK CORONARY ARTERIES
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
MONITORING BLOOD PRESSURE AT HOME AND ON A SECURE WEB SITE MAY HELP CONTROL HYPERTENSION
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TV Note: This week's JAMA Video News Report is on the effectiveness in controlling blood pressure of home blood pressure monitoring combined with Web-based pharmacist care. The report will be fed Tuesday, June 24, from 9:00 - 9:30 a.m. ET and 2:00 - 2:30 p.m. ET, on Galaxy 26 (formerly Intelsat America 6) C-Band, Transponder 14, downlink frequency: 3880 vertical, audio 6.2/6.8. For more information, call 312/464-JAMA.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, June 24, 2008
Media Advisory: To contact Beverly B. Green, M.D., M.P.H., call Rebecca Hughes at 206-287-2055. To contact editorial co-author Eric D. Peterson, M.D., M.P.H., call Michelle Gailiun at 919-660-1306.
HOME BLOOD PRESSURE MONITORING COMBINED WITH WEB-BASED PHARMACY CARE HELPS IMPROVE BLOOD PRESSURE CONTROL
CHICAGO—Patients with hypertension who monitored their blood pressure from home and received Web-based pharmacist care showed greater improvement in blood pressure control than patients who received usual care, according to a study in the June 25 issue of JAMA.
Hypertension (high blood pressure) is one of the leading causes of death worldwide. Almost 1 in 3 U.S. adults has hypertension, defined as a sustained systolic and diastolic blood pressure (BP) of 140 and 90 mm Hg or higher, respectively. Lowering BP with antihypertensive medications decreases the risk of death and major disability from cardiovascular and kidney disease, but hypertension remains inadequately treated in the majority of affected individuals, according to background information in the article.
Electronic medical records (EMRs) and secure patient Web sites increasingly allow patients to view portions of their medical records, access health care services and communicate with their health care team online. However, little is known about the effectiveness of Web services in the care of chronic conditions.
Beverly B. Green, M.D., M.P.H., of the Group Health Center for Health Studies, Seattle, and colleagues tested whether hypertension care could be successfully provided remotely over the Web without in-person clinic visits. The trial included 778 participants age 25 to 75 years who had uncontrolled hypertension and who also had Internet access. Care was delivered over a secure patient Web site from June 2005 to December 2007. The Web site included online services such as patients being able to send email to their physician, refilling prescriptions, requesting appointments, getting test results and looking up health information.
Participants were randomly assigned to usual care, home BP monitoring and secure patient Web site training only, or home BP monitoring and secure patient Web site training plus care management by a pharmacist delivered through Web communications. Of 778 patients, 730 (94 percent) completed the 1-year follow-up visit.
The researchers found that compared with patients receiving usual care, the BP control of the home BP monitoring and Web training only group had a nonsignificant increase in the percentage of patients with controlled BP (defined as systolic BP less than 140 mm Hg and diastolic BP less than 90 mm Hg). The addition of Web-based pharmacist care to home BP monitoring and Web training resulted in 25 percent more patients with controlled BP (56 percent) compared with those receiving usual care (31 percent) and 20 percent more patients with controlled BP compared with the home BP monitoring and Web training only group (36 percent).
Compared with usual care, greater reductions in systolic BP occurred in the group receiving home BP monitoring and Web training plus pharmacist care and in the group receiving home BP monitoring and Web training only. The group receiving home BP monitoring and Web training plus pharmacist care also had a significant decrease in diastolic BP compared with the group receiving usual care. For the group with baseline systolic BP of 160 mm Hg or higher, the group receiving home BP monitoring and Web training plus pharmacist care had 3.3 times more patients with BP in control, compared with usual care.
“We believe the pharmacists were successful because they provided planned care to a defined population, consistently applied stepped medication protocols, and used comprehensive information systems, a patient-shared EMR, and Web communications to collaborate with patients and their physicians,” the authors write. “Our findings demonstrate the effectiveness of using home BP monitoring combined with pharmacy care over the Web to improve BP control for patients with essential hypertension. More studies are needed to determine whether similar care can be applied to other chronic diseases, be implemented in other settings, and decrease costs.”
(JAMA. 2008;299[24]:2857-2867. Available pre-embargo to the media 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: IMPROVING HYPERTENSION CONTROL RATES — TECHNOLOGY, PEOPLE, OR SYSTEMS?
