PRESIDENT OBAMA has nominated Francis Collins to be the next director of the National Institutes of Health. It would seem a brilliant choice. Dr. Collins’s credentials are impeccable: he is a physical chemist, a medical geneticist and the former head of the Human Genome Project. He is also, by his own account, living proof that there is no conflict between science and religion. In 2006, he published “The Language of God,” in which he claimed to demonstrate “a consistent and profoundly satisfying harmony” between 21st-century science and evangelical Christianity./.../
Thursday, July 30, 2009
Wednesday, July 29, 2009
Published 14 July 2009, doi:10.1136/bmj.b2840
Cite this as: BMJ 2009;339:b2840
Research Methods & Reporting
Assessing the severity of the novel influenza A/H1N1 pandemic
Tini Garske, research associate , Judith Legrand, research associate, Christl A Donnelly, professor of statistical epidemiology , Helen Ward, clinical reader in social epidemiology, Simon Cauchemez, RCUK fellow in pathogen population dynamics, Christophe Fraser, reader in theoretical biology, Neil M Ferguson, professor of mathematical biology, Azra C Ghani, professor in infectious disease epidemiology
1 MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London W2 1PG
Correspondence to: T Garske email@example.com
A major concern about the emergence of the novel strain of influenza A/H1N1 is the severity of illness it causes. Tini Garske and colleagues propose methods to obtain accurate estimates of the case fatality ratio as the pandemic unfolds
The World Health Organization’s declaration of a pandemic of the novel influenza A/H1N1 virus raises questions about the potential morbidity and mortality. By 10 July 2009, nearly 100 000 cases had been reported worldwide; however, most deaths (429 in total) have been reported in the American continents (the US, Mexico, Argentina, and Canada), with smaller numbers in other countries including the United Kingdom.1 At first sight, the data seem to imply that this new virus is relatively mild, with case fatality ratios around 0.5%, similar to the upper range of that seen for seasonal influenza2 and relatively low hospitalisation ratios. However, the case fatality ratio seems to vary substantially between countries, and deaths have occurred in much younger people than is the case for seasonal influenza.3 4
There are many reasons why simple interpretations of these crude figures at the beginning of a pandemic may be misleading both in terms of assessing severity and in making comparisons between countries. Here, we discuss some of the important mechanisms resulting in biases, propose study designs and associated statistical methods to estimate the case fatality ratio given these limitations, and show their strengths using simulated data. The two main sources of bias in estimates of the case fatality ratio we considerstem from shifts in case ascertainment (over time, efforts may become more focused on the most severe cases, leading to an overestimation of the case fatality ratio) and from the inevitable delay between symptom onset and death, which in the early phase of the epidemic can lead to underestimation of the case fatality ratio if it is not adjusted for./.../
Published 9 June 2009, doi:10.1136/bmj.b2030
Cite this as: BMJ 2009;338:b2030
Self administered cognitive screening test (TYM) for detection of Alzheimer’s disease: cross sectional study
Jeremy Brown, consultant neurologist, George Pengas, clinical research fellow, Kate Dawson, research nurse, Lucy A Brown, honorary research assistant, Philip Clatworthy, clinical research fellow
1 Department of Neurology, Addenbrooke’s Hospital, Cambridge CB2 2QQ
Correspondence to: J Brown firstname.lastname@example.org
AbstractObjective To evaluate a cognitive test, the TYM ("test your memory"), in the detection of Alzheimer’s disease.
Design Cross sectional study.
Setting Outpatient departments in three hospitals, including a memory clinic.
Participants 540 control participants aged 18-95 and 139 patients attending a memory clinic with dementia/amnestic mild cognitive impairment.
Intervention Cognitive test designed to use minimal operator time and to be suitable for non-specialist use.
Main outcome measures Performance of normal controls on the TYM. Performance of patients with Alzheimer’s disease on the TYM compared with age matched controls. Validation of the TYM with two standard tests (the mini-mental state examination (MMSE) and the Addenbrooke’s cognitive examination-revised (ACE-R)). Sensitivity and specificity of the TYM in the detection of Alzheimer’s disease.
