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Jennifer A. Meddings, MD, MSc; Heidi Reichert, MA; Mary A.M. Rogers, PhD, MS; Sanjay Saint, MD, MPH; Joe Stephansky, PhD; and Laurence F. McMahon Jr., MD, MPH

Claims data are used to deny payment for certain hospital-acquired conditions, including catheter-associated urinary tract infections (UTIs). Most hospital-acquired UTIs are catheter-associated. Data from 96 Michigan hospitals showed that hospitals frequently requested payment for non–catheter-associated UTIs. Although UTIs were rarely coded as hospital-acquired or catheter-associated, surveillance data show that such infections are common. Nonpayment for hospital-acquired, catheter-associated UTIs reduced payment for very few hospitalizations. The study suggests that discharge claims are inadequate for monitoring hospital-acquired catheter-associated UTI.

Topics: catheter-related infection, hospital payment, urinary tract infection
Kogieleum Naidoo, MBChB; Nonhlanhla Yende-Zuma, MSc; Nesri Padayatchi, MBChB; Kasavan Naidoo, MSc; Niraksha Jithoo, MBChB; Gonasagrie Nair, MBChB; Sheila Bamber, MBChB; Santhana Gengiah, MA; Wafaa M. El-Sadr, MD, MPH; Gerald Friedland, MD; and Salim Abdool Karim, PhD

Co-treatment of HIV and tuberculosis is associated with increased risk for the immune reconstitution inflammatory syndrome (IRIS). This study examined the optimal timing of initiating antiretroviral therapy (ART) for HIV-infected patients receiving treatment for tuberculosis. When ART was introduced within the first 4 weeks of tuberculosis treatment, IRIS was more frequent and severe and resolved more slowly. These findings are particularly relevant to patients with CD4+ counts less than 0.050 × 109 cells/L, given the increased survival benefit of early ART initiation in this group. These observations emphasize the need to individualize timing of ART initiation during tuberculosis therapy.

Topics: hiv, tuberculosis, tuberculosis and hiv, anti-retroviral agents, immune reconstitution inflammatory syndrome
Keri N. Althoff, PhD, MPH; Kate Buchacz, PhD, MPH; H. Irene Hall, PhD, MPH; Jinbing Zhang, MS; David B. Hanna, MS; Peter Rebeiro, ScM; Stephen J. Gange, PhD; Richard D. Moore, MD, MHS; Mari M. Kitahata, MD, MPH; Kelly A. Gebo, MD, MPH; Jeffrey Martin, MD; Amy C. Justice, MD, PhD; Michael A. Horberg, MD; Robert S. Hogg, PhD; Timothy R. Sterling, MD; Angela Cescon, MPH; Marina B. Klein, MD; Jennifer E. Thorne, MD, PhD; Heidi M. Crane, MD, MPH; Michael J. Mugavero, MD; Sonia Napravnik, PhD; Gregory D. Kirk, MD, PhD; Lisa P. Jacobson, ScD; John T. Brooks, MD, for the North American AIDS Cohort Collaboration on Research and Design
Includes: Audio/Video

The complexity of the U.S. health care system creates challenges for monitoring the HIV epidemic. This study pooled and analyzed data from the more than 45 000 participants in the largest cohort of HIV-infected adults in the United States. From 2000 to 2008, the proportions of participants who were prescribed highly active antiretroviral therapy and those with an undetectable viral load increased, as did the median CD4 cell count at death. Because the cohort participants were demographically similar to all U.S. persons living with HIV infection, these data may be useful in monitoring trends in HIV care.

