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, January 26, 2009)
Health Information Technologies Associated With Better Outcomes, Lower Costs
Substance Use Common Among Patients With TB, Associated With Treatment Difficulties
Combined Aerobic and Strength Exercises May Help Decrease Functional Limitations and Insulin Resistance Among Obese Older Adults
Study Examines Relationship Between Loop Diuretic Use and Fractures, Falls and Bone Mineral Density in Postmenopausal Women
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, January 26, 2009
Media Advisory: To contact Ruben Amarasingham, M.D., M.B.A., call Candace White at 214-590-8054. To contact editorial author David W. Bates, M.D., M.Sc., call Kevin Myron at 617-534-1605 or e-mail kmyron{at}partners.org.
Health Information Technologies Associated With Better Outcomes, Lower Costs
CHICAGO—Patients at Texas hospitals that have automated some aspects of their health information systems appear to have fewer complications, lower death rates and reduced costs, according to a report in the January 26 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
"In recent years, American health care has been criticized as fragmented, expensive, unsafe and unfair," the authors write as background information in the article. "Clinical or ‘health' information technologies, such as electronic medical records, computerized provider order entry systems and clinical decision support systems, have emerged as one antidote, promising reductions in waste, gains in communication, improvements in quality and new accountabilities through automated performance measurement." A hospital's clinical information system can be divided into four categories, the authors note: medical notes and records, test results, order entry (instructions for the treatment of patients) and decision support (programs that assist physicians and other providers with decision-making tasks).
Ruben Amarasingham, M.D., M.B.A., of Parkland Health & Hospital System and University of Texas Southwestern Medical Center, Dallas, and colleagues compared urban hospitals in Texas using a tool that measures physicians' interactions with the information system. Physicians from 41 hospitals rated their facilities' automation in each of the four areas in surveys taken in 2005 and 2006. The researchers then examined rates of inpatient death, complications, costs and length of stay for 167,233 patients older than 50 who were admitted to these hospitals for a variety of conditions during the same timeframe.
For all of the medical conditions studied, increased automation of notes and records was associated with a 15-percent decrease in the odds of in-hospital death. At hospitals with higher order entry scores, those with myocardial infarction (heart attack) had 9 percent lower odds of death and those undergoing coronary artery bypass graft had 55 percent lower odds of death. Patients with all causes of hospitalization had 16 percent lower odds of developing complications at hospitals whose decision support systems were highly automated. "Higher scores on test results, order entry and decision support were associated with lower costs for all hospital admissions (-$110, -$132 and -$538, respectively)," the authors write.
"Prior reports have suggested that decision support helps health care providers manage large amounts of incoming data, provides context for decision making in light of guidelines and may help physicians avoid ‘sins of omission,' reputed by some authors to be the largest source of medical errors," they continue. "Knowledge aids provided in this fashion could reduce the risk of complications and possibly death, providing a theoretical basis for the association we observed."
"Clinical information technologies hold great promise as a tool to improve hospital medicine," they conclude. "We found that, for certain conditions, greater automation of a hospital's information system may be associated with reductions in mortality [death], complications and costs, suggesting that information technologies that are properly designed and executed around clinical workflows could meet that promise."
(Arch Intern Med. 2009;169[2]:108-114. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by a grant from the Commonwealth Fund, New York. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Editorial: Results Inform Health IT Debate
CHICAGO—"Amarasingham et al found impressive relationships between the presence of several technologies and complication and mortality rates and lower costs," writes David W. Bates, M.D., M.Sc., of Brigham and Women's Hospital, Boston, in an accompanying editorial.
"At the end of the day, does this article mean that hospitals should now climb on the health information technology bandwagon? The data are too circumstantial to answer this definitively, but they provide another extremely important set of results," Dr. Bates continues.
"More of such analyses should be done, and they are likely to be helpful in convincing policy experts including skeptics like those at the Congressional Budget Office of the benefits when these technologies are in routine use. For large- and medium-sized hospitals, it appears that the time is now."
(Arch Intern Med. 2009;169[2]:105-107. 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, January 26, 2009
Media Advisory: To contact John E. Oeltmann, Ph.D., call the CDC Division of Media Relations at 404-639-3286 or e-mail in.the.news{at}cdc.gov.