Results Control participants completed the TYM with an average score of 47/50. Patients with Alzheimer’s disease scored an average of 33/50. The TYM score shows excellent correlation with the two standard tests. A score of 42/50 had a sensitivity of 93% and specificity of 86% in the diagnosis of Alzheimer’s disease. The TYM was more sensitive in detection of Alzheimer’sdisease than the mini-mental examination, detecting 93% of patientscompared with 52% for the mini-mental state exxamination. The negative and positive predictive values of the TYM with the cut off of 42 were 99% and 42% with a prevalence of Alzheimer’s disease of 10%. Thirty one patients with non-Alzheimer dementias scored an average of 39/50.
Conclusions The TYM can be completed quickly and accurately by normal controls. It is a powerful and valid screening test for the detection of Alzheimer’s disease.
A special report on health care and technology
Medicine goes digital
Apr 16th 2009
From The Economist print edition
The convergence of biology and engineering is turning health care into an information industry. That will be disruptive, says Vijay Vaitheeswaran (interviewed here), but also hugely beneficial to patients
INNOVATION and medicine go together. The ancient Egyptians are thought to have performed surgery back in 2750BC, and the Romans developed medical tools such as forceps and surgical needles. In modern times medicine has been transformed by waves of discovery that have brought marvels like antibiotics, vaccines and heart stents.
Given its history of innovation, the health-care sector has been surprisingly reluctant to embrace information technology (IT). Whereas every other big industry has computerised with gusto since the 1980s, doctors in most parts of the world still work mainly with pen and paper.
Treating Alcohol Addiction: Can a Pill Replace Abstinence?
- They call it "the switch." Alcoholics who take an anticraving medication called baclofen say the drug allows them to resist the most powerful triggers of relapse: former drinking buddies, a favorite bar, the sight of alcohol or even the most potent drinking cue of all, having a single drink.
Bob, 62, a business owner in the Midwest, who asked not to be identified by his real name, experienced his switch at a dinner party two years ago. Bob had battled alcohol dependency for several decades, regularly drinking at least 35 beers a week. Normally he would have downed several glasses of wine before dinner, he says, but that night, after taking baclofen for two weeks, he found himself sipping soda water instead, engrossed in conversation. "I realized I wasn't having that nagging feeling in my head, 'I should really get a drink,'" says Bob. "It never appeared during the dinner either so that was the eureka moment." He continues to take baclofen and now drinks about two or three times per week, no more than a beer or two at a time. (Read about the many faces of addiction.)/.../
Monday, July 27, 2009
Big Tobacco Sets Its Sights on Africa
- It's easy enough to buy a smoke at Isa Yakubu's grocery store on a busy street in Lagos, Nigeria. Never mind if you don't have much money. Most local merchants are happy to break open a pack and sell cigarettes one at a time — single sticks, as they're known — for about 10 Nigerian naira, or 7 cents. "St. Moritz is the most popular brand," says Yakubu. "But [people] also like Rothmans and Benson & Hedges."
Single sticks go fast at 7 cents each — an especially good price point for kids. And while Yakubu says he doesn't sell to children, other shopkeepers do. About 25% of teens — some as young as 13 — use tobacco in some parts of Nigeria, double the smoking rate of Nigerian men, and many pick up the habit by age 11. That's a demographic powder keg, one that means big trouble if you're a health expert and big promise if you're a tobacco executive. Both sides agree on one thing, though: across all of Africa, cigarettes are set for boom times. (See pictures of vintage pro-smoking propaganda.)/.../
Thursday, July 23, 2009
Em tempos da gripe, por Aloyzio Achutti*
Perigos e perdas podem ser mais educativos do que tempos de bonança.
Esta epidemia de gripe está nos ensinando hábitos de civilidade e higiene não incorporados em nossa cultura: espirrar e tossir no lenço, evitar ambientes restritos e contato muito íntimo, manter as mãos limpas e lavá-las com frequência, cuidar com as portas de entrada mais frequentes (boca, nariz e olhos), procurar mais precocemente assistência médica...
