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Hemoglobin A1c (HbA1c) levels are known to be higher in black persons than in white persons at any given level of glucose control, so a higher HbA1c threshold for diagnosing diabetes in black persons has been proposed. This cross-sectional study found that retinopathy begins to increase in prevalence at lower HbA1c levels in black persons than in white persons. These observations do not support using a higher HbA1c threshold for diagnosing diabetes in black persons than in white persons.
Decreasing inappropriate use of antibiotics to treat viral respiratory infections requires understanding factors that influence antibiotic prescribing. This study examined physicians' antibiotic prescribing for febrile respiratory illness during pandemic and seasonal influenza periods and found that prescription varied widely. Physicians who had seen more patients with febrile respiratory illness in the previous week were less likely to prescribe antibiotics. They were also less likely to prescribe antibiotics during the 2009 pandemic influenza period than during other periods. The findings suggest that recent clinical experience and contextual knowledge of local epidemiology can influence the antibiotic-prescribing behavior of physicians.
Hospital noise that disrupts sleep is among the most common complaints of hospitalized patients. This study examined how different hospital noises affected the sleep of healthy, young volunteers during observation in a sleep laboratory. The disruptive effect of noises recorded in an actual hospital varied by the type and level of sound emitted and by the volunteer's stage of sleep. Electronic sounds designed to be alerting, staff conversations, and voice paging were most disruptive. Reduction of hospital noise through policies, procedures, and building design may lead to improved patient sleep.
Intra-articular injection of hyaluronic acid, also known as viscosupplementation, is used to treat symptomatic knee osteoarthritis. This review examined evidence of benefits and risks of viscosupplementation compared with sham or usual care control interventions in adults with knee osteoarthritis. The 89 identified randomized trials were of generally poor quality, and adverse event data were often poorly presented. However, trials suggested that viscosupplementation had minimal effects on pain and function but increased risk for serious adverse events.
This Update summarizes studies published in 2011 that the author considers highly relevant to the practice of nephrology. Topics include chronic kidney disease, glomerular disease, acute kidney injury, and hypertension.
This USPSTF recommendation on counseling to prevent falls in community-dwelling adults aged 65 years or older updates its 1996 recommendation. The Task Force recommends exercise or physical therapy and vitamin D supplementation to prevent falls in this population. It does not recommend performing an in-depth multifactorial risk assessment with comprehensive management of identified risks to prevent falls in all community-dwelling adults aged 65 years or older.
Improving the appropriateness of opioid prescribing is a major priority. The U.S. Food and Drug Administration has mandated that pharmaceutical manufacturers develop risk evaluation and management strategies for opioids, including a provision whereby industry is required to develop educational materials and initiatives to train practitioners on appropriate opioid use. This commentary discusses the components, goals, and weaknesses of the program.
The “rapid-learning health system” is posited as a conceptual strategy to spur transformation in how health systems generate and apply knowledge. It uses health information technology and a growing health data infrastructure to access and apply evidence in real time, while simultaneously drawing knowledge from real-world care-delivery processes. This article describes an evolving learning health system at Group Health Cooperative, the 6 phases characterizing its approach, and examples of organization-wide applications.
In this issue, Hebert and colleagues examined how knowledge about the 2009 H1N1 influenza pandemic acted as a contextual mediator of clinicians' prescribing behavior for patients with febrile respiratory illness. The editorialists discuss the study's findings and conclude that we need to understand not only which contextual factors shape prescribing practices, but how and why.
In this issue, the USPSTF releases its recommendation on the prevention of falls in community-dwelling older adults. Exercise or physical therapy and vitamin D supplementation received grade B recommendations, and multifactorial risk assessment and management received a C grade. The editorialists discuss the recommendation and its implications for practice.
There is no objective decision aid, instrument, or measure that can help me balance the benefits of prescribing opioids to treat pain with the risks I worried about, including tolerance, physiologic dependence, diversion, and overdose.