Substance Use Common Among Patients With TB, Associated With Treatment Difficulties
CHICAGO—About one in five U.S. tuberculosis patients reports abusing alcohol or using illicit drugs, and those who do appear more contagious and difficult to treat, according to a report in the January 26 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
The annual rate of new tuberculosis (TB) cases in the United States is among the lowest in the world, according to background information in the article. However, certain groups remain at higher risk. "The epidemiology of TB in the United States has been best summarized by Iseman: ‘As the epidemic tide of tuberculosis recedes from the shores of America, small tidepools of disease remain behind: pools populated by immigrants, the elderly and the immunocompromised'," the authors write. "A less frequently discussed tidepool that complicates U.S. TB control efforts is the illicit drug–using and alcohol-abusing population."
John E. Oeltmann, Ph.D., of the Centers for Disease Control and Prevention, Atlanta, and colleagues analyzed data from 153,268 patients 15 years or older who were reported to have TB between 1997 and 2006. Of these, 28,650 (18.7 percent) reported substance abuse—a larger percentage than those who reported any other established risk factors for TB, including recent immigration to the United States (12.9 percent), infection with HIV (9.5 percent), living in a group setting (6.6 percent), homelessness (6.3 percent) or working in a high-risk occupation (4.3 percent).
"Our results suggest that substance abuse is the most commonly reported modifiable behavior impeding TB elimination efforts in the United States," the authors write. Among patients who were negative for HIV, those who reported substance abuse were 1.8 times more likely to have a more contagious form of TB (as indicated by a positive sputum smear). Females who were substance abusers were 2.4 times more likely to experience treatment failure than were other females.
"The relation between substance abuse and increased transmission of Mycobacterium tuberculosis can be explained in several ways, some of which are indirect and revolve around delayed diagnosis and difficulties identifying at-risk contacts, screening them for TB and treating patients with positive findings," the authors write. "Persons who abuse substances may have less access to routine medical care, potentially leading to delayed diagnoses. As the disease progresses, patients tend to become more contagious."
Patients who abuse substances are less likely to be screened for TB or to begin and complete treatment for latent infection or active disease, the authors note—problems compounded by the compromised immune systems of individuals who abuse alcohol, crack cocaine, heroin, marijuana and methamphetamines. In addition, antituberculosis medications are usually metabolized by the liver, which is often damaged by substance abuse.
"Tuberculosis control and substance abuse programs need to work together to simultaneously treat the diseases of addiction and TB," the authors conclude.
(Arch Intern Med. 2009;169[2]:189-197. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was funded by the Centers for Disease Control and Prevention, Division of Tuberculosis Elimination. 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, January 26, 2009
Media Advisory: To contact corresponding author Robert Ross, Ph.D., call Alissa Clark at 613-533-6000, ext. 77513, or e-mail alissa.clark{at}queensu.ca.
Combined Aerobic and Strength Exercises May Help Decrease Functional Limitations and Insulin Resistance Among Obese Older Adults
CHICAGO—Sedentary, obese older adults appear to improve their functional abilities and reduce insulin resistance through a combination of resistance and aerobic exercises, according to a report in the January 26 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Older adults currently comprise less than 13 percent of the U.S. population but account for about 35 percent of total personal health care costs, according to background information in the article. "Projections indicating that the U.S. population 65 years and older will increase from 12 percent in 2000 to 20 percent in 2030 underscore the urgent need to develop effective strategies designed to manage the risk factors for disease and disability and thereby improve the overall health and quality of life of older adults," the authors write.
"With respect to risk factors for disease, it is well established that aging is associated with a marked increase in insulin resistance, a primary defect that precedes serious diseases, including diabetes, stroke and coronary heart disease independent of other major cardiovascular disease risk factors," they continue. "Aging is also associated with a progressive increase in functional limitations that affect activities of daily living and quality of life and that are highly predictive of subsequent disability."