Pode-se notar também uma evolução favorável, tanto por parte do cidadão comum quanto dos profissionais da saúde, comprometendo-se no que se costuma chamar de vigilância epidemiológica: acompanhar a dinâmica da doença na população, relação de casos comprometidos, mecanismos de propagação e estratégias de prevenção.
Um aspecto particular vale salientar: os afetados, internados e mortos não são mais apenas números: têm sexo, idade, profissão, família, circunstantes, têm endereço e viajam. São pessoas como nós, se relacionam entre si, e conosco. A pandemia nos coloca dentro do mesmo caldeirão e não nos permite fugir, alienando-nos do que se passa em nossa sociedade. O fenômeno não pode mais ser tratado como um objeto na bancada de laboratório, no cavalete da oficina, ou na sala de operação. Está muito próximo de nós, estamos dentro.
É possível que mais adiante se conclua que esta pandemia não seja mais mortal do que outras, e que tenha nos chamado atenção particularmente por ter vindo fora da época esperada e por nos pegar em momento de crise global: ambiental, de costumes, política e econômica. Há quem diga que a mobilização face à epidemia esteja servindo para distrair a atenção de outros problemas.
Parece que os danos desta epidemia não serão maiores do que os provocados pelos surtos das que nos afetam regularmente todos os anos, e certamente serão muito menores do que os relacionados com doenças cardiovasculares, câncer, acidentes, drogas e outros males.
É possível que a epidemia nos sensibilize para a prevenção, inclusive de outras doenças às quais já nos acostumamos. Assim como o vírus entra em nosso organismo, e quase pelas mesmas vias, a poluição atmosférica, e a fumaça do cigarro fumado pela própria pessoa, ou por circunstantes, penetra na intimidade do corpo e não adianta lavar as mãos nem usar máscaras, como as aconselhadas para evitar a gripe. Também a manutenção da saúde global nos torna menos suscetíveis se formos contaminados.
Uma das maiores lições poderá ser a de que temos capacidade de nos mobilizar, de sermos solidários. Não estamos sós e tem gente do nosso lado que pode nos afetar com o que lhes acontece, e que precisamos respeitar. O que está acontecendo com a gripe é o mesmo que acontece com nosso ambiente, nossos costumes, a política e a economia. Depende de como nos relacionamos.
Wednesday, July 22, 2009
Tue Jul 21, 2009 7:44pm
By Sam Cage
ZURICH (Reuters) - A contest to choose the seven natural wonders of the world could net a billion online and telephone votes, the head of the group organising the competition told Reuters.
An expert panel on Tuesday nominated 28 sites -- including the Amazon rainforest, the Dead Sea and Grand Canyon - for a short list for the New 7 Wonders of competition, the winners of which will be announced in 2011 after a global vote conducted online and via telephone and sms votes./.../
Tuesday, July 21, 2009
Monday, July 20, 2009
|© Miguel Boyayan|
Os experimentos em animais ajudam a avaliar com precisão os riscos à saúde para os 20 milhões de fumantes no Brasil, o equivalente a 16% da população acima de 18 anos, que talvez não possam mais fumar em espaços públicos no estado de São Paulo a partir de agosto, de acordo com uma lei ainda em debate. “Vários estudos têm mostrado que pessoas expostas à fumaça de cigarro apresentam um maior risco de desenvolver sinusite crônica e, ainda, que a exposição à fumaça de cigarro piora a evolução de pacientes operados de sinusite crônica”, comenta Edwin Tamashiro, que detalhou as alterações da fumaça sobre o desenvolvimento dos cílios em um artigo publicado em abril na revista American Journal of Rhinology and Allergy. Outros estudos servem de alerta, como o realizado na Unifesp mostrando que a prática de exercício físico pode intensificar os danos provocados pela exposição à fumaça de cigarro, em vez de os impedir, como era esperado. /.../
Está online o primeiro dicionário da língua portuguesa, escrito por Raphael Bluteau (1638-1734).
A edição da História do Brasil (1627), de Frei Vicente do Salvador, preparada por Capistrano de Abreu, está online.