In an accompanying editorial, Daniel W. Jones, M.D., of the University of Mississippi Medical Center, Jackson, and president of the American Heart Association, and Eric D. Peterson, M.D., M.P.H., of the Duke Clinical Research Institute, Durham, N.C., and Contributing Editor, JAMA, comment on the findings of Green and colleagues.
“...it is clear that the current office-based, physician-centric model for BP treatment has not achieved desired rates for BP control. The study by Green and colleagues demonstrates that even early versions of Web and home BP monitoring technologies can facilitate better BP control if and when they are integrated with receptive clinical personnel. While certainly more work will be needed to refine these models, the future of BP management has taken a significant turn for the better. By finding new tools, ensuring appropriate use by patients and clinicians, and integrating these systems into clinical practice, it will be possible to achieve more effective and cost-effective BP control, and ultimately to save lives.”
(JAMA. 2008;299[24]:2896-2898. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, June 24, 2008
Media Advisory: To contact corresponding author Erik Jan van Lieshout, M.D., email: e.j.vanlieshout{at}amc.nl. To contact editorial author Donald M. Berwick, M.D., M.P.P., F.R.C.P., call Jessie DuPont at 212-576-2700, ext. 232.
ELECTROMAGNETIC INTERFERENCE FROM SOME RADIO FREQUENCY IDENTIFICATION DEVICES MAY POSE HAZARDS TO MEDICAL EQUIPMENT
CHICAGO—The use of radio frequency identification devices appears to have the potential to cause critical care medical equipment to malfunction, according to a study in the June 25 issue of JAMA.
“Applications of autoidentification technologies such as radio frequency identification (RFID) in everyday life include security access cards, electronic toll collection, and antitheft clips in retail clothing. RFID applications in health care have received increasing attention because of the potentially positive effect on patient safety and also on tracking and tracing of medical equipment and devices. The current expenditure levels on RFID systems within health care in the United States are estimated to be approximately $90 million per year with 10-year growth projections to $2 billion,” the authors write.
Possible applications of RFID include drug blister packs, which could be marked to prevent drug counterfeiting; and the quality of blood products being monitored with temperature-sensitive RFID tags. The decreasing size and cost of RFID tags also permits use in surgical sponges, endoscopic capsules and endotracheal tubes, according to background information in the article. The potential for harmful electromagnetic interference (EMI) by electronic anti-theft surveillance systems on implantable pacemakers and defibrillators is known, but the effect on critical care devices in not certain.
Remko van der Togt, M.Sc., of Vrije University, Amsterdam, the Netherlands, and colleagues conducted a study in a controlled, non-clinical setting to assess and classify incidents of electromagnetic interference by RFID on critical care equipment. The tests were performed in a one-bed patient room in an intensive care unit (ICU) and with no patients present. Electromagnetic interference by two RFID systems (active [with batteries and ability to transmit information] and passive [without batteries, information retrieved by RFID reader] was assessed in the proximity of 41 medical devices (in 17 categories, 22 different manufacturers). The devices included items such as external pacemakers, mechanical ventilators, infusion/syringe pumps, dialysis devices, defibrillators, monitors and anesthesia devices. Incidents of EMI were classified according to a critical care adverse events scale as hazardous, significant, or light.
All 41 medical devices were submitted to 3 EMI tests resulting in 123 EMI tests. A total of 34 EMI incidents were found; 22 were classified as hazardous, 2 as significant, and 10 as light. The passive signal induced a higher number of incidents (26 in 41 EMI tests; 63 percent), and hazardous incidents (17), compared with the active signal.
Hazardous incidents included: total switch-off and change in set ventilation rate of mechanical ventilators; complete stoppage of syringe pumps; malfunction of external pacemakers; complete stoppage of renal replacement devices, and interference in the atrial and ventricular electrogram curve read by the pacemaker programmer.
The median (midpoint) distance between reader and device at which all types of incidents occurred was 11.8 inches. Hazardous incidents occurred at a median distance of 9.8 inches.
“The lack of standardization of RFID in health care permits RFID systems originally designed for logistics to enter the medical arena on the basis of requirements such as the range at which medical tagged items or individuals are to be detected. However, the economic benefits of optimal health care logistics, including a supply chain of RFID-tagged disposables or pharmaceuticals, could face barriers in the critical care environment. The intensity of electronic life-supporting medical devices in this area requires careful management of the introduction of new wireless communications such as RFID,” the authors write.
“Implementation of RFID in the ICU and other similar health care environments should require on-site EMI tests in addition to updated international standards.”