Lance E. Davidson, Ph.D., of Queen's University, Kingsland, Ontario, Canada, and Columbia University, New York, and colleagues conducted a randomized clinical trial involving 136 sedentary older adults who were abdominally obese, meaning they had a waist circumference of at least 102 centimeters (40 inches) for men or 88 centimeters (35 inches) for women. For six months, participants were randomly assigned to one of four groups: resistance exercise (one set of nine exercises, 20 minutes three times per week), aerobic exercise (30 minutes of moderate-intensity treadmill walking five times per week), combined exercise (30 minutes of aerobic exercise three times per week plus 60 minutes of resistance training weekly) and a control group that did not exercise.
After six months, insulin resistance improved in the aerobic and combined exercise groups as compared with the control group. In addition, all exercise groups improved their functional limitation (as measured by tests such as the number of times a person could stand up out of a chair in 30 seconds or step in place in two minutes) compared with the control group. The combined exercise group showed greater improvement than the aerobic only group. Finally, cardiorespiratory fitness increased in the aerobic and combined exercise groups but not in the resistance exercise group.
"That these observations were obtained in response to 90 minutes of moderate-intensity aerobic exercise combined with 60 minutes of resistance exercise performed across three days each week is promising and suggests that substantial improvement in overall health through effective management of risk factors for disease and disability can be achieved in a pragmatic manner," the authors write. "Health care providers are encouraged to promote performance of resistance and aerobic exercise by older adults for simultaneous reduction of insulin resistance and functional limitations, established risk factors for disease and disability."
(Arch Intern Med. 2009;169[2]:122-131. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by a research grant from the Canadian Institutes of Health Research. Dr. Ross has received honoraria from scientific, educational and community groups; research grants from M&M Mars Inc., Roche Pharmaceutical and Sanofi-Aventis Inc, and royalties from Human Kinetics. 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, January 26, 2009
Media Advisory: To contact Laura D. Carbone, M.D., M.S., call Dena L. Owens at 901-448-4072 or e-mail dowens10{at}utmem.edu.
Study Examines Relationship Between Loop Diuretic Use and Fractures, Falls and Bone Mineral Density in Postmenopausal Women
CHICAGO—The use of loop diuretics does not appear to be associated with changes in bone mineral density, falls or fractures in postmenopausal women, according to a report in the January 26 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. However, prolonged use of loop diuretics may increase fracture risk in this group.
Developing osteoporosis and heart failure are of particular concern for many postmenopausal women; half of them experience osteoporosis-related fractures in their lifetime and at age 40 their lifetime risk for developing heart failure is one in five, according to background information in the article. Loop diuretics are commonly prescribed for the treatment of congestive heart failure. These agents "increase calcium excretion and, in some studies, hypercalciuria is associated with low bone mineral density, a risk factor for fractures," the authors note.
Laura D. Carbone, M.D., M.S., of the University of Tennessee Health Science Center, Memphis, and colleagues examined the use of loop diuretics and changes in bone mineral density, falls and fractures in 133,855 women enrolled in the Women's Health Initiative (WHI) from October 1993 to December 1998. Bone mineral density was measured for 300 diuretic users and 9,124 non-users at baseline and at year three of the study. Falls and fractures were recorded for an average of 7.7 years.
Of the participants, 3,411 used loop diuretics and 130,444 did not. The association between loop diuretic use and total fractures, hip fractures, clinical vertebral fractures and falls was not significant. However, women who had used loop diuretics for more than three years had modest increased risks for other clinical fractures and total fractures.
"No significant differences were found between loop diuretic users and nonusers in baseline bone mineral density of the total hip, lumbar spine, total body, year three bone mineral density of the total hip, lumbar spine, total body or change in bone mineral density measurements from baseline to year three," the authors write.
"In conclusion, no significant association was found between ever use of loop diuretics and changes in bone mineral density, falls or fractures in postmenopausal women in the WHI. However, prolonged use of loop diuretics was associated with higher fracture risk in postmenopausal women," the authors write. "Therefore, it may be important to consider fracture prevention measures in women who receive loop diuretic therapy."
(Arch Intern Med. 2009;169[2]:132-140. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: The WHI Program is funded by the National Heart, Lung, and Blood Institute of Health, U.S. Public Health Service contract. 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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