Está sendo construído um moderno edifício para a Brasiliana USP no coração da Universidade de São Paulo.
| 10 Things to Know about Health (pdf) |
UNNATURAL CAUSES, 2008
A two-page handout that briefly describes ten key messages about health equity, as presented in the PBS series UNNATURAL CAUSES, useful for spurring discussion and raising awareness./.../
Saturday, July 18, 2009
'Master' Switch Governs Antibody Production
|By Michael Smith, North American Correspondent, MedPage Today|
Published: July 16, 2009
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
During a series of animal experiments, scientists found that the protein Bcl6 is the "on" switch that governs the production of so-called T follicular helper cells, according to Shane Crotty, PhD, of the La Jolla Institute for Allergy & Immunology in La Jolla, Calif., and colleagues.
T follicular helper cells -- known as TFH cells for short -- are a subset of CD-positive T cells that help B cells differentiate and produce antibodies, the team reported online in Science.
In the absence of the Bcl6 protein, TFH cells do not arise and a key step in the production of antibodies -- differentiation of germinal centers in the lymph nodes -- does not happen, the researchers showed. /.../
Friday, July 17, 2009
baptized June 5, 1723, Kirkcaldy, Fife, Scot.
died July 17, 1790, Edinburgh
Scottish social philosopher and political economist. After two centuries, Adam Smith remains a towering figure in the history of economic thought. Known primarily for a single work—An Inquiry into the Nature and Causes of the Wealth of Nations (1776), the first comprehensive system of political economy—Smith is more properly regarded as a social philosopher whose economic writings constitute only the capstone to an overarching view of political and social evolution. If his masterwork is viewed in relation to his earlier lectures on moral philosophy and government, as well as to allusions in The Theory of Moral Sentiments (1759) to a work he hoped to write on “the general principles of law and government, and of the different revolutions they have undergone in the different ages and periods of society,” then The Wealth of Nations may be seen not merely as a treatise on economics but also as a partial exposition of a much larger scheme of historical evolution./.../
- ResourcesThe latest edition of Nature to celebrate Darwin's life and work looks at the human side of evolution. We have features on looking for Darwin in the genome, and on what evolution has done to shape human nature, while our editorial and two commentaries look at some of the problems inherent in applying biology to questions about humanity. We also have an essay on Darwin's pigeons and poetry by his great great grand-daughter Ruth Padel. And in a special insight we bring together reviews by a range of experts on current hot topics in evolution.
The 200th anniversary of the birth of Charles Robert Darwin felt on 12 February 2009. No single researcher has since matched his collective impact on the natural and social sciences; on politics, religions, and philosophy; on art and cultural relations. In this landmark year, our Nature news special provides continuously updated news, research and analysis on Darwin's life, his science and his legacy./.../
Wednesday, July 15, 2009
| || |
Department of Medicine
Duke University School of Medicine
Durham, North Carolina
Director, Clinical Electrophysiology Lab
St. Vincent Indianapolis Hospital
| || |
Institute of Cardiovascular Science & Medicine
University of Hong Kong
Hong Kong, China
| || |
University of Buenos Aires
Chief of Electrophysiology and Pacing
Buenos Aires, Argentina
Expiration date: March 10, 2010
Sudden cardiac arrest (SCA) accounts for approximately 325,000 deaths per year in the United States, representing an incidence of 0.1% to 0.2% per year in the adult population. The incidence of SCA in other countries though, appear to be lower and may be attributed to inadequate methods for identifying high-risk candidates as well as the prevalence of coronary artery disease prevalence in those populations. Revascularization, pacemaker, and implantation of an implantable cardioverter defibrillator (ICD) have been found to be highest in North America and Western Europe and lowest in South America and Eastern Europe, demonstrating that the incidence, etiology, and management of SCA may vary by region. Ongoing studies and discussions will be needed to address these continental and regional differences, including reimbursement issues and the need for additional education surrounding emerging clinical trial data and clinical guidelines, to ensure clinician awareness and facilitate appropriate patient analysis and management. Join Drs. Prystowsky, Lau, and Oseroff as they provide an international perspective on various prevention strategies of SCA including challenges faced in the Pacific Rim and South America./.../
BY LAURAN NEERGAARD
The doctor had barely pulled away the needle when a blister appeared on Tracey Berg-Fulton's abdomen: An experimental shot was revving up the 24-year-old's immune system -- part of a bold quest to create a vaccine-like therapy for diabetes.