Topics: hiv, cell count, viral load result, blood hiv rna, anti-retroviral agents, t-lymphocyte, ...
Hsin-Chieh Yeh, PhD; Todd T. Brown, MD, PhD; Nisa Maruthur, MD, MHS; Padmini Ranasinghe, MD, MPH; Zackary Berger, MD, PhD; Yong D. Suh, MBA, MSc; Lisa M. Wilson, ScM; Elisabeth B. Haberl, BA; Jessica Brick, MD; Eric B. Bass, MD, MPH; and Sherita Hill Golden, MD, MHS

This systematic review assessed evidence from 33 randomized, controlled trials on how intensive insulin therapy (multiple daily injections [MDI] vs. continuous subcutaneous insulin infusion [CSII]) or method of monitoring (self-monitoring of blood glucose [SMBG] vs. real-time continuous glucose monitoring [rt-CGM]) affects outcomes in type 1 and 2 diabetes. Reviewers found that CSII and MDI have similar effects on glycemic control and hypoglycemia, but CSII has a more favorable effect in adults with type 1 diabetes. For glycemic control, rt-CGM is superior to SMBG and sensor-augmented insulin pumps are superior to MDI and SMBG without increasing the risk for hypoglycemia.

Topics: diabetes mellitus, hypoglycemia, diabetes mellitus, type 1, hemoglobin a, insulin, glucose measurement ...
Crystal Smith-Spangler, MD, MS; Margaret L. Brandeau, PhD; Grace E. Hunter, BA; J. Clay Bavinger, BA; Maren Pearson, BS; Paul J. Eschbach; Vandana Sundaram, MPH; Hau Liu, MD, MS, MBA, MPH; Patricia Schirmer, MD; Christopher Stave, MLS; Ingram Olkin, PhD; and Dena M. Bravata, MD, MS

This systematic review compared the evidence from 237 studies on the health, nutritional, and safety characteristics of organic and conventional foods. It found that the published literature lacks strong evidence that organic foods are significantly more nutritious than conventional foods but suggests that consumption of organic foods may reduce exposures to pesticide residues and antibiotic-resistant bacteria. The clinical significance of these reductions, however, is uncertain.

Topics: diet, chickens, food, milk, pesticide residues, pesticides, bacteria, organic food, meat, nutrients, ...

This USPSTF recommendation on behavioral counseling interventions to promote a healthful diet and physical activity for cardiovascular disease prevention in adults updates its 2002 and 2003 recommendations. The Task Force's recommendation: Clinicians should selectively counsel patients rather than incorporate counseling into the care of all adults in the general population.

Topics: diet, behavior therapy, counseling, cardiovascular disease prevention, physical activity, cardiovascular diseases
Virginia A. Moyer, MD, MPH, on behalf of the U.S. Preventive Services Task Force

This USPSTF recommendation on screening for and management of obesity in adults updates its 2003 recommendation. The Task Force's recommendation: Clinicians should screen adults for obesity and offer or refer patients with a body mass index of 30 kg/m2 or higher to intensive, multicomponent behavioral interventions.

Topics: obesity, behavior therapy, weight reduction

In this issue, Meddings and colleagues report a cross-sectional, statewide analysis of the impact of nonpayment for hospital-acquired, catheter-associated UTI. The editorialist discusses the study's findings and its implications for local and national quality improvement initiatives based on accurate data on the financial impact of nonpayment for certain hospital-acquired conditions.

Topics: quality of care, data collection, accuracy
David J. Einstein, MD
Includes: Audio/Video

I glanced back at the patient, who was trying with his limited strength to slip an arm into a suit sleeve. Apparently, he had decided his time had come today and that he needed to face death in formal dress, and I would add the last accessory with this blue necktie.

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J. Christopher Gallagher, MD; and Adarsh Sai, MBBS
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Mark A. Jones, PhD; Rokuro Hama, MD; and Chris Del Mar, MD
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Carl Heneghan, DPhil; Tom Jefferson, MD; and Peter Doshi, PhD
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Holger J. Schünemann, MD, MSc, PhD; Nancy Santesso, MLIS, RD; Jan Brozek, MD, on behalf of the Antivirals for Treatment of Influenza Observational Studies Group
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Regina S. Bower, MD; Grant W. Mallory, MD; Macaulay Nwojo, BS; Fredric B. Meyer, MD; and Yogish C. Kudva, MD
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Richard Bronson, MD
Includes: Audio/Video
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Larry K. Kociolek, MD; and Stanford T. Shulman, MD
Includes: CME
Topics: pharyngitis
Topics: physical activity, cardiovascular diseases, counseling, life style, cardiovascular disease prevention
Topics: obesity
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