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In this survey of Medicare beneficiaries, the authors examined the relationship of obesity with all-cause mortality and the development and progression of disability. Only patients with markedly elevated body mass index (BMI) had increased all-cause mortality. However, patient reports of new or worsening disability increased in a dose-related manner as BMI increased above the normal range. Older obese adults may be an appropriate target group for interventions to prevent or decrease disability.
Cross-sectional studies have linked selenium levels to blood cholesterol levels. In this randomized trial, investigators found that selenium supplementation was associated with modest reductions in total and non–high-density lipoprotein (HDL) cholesterol levels. Supplementation at higher doses was associated with increases in HDL cholesterol levels. These findings more definitively identify the effects of selenium on lipids but do not justify its use to treat dyslipidemia.
Financial incentives will be available for providers that demonstrate meaningful use of electronic health records to facilitate health information exchange and improve patient outcomes. Regional health information organizations (RHIOs) aim to help providers meet meaningful use criteria. This 2009 survey found 75 operational RHIOs that covered approximately 14% of U.S. hospitals and 3% of ambulatory practices. Only 13 RHIOs facilitated the types of data exchange required to meet meaningful use criteria, and most RHIOs were not financially viable.
Metformin and sulfonylureas are inexpensive, first-line therapies for type 2 diabetes but are often insufficient to control blood glucose levels. This meta-analysis of 18 trials found that all other available drugs decreased hemoglobin A1c levels about equally when added to metformin and sulfonylurea therapy, and there were no clear between-drug differences. Insulin was associated with more weight gain and hypoglycemia. Evidence suggests no clear differences in benefit between drugs when adding a third agent to metformin and sulfonylurea therapy. Patient preferences and characteristics should guide the choice of drug.
Subgroup analyses in randomized trials require careful interpretation of potential confounding because the factors defining the subgroups are not randomized. Using examples from published trials, the authors show that adjustment for confounding is not necessary if the purpose of the subgroup analysis is simply to see whether the effect of an intervention varies across subgroups (“effect heterogeneity”). However, if the aim is to determine whether an intervention on the secondary factor would change the effect of the primary intervention (“causal interaction”), then controlling for confounders is essential.
This Update summarizes studies published in 2010 that the author considers highly relevant to the practice of endocrinology. Topics include calcium and bone metabolism, diabetes and metabolism, obesity, male hypogonadism, and thyroid hormone levels.
To reduce the costs of care and improve quality, the government is stimulating adoption of health information technology by providing financial incentives for physicians who demonstrate meaningful use of electronic health records. The author argues that aspects of the current policy make it difficult to reduce costs and improve quality. Modification of the policy to build on the needs of providers may be helpful.
The Agency for Healthcare Research and Quality sponsored an international group of experts in patient safety and evaluation methods to develop criteria to improve the design, evaluation, and reporting of practice research in patient safety. This article reports the group's recommendations, which include increased use of theory and logic models, more detailed description of interventions and their implementation, enhanced explanation of desired and unintended outcomes, and greater description and measurement of context and of how context influences interventions.
Two articles in this issue focus on meaningful use incentives to promote adoption of health information technology. Adler-Milstein and colleagues surveyed 175 RHIOs and found deficiencies in the ability of existing RHIOs to support clinicians who are aiming to meet federal meaningful use criteria. Hussain critiques the top-down approach adopted by the meaningful use policy and proposes an alternative one that builds on the needs of providers first. The editorialist discusses the articles' findings and describes the adoption of electronic health records as moving toward “an uncertain but quite promising future.”
In this issue, Shekelle and colleagues provide a framework for enhancing research on patient safety by proposing criteria for the design and reporting of studies to facilitate their translation into practice. The editorialists believe that increasing our knowledge about what works in patient safety and other quality improvement efforts is critical to making health care safer.