''If we're right, that is what's going to stop Type 1 diabetes,'' Dr. David Finegold said after administering the last of four shots.
It's a big ``if.''
The research is in its infancy, a first-step experiment to be sure the vaccine approach is safe before researchers at Children's Hospital of Pittsburgh test their real target -- kids newly diagnosed with this deadliest form of diabetes.
It's also part of a big shift: Scientists increasingly hope to control Type 1 diabetes by curbing the rogue immune cells that cause it, before patients become completely dependent on daily insulin injections to survive./.../
Tuesday, July 14, 2009
|From the Centers for Disease Control and Prevention: Morbidity and Mortality Weekly Report|
Cigarette smoking in the United States results in an estimated 443,000 premature deaths and $193 billion in direct health-care expenditures and productivity losses each year.1 During 2007, an estimated 19.8% of adults in the United States were current smokers.2 To update 2006 state-specific estimates of cigarette smoking, CDC analyzed data from the 2007 Behavioral Risk Factor Surveillance System (BRFSS) survey and examined trends in cigarette smoking from 1998-2007. Results of these analyses indicated substantial variation in current cigarette smoking during 2007 (range: 8.7%-31.1%) among the 50 states, the District of Columbia (DC), Guam, Puerto Rico (PR), and the U.S. Virgin Islands (USVI). Trend analyses of 1998-2007 data indicated that smoking prevalence decreased in 44 states, DC, and PR, and six states had no substantial changes in prevalence after controlling for age, sex, and race/ethnicity. However, only Utah and USVI met the Healthy People 2010 target for reducing adult smoking prevalence to 12% (objective 27-1a).3 The Institute of Medicine (IOM) calls for full implementation of comprehensive, evidence-based tobacco control programs at CDC-recommended funding levels to achieve substantial reductions in tobacco use in all states and areas.4/.../
Cost-Effectiveness of Interventions to Promote Physical Activity: A Modelling Study
Linda J. Cobiac*, Theo Vos, Jan J. Barendregt
Physical inactivity is a key risk factor for chronic disease, but a growing number of people are not achieving the recommended levels of physical activity necessary for good health. Australians are no exception; despite Australia's image as a sporting nation, with success at the elite level, the majority of Australians do not get enough physical activity. There are many options for intervention, from individually tailored advice, such as counselling from a general practitioner, to population-wide approaches, such as mass media campaigns, but the most cost-effective mix of interventions is unknown. In this study we evaluate the cost-effectiveness of interventions to promote physical activity.
Methods and Findings
From evidence of intervention efficacy in the physical activity literature and evaluation of the health sector costs of intervention and disease treatment, we model the cost impacts and health outcomes of six physical activity interventions, over the lifetime of the Australian population. We then determine cost-effectiveness of each intervention against current practice for physical activity intervention in Australia and derive the optimal pathway for implementation. Based on current evidence of intervention effectiveness, the intervention programs that encourage use of pedometers (Dominant) and mass media-based community campaigns (Dominant) are the most cost-effective strategies to implement and are very likely to be cost-saving. The internet-based intervention program (AUS$3,000/DALY), the GP physical activity prescription program (AUS$12,000/DALY), and the program to encourage more active transport (AUS$20,000/DALY), although less likely to be cost-saving, have a high probability of being under a AUS$50,000 per DALY threshold. GP referral to an exercise physiologist (AUS$79,000/DALY) is the least cost-effective option if high time and travel costs for patients in screening and consulting an exercise physiologist are considered.
Intervention to promote physical activity is recommended as a public health measure. Despite substantial variability in the quantity and quality of evidence on intervention effectiveness, and uncertainty about the long-term sustainability of behavioural changes, it is highly likely that as a package, all six interventions could lead to substantial improvement in population health at a cost saving to the health sector.
