Mary Ann Moon

Most young women who received chest radiation for childhood cancer are not being appropriately screened for breast cancer, despite their high risk, according to a report.

The main barrier to screening is not a lack of medical contact; rather, it is that their physicians do not advise them to undergo mammography, most likely because the clinicians are not aware of these patients' high risk, said Dr. Kevin C. Oeffinger of Memorial Sloan-Kettering Cancer Center, New York, and his associates.

Experts recommend that women who were treated with moderate- to high-dose chest radiation for a pediatric malignancy initiate breast cancer surveillance starting at age 25 years, or 8 years after undergoing radiotherapy, whichever comes last. The median age of breast cancer diagnosis in these patients is 32–35 years, and their previous exposure to radiation or anthracycline limits their treatment options.

There are an estimated 20,000–25,000 such women in the United States, and as many as 20% of female cancer survivors worldwide fall into this category.

Dr. Oeffinger and his colleagues studied breast cancer surveillance using the large, geographically diverse population of women participating in the Childhood Cancer Survivor Study. This study follows more than 9,000 survivors who were diagnosed between 1970 and 1986.

A random sample of 551 CCSS participants now aged 25–50 years who received at least 20 Gy of chest radiation therapy as children were surveyed regarding breast cancer surveillance. Two comparison groups—561 CCSS subjects who had not undergone chest radiation and 622 siblings of CCSS subjects who had never had cancer—also were assessed.

Nearly half of the women under age 40 years who had been exposed to pediatric radiotherapy had never had a mammogram, and only 23% had undergone mammography within the preceding year. This “much lower than expected” rate was still somewhat higher than the rates in the CCSS siblings (11%) and the cancer survivors who had not undergone chest radiotherapy (15%).

Women in this age group who said their physicians had recommended mammography were three times more likely to undergo screening than were those who said their physicians had not. However, only one-third of these high-risk women said that their physicians had recommended mammography.

The two most commonly reported barriers to screening in this age group were “doctor didn't order it” (31%) and “I'm too young” (30%).

Women aged 40–50 years who had been exposed to radiotherapy fared slightly better, but still only 53% engaged in regular breast cancer screening. In this age group, the most commonly reported barriers to screening were “put it off,” “didn't get around to it,” “too expensive,” or “no insurance.”

In contrast, nearly 90% of the study participants reported having a recent Pap smear, so medical access and knowledge of general women's health issues were not lacking. Instead, “one of the primary barriers is likely a lack of clinician familiarity with childhood cancer survivors and their risk of breast cancer,” Dr. Oeffinger and his colleagues said (JAMA 2009;301:404–14).

Many childhood cancer survivors are not being screened for breast cancer. ©Brand X Pictures

Most young women who received chest radiation for childhood cancer are not being appropriately screened for breast cancer, despite their high risk, according to a report.

The main barrier to screening is not a lack of medical contact; rather, it is that their physicians do not advise them to undergo mammography, most likely because the clinicians are not aware of these patients' high risk, said Dr. Kevin C. Oeffinger of Memorial Sloan-Kettering Cancer Center, New York, and his associates.

Experts recommend that women who were treated with moderate- to high-dose chest radiation for a pediatric malignancy initiate breast cancer surveillance starting at age 25 years, or 8 years after undergoing radiotherapy, whichever comes last. The median age of breast cancer diagnosis in these patients is 32–35 years, and their previous exposure to radiation or anthracycline limits their treatment options.

There are an estimated 20,000–25,000 such women in the United States, and as many as 20% of female cancer survivors worldwide fall into this category.

Dr. Oeffinger and his colleagues studied breast cancer surveillance using the large, geographically diverse population of women participating in the Childhood Cancer Survivor Study. This study follows more than 9,000 survivors who were diagnosed between 1970 and 1986.

A random sample of 551 CCSS participants now aged 25–50 years who received at least 20 Gy of chest radiation therapy as children were surveyed regarding breast cancer surveillance. Two comparison groups—561 CCSS subjects who had not undergone chest radiation and 622 siblings of CCSS subjects who had never had cancer—also were assessed.

Nearly half of the women under age 40 years who had been exposed to pediatric radiotherapy had never had a mammogram, and only 23% had undergone mammography within the preceding year. This “much lower than expected” rate was still somewhat higher than the rates in the CCSS siblings (11%) and the cancer survivors who had not undergone chest radiotherapy (15%).

Women in this age group who said their physicians had recommended mammography were three times more likely to undergo screening than were those who said their physicians had not. However, only one-third of these high-risk women said that their physicians had recommended mammography.

The two most commonly reported barriers to screening in this age group were “doctor didn't order it” (31%) and “I'm too young” (30%).

Women aged 40–50 years who had been exposed to radiotherapy fared slightly better, but still only 53% engaged in regular breast cancer screening. In this age group, the most commonly reported barriers to screening were “put it off,” “didn't get around to it,” “too expensive,” or “no insurance.”

