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This Week in JAMA |

This Week in JAMA FREE

JAMA. 2002;288(12):1439. doi:10.1001/jama.288.12.1439.
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NEUROPSYCHIATRIC SYMPTOMS IN DEMENTIA AND MCI

Neuropsychiatric symptoms accompany dementia and also mild cognitive impairment (MCI), a cognitive condition in elderly persons of insufficient severity to qualify for a diagnosis of dementia. To estimate the prevalence of neuropsychiatric symptoms among persons with dementia and MCI, Lyketsos and colleagues evaluated participants with dementia or MCI enrolled in the Cardiovascular Health Study using ratings from the Neuropsychiatric Inventory. Three quarters of participants with dementia exhibited a neuropsychiatric symptom in the previous month, with apathy, depression, and agitation/aggression being the most common. Among participants with MCI, 43% exhibited a neuropsychiatric symptom in the previous month, most commonly depression, apathy, and irritability.

PUBLIC REPORTING OF HMO PERFORMANCE DATA

Public disclosure of data on health care quality by health maintenance organizations (HMOs) is voluntary. McCormick and colleagues linked data for 1997, 1998, and 1999 from the National Committee for Quality Assurance annual Quality Compass databases to determine if withdrawal from public disclosure of Health Plan Employer Data and Information Set (HEDIS) quality scores was related to an HMO's HEDIS performance 1 year earlier. Health plans in the lowest tertile of HEDIS scores for overall quality of care were significantly more likely to withdraw from public disclosure in 1998 and 1999 than were health plans in the highest tertile. In an editorial, Berwick suggests ways to implement public reporting of health care performance by health plans, hospitals, and large medical group practices and clinics.

LOSARTAN VS ATENOLOL FOR ISOLATED SYSTOLIC HYPERTENSION

The Losartan Intervention For Endpoint reduction (LIFE) study, a randomized controlled trial, compared the long-term effects of losartan-based vs atenolol-based antihypertensive therapy in patients with hypertension and electrocardiographically documented left ventricular hypertrophy on the incidence of cardiovascular morbidity and mortality. In this subgroup analysis of patients with isolated systolic hypertension, Kjeldsen and colleagues found that risk of the composite end point of cardiovascular death, stroke, or myocardial infarction was lower in the losartan group. Risk of cardiovascular mortality and stroke was reduced in the losartan group as was incidence of new-onset diabetes and total mortality.

ANEMIA AND BLOOD TRANSFUSIONS IN CRITICALLY ILL PATIENTS

Anemia is a common problem among critically ill patients but optimal management of anemia in this patient population is not clearly defined. In this prospective observational survey of critically ill patients hospitalized in intensive care units (ICUs), Vincent and colleagues found that blood loss through blood drawing averaged 41 mL per day. Almost one third of patients had an admitting hemoglobin level less than 10 g/dL, and 37% received a red blood cell transfusion while in the ICU. In an analysis using a matching strategy based on propensity to receive a transfusion, 28-day mortality was higher among patients who received red blood cell transfusions than among patients who did not receive transfusions. In an editorial, Hébert and Fergusson emphasize the need for randomized clinical trials to assess red blood cell transfusions and blood-conserving strategies in critically ill patients.

CLINICIAN'S CORNER

Since being involved in a third motor vehicle collision within 2½ years, Mr M has had nightmares about driving, difficulty sleeping, trouble concentrating, and diffuse fear and anxiety. His primary care physician is considering a diagnosis of posttraumatic stress disorder (PTSD). Stein discusses the definition and epidemiology of PTSD, risk factors for PTSD, and diagnosis and management of PTSD in primary care.

A PIECE OF MY MIND

"I cannot recall exactly when I found out that our doctor was something other than a physician." From "A Man of His Words."

CONTEMPO UPDATES

Preventing physician burnout.

MEDICAL NEWS & PERSPECTIVES

Two groups of researchers in Boston are each performing experiments seeking to validate their separate hypotheses that immune cells—or maybe mast cells—are responsible for rheumatoid arthritis.

PSYCHOSOCIAL PROBLEMS IN YOUTH

A comprehensive review of the research portfolio of the US Department of Health and Human Services, including the National Institutes of Health, found that only 21 of 45 022 research abstracts in the portfolio addressed behavioral or emotional issues in children and adolescents, and only 11 of the 21 examined these issues in the context of primary care.

JAMA PATIENT PAGE

For your patients: Information about mental retardation.

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