Submitted on February 13, 2009
Accepted on May 8, 2009
Nina yen MD, MPH, DrMed*,
Gry Poulsen MSc, Heather A. Boyd PhD, Jan Wohlfahrt MSc, DrMed, Peter K.A. Jensen MD, DrMed, and Mads Melbye MD, DrMed
From the Department of Epidemiology Research (N.., G.P., H.A.B., J.W., M.M.), Statens Serum Institut, Copenhagen, Denmark; Department of Public Health and Primary Health Care (N..), Faculty of Medicine and Odontology, University of Bergen, Bergen, Norway; Center for Medical Genetics and Molecular Medicine (N..), Haukeland University Hospital, Bergen, Norway; and Department of Clinical Genetics (P.K.A.J.), Århus University Hospital, Århus, Denmark.
* To whom correspondence should be addressed. E-mail: email@example.com .
Background—Knowledge of the familial contribution to congenital heart diseases (CHD) on an individual and population level is sparse. We estimated an individual's risk of CHD given a family history of CHD, as well as the contribution of CHD family history to the total number of CHD cases in the population.
Methods and Results—In a national cohort study, we linked all Danish residents to the National Patient Register, the Causes of Death Register, the Danish Central Cytogenetic Register, and the Danish Family Relations Database, yielding 1 763 591 persons born in Denmark between 1977 and 2005, of whom 18 708 had CHD. Individuals with CHD were classified by phenotype. We estimated recurrence risk ratios and population-attributable risk. Among first-degree relatives, the recurrence risk ratio was 79.1 (95% confidence interval [CI] 32.9 to 190) for heterotaxia, 11.7 (95% CI, 8.0 to 17.0) for conotruncal defects, 24.3 (95% CI,12.2 to 48.7) for atrioventricular septal defect, 12.9 (95% CI, 7.48 to 22.2) for left ventricular outflow tract obstruction, 48.6 (95% CI, 27.5 to 85.6) for right ventricular outflow tract obstruction, 7.1 (95% CI, 4.5 to 11.1) for isolated atrial septal defect, and 3.4 (95% CI, 2.2 to 5.3) for isolated ventricular septal defect. The overall recurrence risk ratio for the same defect was 8.15 (95% CI, 6.95 to 9.55), whereas it was 2.68 (95% CI, 2.43 to 2.97) for different heart defects. Only 2.2% of heart defect cases in the population (4.2% after the exclusion of chromosomal aberrations) were attributed to CHD family history in first-degree relatives.
Conclusions—Specific CHDs showed highly variable but strong familial clustering in first-degree relatives, ranging from 3-fold to 80-fold compared with the population prevalence, whereas the crossover risks between dissimilar cases of CHD were weaker. Family history of any CHD among first-degree relatives accounted for a small proportion of CHD cases in the population.
Sunday, July 12, 2009
Saturday, July 11, 2009
Friday, July 10, 2009
Graduado em Medicina pela Faculdade de Ciências Médicas e Biológicas de Botucatu (Unesp) e com Mestrado em Psiquiatra Social e Transcultural pela McGill University de Montreal, no Canadá, José Manuel Bertolote é o entrevistado da semana. Durante 20 anos foi coordenador da equipe de transtornos mentais e neurológicos na sede da Organização Mundial da Saúde, em Genebra. Membro do Conselho Consultivo da Abead, atualmente é professor colaborador do Departamento de Neurologia, Psicologia e Psiquiatria, da Faculdade de Medicina de Botucatu (Unesp). Confira a entrevista!
1. No recente relatório mundial sobre drogas divulgado pela ONU, o Brasil foi apontado como o maior mercado consumidor de cocaína da América do Sul e está entre os líderes no uso de drogas injetáveis. Por que chegamos a este ponto?
Primeiramente devemos considerar como são levantados esses dados. Normalmente esses dados são decorrentes de informações obtidas com a repressão, ou seja, com a polícia. Portanto se supõe que quanto mais drogas são apreendidas, maior é o consumo. /.../
1 day ago
LONDON (AP) — The World Health Organization has approved a second cervical cancer vaccine, this one made by GlaxoSmithKline, meaning U.N. agencies and partners can now officially buy millions of doses of the vaccine for poor countries worldwide.