(JAMA. 2008;299[24]:2884-2890. Available pre-embargo to the media 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: TAMING THE TECHNOLOGY BEAST
In an accompanying editorial, Donald M. Berwick, M.D., M.P.P., F.R.C.P., of the Institute for Healthcare Improvement, Cambridge, Mass., writes that this study provides important information.
“From the particular case of RFID and EMI, therefore, emerge 2 important lessons. First, design in isolation is risky; even the most seductive technology will interact in the tightly coupled health care world in ways physicians and other members of the health care team had better understand, or they and their patients may pay a dear price. Second, no matter how good the design, in the end the battle for high safety and reliability in health care is never won. Safety is not a condition, it is a process. It can only emerge continually in a culture that is alert, cooperative, transparent, and resilient when the unexpected happens, as it always will.”
(JAMA. 2008;299[24]:2898-2899. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, June 24, 2008
Media Advisory: To contact David J. Malenka, M.D., call Jason Aldous at 603-653-1913.
USE OF DRUG-RELEASING STENTS ASSOCIATED WITH DECREASE IN REPEAT PROCEDURES TO UNBLOCK CORONARY ARTERIES
CHICAGO—The widespread adoption of the use of drug-releasing coronary artery stents into routine practice is associated with a decrease in the need for repeat procedures to unblock coronary arteries and also do not appear to increase the risk of death, compared to bare-metal stents, according to a study in the June 25 issue of JAMA.
“There has been a growing concern about the possibility of an increased risk of stent thrombosis (ST; formation of a clot in a blood vessel) associated with the use of drug-eluting [releasing] stents compared with bare-metal stents. Although a relatively rare event, stent thrombosis is associated with a high risk of myocardial infarction (MI; heart attack) and death and any suggestion of possible excess risk has justifiably been the focus of intense investigation,” the authors write. Despite several recent studies, there remains uncertainty about the trade-offs between the safety and effectiveness of drug-eluting stents.
David J. Malenka, M.D., of Dartmouth-Hitchcock Medical Center, Lebanon, N.H., and colleagues performed a study to compare the rates of revascularization (repeat procedure to unblock a coronary artery), heart attack and survival, before and after the availability of drug-eluting stents. The study included 38,917 Medicare patients who underwent non-emergency coronary stenting from October 2002 through March 2003 when only bare-metal stents were available and 28,086 similar patients who underwent coronary stenting from September through December 2003, when 61.5 percent of patients received a drug-eluting stent and 38.5 percent received a bare-metal stent. Follow-up data were available through December 2005.
During the 2 years of observation, 22.8 percent of patients in the bare-metal stent era group underwent a repeat revascularization (20.0 percent, percutaneous coronary intervention [PCI; procedures such as balloon angioplasty or stent placement used to open narrowed coronary arteries]; 4.2 percent, coronary artery bypass graft [CABG]). In the drug-eluting stent era group, 19.0 percent of patients underwent a repeat revascularization (17.1 percent PCI; 2.7 percent CABG). The risk of repeat revascularization decreased by approximately 18 percent in the drug-eluting stent era compared with the bare-metal stent era.
There was no difference in unadjusted mortality risks at 2 years (8.4 percent vs. 8.4 percent), but a small decrease in ST-elevation myocardial infarction (STEMI; a certain pattern on an electrocardiogram following a heart attack) existed (2.4 percent vs. 2.0 percent). The adjusted risk of death or STEMI at 2 years was similar.
“Although such an analysis will not answer the question of what is the true rate of stent thrombosis with drug-eluting stent vs. the rate with bare-metal stent, it does address the important question of whether, on-average, the population of stented patients is being helped or hurt by the widespread use of this technology,” the authors write.
“Although other data may suggest some incremental risk of stent thrombosis with the use of drug-eluting stents, we can detect no adverse consequence to the health of the population. We speculate that whatever the increased risk of stent thrombosis associated with drug-eluting stent use is, it is more than offset by a decrease in the risk of developing restenosis [renarrowing of a coronary artery after angioplasty] and the attendant risk of a procedure to treat that restenosis.”
(JAMA. 2008;299[24]:2868-2876. Available pre-embargo to the media 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.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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JAMA REPORTS
VIDEO: Windows Media | Quicktime
MONITORING BLOOD PRESSURE AT HOME AND ON A SECURE WEB SITE MAY HELP CONTROL HYPERTENSION
INTRO:
Nearly one out of three adults in the United States has high blood pressure and most are not receiving adequate treatment that is needed to bring high blood pressure under control. A recent study finds that monitoring blood pressure in your own home combined with Web communication with a pharmacist may help to lower your blood pressure level into a normal range. Jennifer Mitchell explains in this week’s JAMA Report.
