This Week in JAMA FREE

Two articles in this issue address the relationship between obstructive sleep apnea (OSA) treatment with continuous positive airway pressure (CPAP) and incident hypertension or cardiovascular events. Barbé and colleagues report results of a clinical trial in which 725 patients with OSA but no daytime sleepiness were randomly assigned to receive CPAP treatment or usual care with no active intervention and were followed up for a median 4 years. The authors found that compared with usual care, prescription of CPAP was not associated with a reduction in incident hypertension or cardiovascular events. In a prospective cohort study of 1889 individuals who were normotensive at baseline and referred for evaluation of sleep-disordered breathing, Marin and colleagues assessed the association between CPAP treatment of OSA and the risk of incident hypertension during a median 12.2 years' follow-up. The authors report that compared with individuals without OSA, patients with untreated OSA had an increased risk and patients with OSA treated with CPAP had a lower risk of incident hypertension. In an editorial, Kapur and Weaver discuss the evidence that supports a relationship between OSA and incident hypertension, and potential benefits of treatment with CPAP.

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In a cluster randomized controlled trial that involved 36 nursing homes and 4449 patients, Köpke and colleagues examined the effect of a guideline-based, multi-component intervention to decrease the use of physical restraints (devices, material, or equipment that prevents residents' free physical movement). The intervention included staff training and supportive materials for staff, residents, and family or legal guardians on the use of physical restraints; nursing homes in the control group received standard information regarding physical restraint use and methods to avoid their use. At a 6-month follow-up assessment, the authors found that compared with standard information, the guideline-based intervention was associated with a significant decrease in physical restraint use in the participating nursing homes.

Hip fracture is a potentially devastating event for older adults and is associated with complications ranging from delirium to functional loss and death. Using the case of Mr W, an 89-year-old man with multiple chronic comorbidities and a recent hip fracture, Hung and colleagues present an evidence-based, multidisciplinary approach to hip fracture management in older adults that addresses essential elements of acute care, rehabilitation, and recovery. A Viewpoint by Jenq and Tinetti discusses challenges faced by vulnerable patients as they move through the health care system.

A 62-year-old woman has experienced progressive confusion, memory loss, and gait instability over a 6-month period. Computed tomographic imaging of the head demonstrated a third ventricular mass and enlarged lateral ventricles with transependymal flow. What would you do next?

The potential environmental and health risks of “fracking”—using hydraulic fracturing to tap into natural gas reserves—are unclear because of a lack of rigorous scientific evidence.

Drugstore medicine

Evaluating health care program success

Deciphering harm measurement

“[C]an you be truly happy at home if you're unfulfilled, or unhappy, at work?” From “Considering Life Before Lifestyle.”

Dr Bauchner summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

How would you manage worsening motor complications in a man with an 11-year history of Parkinson disease? Go to www.jama.com to read the case. Submit your response by June 3 for possible online posting.

Join Mary Whooley, MD, on Wednesday, June 20, from 2 to 3 PM eastern time to discuss treating depression. To register, go to http://www.ihi.org/AuthorintheRoom.

For your patients: Information about interstitial cystitis.