GlaxoSmithKline PLC said in a statement Thursday the approval would help speed access to Cervarix globally.
WHO had previously approved Gardasil, a competing cervical cancer vaccine made by Merck & Co. With two cervical cancer vaccines now ready to be bought by donor agencies, officials estimate that tens of thousands of lives might be saved.
More than 80 percent of the estimated 280,000 cervical cancer deaths a year occur in developing countries. In the West, early diagnosis and treatment has slashed the disease's incidence.
|Enfermedades crónicas: Prevención y control en las Américas|
Finalidad de las Noticias: Promover la Estrategia Regional y Plan de Acción para un enfoque integrado sobre la prevención y el control de las enfermedades crónicas, incluyendo el régimen alimentario, la actividad física y la salud; y compartir logros relacionados con la Estrategia en todos sus aspectos así como sus cuatro líneas de acción (vigilancia y respuesta, abogacía y política, promoción de salud y prevención y manejo integrado de las enfermedades crónicas y sus factores de riesgo) y noticias sobre la implementación de programas.
Número actual: junio de 2009
Patterns of Hospital Performance in Acute Myocardial Infarction and Heart Failure 30-Day Mortality and Readmission
From the Section of Cardiovascular Medicine (H.M.K., G.C.S., J.C., Y.W., Y.-F.W., E.E.D.) and the Robert Wood Johnson Clinical Scholars Program (H.M.K.), Department of Internal Medicine; Section of Health Policy and Administration (H.M.K., E.H.B.), School of Public Health, Yale University School of Medicine; and the Center for Outcomes Research and Evaluation (H.M.K., Y.W., Z.L.), Yale-New Haven Hospital, New Haven, Conn; Mathematica Policy Research, Inc (A.R.M., E.M.S.), Cambridge, Mass; Centers for Medicare & Medicaid Services (B.M.S., M.T.R.), Baltimore, Md; and the Department of Health Care Policy, Harvard Medical School and Department of Biostatistics, Harvard School of Public Health (S.-L.T.N.), Boston, Mass.
Correspondence to Harlan Krumholz, MD, Yale University School of Medicine, 1 Church St, Suite 200, New Haven, CT 06510. Efirstname.lastname@example.org
Background: In 2009, the Centers for Medicare & Medicaid Services is publicly reporting hospital-level risk-standardized 30-day mortality and readmission rates after acute myocardial infarction (AMI) and heart failure (HF). We provide patterns of hospital performance, based on these measures.
Methods and Results: We calculated the 30-day mortality and readmission rates for all Medicare fee-for-service beneficiaries ages 65 years or older with a primary diagnosis of AMI or HF, discharged between July 2005 and June 2008. We compared weighted risk-standardized mortality and readmission rates across Hospital Referral Regions and hospital structural characteristics. The median 30-day mortality rate was 16.6% for AMI (range, 10.9% to 24.9%; 25th to 75th percentile, 15.8% to 17.4%; 10th to 90th percentile, 14.7% to 18.4%) and 11.1% for HF (range, 6.6% to 19.8%; 25th to 75th percentile, 10.3% to 12.0%; 10th to 90th percentile, 9.4% to 13.1%). The median 30-day readmission rate was 19.9% for AMI (range, 15.3% to 29.4%; 25th to 75th percentile, 19.5% to 20.4%; 10th to 90th percentile, 18.8% to 21.1%) and 24.4% for HF (range, 15.9% to 34.4%; 25th to 75th percentile, 23.4% to 25.6%; 10th to 90th percentile, 22.3% to 27.0%). We observed geographic differences in performance across the country. Although there were some differences in average performance by hospital characteristics,there were high and low hospital performers among all types of hospitals.
Conclusions: In a recent 3-year period, 30-day risk-standardized mortality rates for AMI and HF varied among hospitals and across the country. The readmission rates were particularly high.