VIDEO:
B-ROLL
Patient in kitchen
AUDIO:
PAUL JOHNSON SAYS THERE WERE NO WARNING SIGNS BUT HIS BLOOD PRESSURE HAD SKYROCKETED INTO DANGEROUS TERRITORY.
VIDEO:
SOT/FULL
Super @:10
Paul Johnson
Had High Blood Pressure
Runs: 12
AUDIO:
“I think the highest initial values that I can remember my blood pressure being were a hundred and eighty-five maybe a hundred ninety over ninety-five and yes that worried me a great deal.”
VIDEO:
B-ROLL
Patient getting blood pressure taken at Group Health
Tight blood pressure equipment
Paul at home taking BP
Tight shot typing
Paul at computer
AUDIO:
PAUL ENROLLED IN A RECENT STUDY WITH GROUP HEALTH PRIMARY CARE IN SEATTLE. RESEARCHERS LOOKED AT ABOUT EIGHT HUNDRED MEN AND WOMEN WITH HIGH BLOOD PRESSURE. THEY WANTED TO SEE IF MONITORING BLOOD PRESSURE AT HOME COMBINED WITH EMAILING A REGISTERED PHARMACIST COULD HELP BRING HYPERTENSION UNDER CONTROL.
VIDEO:
SOT/FULL
Super @:38
Beverly Green, M.D., M.P.H.
Family Physician, Group Health
Runs: 06
AUDIO:
“We proved in this trial that you can actually use Web communications that patients do not have to come in. They can use the internet to receive care.”
VIDEO:
B-ROLL
Patient and nurse
Patient taking blood pressure
Paul typing email to pharmacist
AUDIO:
PARTICIPANTS WERE DIVIDED INTO THREE GROUPS. ONE GROUP RECEIVED USUAL CARE. TWO GROUPS WERE GIVEN A HOME BLOOD PRESSURE MONITOR TO MEASURE THEIR BLOOD PRESSURE AT LEAST FOUR TIMES PER WEEK, WITH TRAINING ON A PATIENT WEB SITE. ONE OF THE GROUPS ALSO COMMUNICATED VIA THE WEB SITE WITH A REGISTERED PHARMACIST EVERY TWO WEEKS.
VIDEO:
SOT/FULL
Super @ 1:02
Danette Feuling
Registered Pharmacist
Runs: 07
AUDIO:
“When we do ask patients to work on exercise or diet or make a change in their medication they were able to see that it did have a positive influence.”
VIDEO:
SOT/FULL
Beverly Green, M.D., M.P.H.
Family Physician, Group Health
Runs: 08
AUDIO:
“When you go into the doctor’s office you only get one or two readings and that may not be your usual blood pressure.”
VIDEO:
Pharmacist at computer
GRAPHIC:
“56% Had Blood Pressure Controlled”
“Compared to 31%”
GXF/JAMA COVER
AUDIO:
AT THE END OF TWELVE MONTHS FIFTY-SIX PERCENT OF THOSE WHO RECEIVED WEB-BASED CARE AND COMMUNICATED THROUGH EMAIL WITH A PHARMACIST HAD THEIR BLOOD PRESSURE UNDER CONTROL. COMPARED TO THIRTY-ONE PERCENT OF PATIENTS WHO RECEIVED USUAL CARE. THE STUDY APPEARS THIS WEEK IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
VIDEO:
SOT/FULL
Beverly Green, M.D., M.P.H.
Family Physician, Group Health
Runs: 10
AUDIO:
“Patients with more severe hypertension are typically very hard to control and actually they did the best. They were almost they were more than three times likely to have improved blood pressure control at the end of the study.”
VIDEO:
B-ROLL
Patient in kitchen
Patient walks out front door
Patient walking down street
AUDIO:
PAUL’S BLOOD PRESSURE IS NOW ABOUT ONE TWENTY-FIVE OVER SIXTY-FIVE. HE SAYS BEING AWARE OF HIS BLOOD PRESSURE DAILY ALLOWED HIM TO MAKE GOOD DECISIONS ABOUT DIET AND HIS MEDICATION. JENNIFER MITCHELL THE JAMA REPORT.
TAG:
Researchers say at the end of the study those who received Web based care were on more hypertension medication and often at higher doses than those patients who received usual care. They say pharmacists offered planned care, applied stepped medication protocols and used an existing electronic medical record system to communicate with patients. For more information about this study you can log on to www.jama.com.