In contrast, nearly 90% of the study participants reported having a recent Pap smear, so medical access and knowledge of general women's health issues were not lacking. Instead, “one of the primary barriers is likely a lack of clinician familiarity with childhood cancer survivors and their risk of breast cancer,” Dr. Oeffinger and his colleagues said (JAMA 2009;301:404–14).

Many childhood cancer survivors are not being screened for breast cancer. ©Brand X Pictures

Most young women who received chest radiation for childhood cancer are not being appropriately screened for breast cancer, despite their high risk, according to a report.

The main barrier to screening is not a lack of medical contact; rather, it is that their physicians do not advise them to undergo mammography, most likely because the clinicians are not aware of these patients' high risk, said Dr. Kevin C. Oeffinger of Memorial Sloan-Kettering Cancer Center, New York, and his associates.

Experts recommend that women who were treated with moderate- to high-dose chest radiation for a pediatric malignancy initiate breast cancer surveillance starting at age 25 years, or 8 years after undergoing radiotherapy, whichever comes last. The median age of breast cancer diagnosis in these patients is 32–35 years, and their previous exposure to radiation or anthracycline limits their treatment options.

There are an estimated 20,000–25,000 such women in the United States, and as many as 20% of female cancer survivors worldwide fall into this category.

Dr. Oeffinger and his colleagues studied breast cancer surveillance using the large, geographically diverse population of women participating in the Childhood Cancer Survivor Study. This study follows more than 9,000 survivors who were diagnosed between 1970 and 1986.

A random sample of 551 CCSS participants now aged 25–50 years who received at least 20 Gy of chest radiation therapy as children were surveyed regarding breast cancer surveillance. Two comparison groups—561 CCSS subjects who had not undergone chest radiation and 622 siblings of CCSS subjects who had never had cancer—also were assessed.

Nearly half of the women under age 40 years who had been exposed to pediatric radiotherapy had never had a mammogram, and only 23% had undergone mammography within the preceding year. This “much lower than expected” rate was still somewhat higher than the rates in the CCSS siblings (11%) and the cancer survivors who had not undergone chest radiotherapy (15%).

Women in this age group who said their physicians had recommended mammography were three times more likely to undergo screening than were those who said their physicians had not. However, only one-third of these high-risk women said that their physicians had recommended mammography.

The two most commonly reported barriers to screening in this age group were “doctor didn't order it” (31%) and “I'm too young” (30%).

Women aged 40–50 years who had been exposed to radiotherapy fared slightly better, but still only 53% engaged in regular breast cancer screening. In this age group, the most commonly reported barriers to screening were “put it off,” “didn't get around to it,” “too expensive,” or “no insurance.”

In contrast, nearly 90% of the study participants reported having a recent Pap smear, so medical access and knowledge of general women's health issues were not lacking. Instead, “one of the primary barriers is likely a lack of clinician familiarity with childhood cancer survivors and their risk of breast cancer,” Dr. Oeffinger and his colleagues said (JAMA 2009;301:404–14).

Many childhood cancer survivors are not being screened for breast cancer. ©Brand X Pictures

The third-generation smallpox vaccine LC16m8 was found to be as immunogenic as existing smallpox vaccines but appeared to be safer in a study of over 3,000 Japanese adults.

The live, attenuated, tissue-cultured LC16m8 vaccine proved to be immunogenic in adults who had never received any smallpox vaccination, and it produced an adequate booster response in those who had been vaccinated.

As important, the LC16m8 vaccine produced minimal local reactions and no severe adverse events, said Dr. Tomoya Saito of the department of tropical medicine and parasitology, Keio University, Tokyo, and associates.

"Developing a vaccine that is safer than first-generation vaccines yet highly immunogenic is crucial to constructing a prevention plan in the event of a bioterrorist attack," the investigators noted.

They assessed the LC16m8 vaccine in healthy personnel in the Japan Self-Defense Forces inoculated in 2002–2005. Nearly 99% were men, and all were Asian. A total of 1,529 had never been vaccinated, and 1,692 had previously been vaccinated against smallpox (JAMA 2009;301:1025–33).

The proportion of "takes"—the visible skin reactions to a single intraepidermal scarification—was comparable to that seen with other vaccines, as were serum levels of neutralizing antibodies.

The seroconversion rate was over 90% in those who were never vaccinated and 60% in those who were previously vaccinated, Dr. Saito and colleagues wrote.

There were no severe adverse events such as autoinoculation/contact inoculation, eczema vaccinatum, progressive vaccinia, generalized vaccinia, encephalitis, or the myopericarditis that has been "a major concern" in the U.S. vaccination program. The researchers noted that while the total sample size in the study limited their ability to "conclusively confirm that absence of severe adverse events," their results support the conclusion that LC16m8 "causes minimal local manifestations and systemic adverse effects."

The study findings suggest that LC16m8 is "a viable alternative to first-, second-, and other third-generation vaccines in a smallpox preparedness program," they added.

The lesions on this patient's arm were caused by the smallpox virus, variola major. CDC/Dr. John Noble Jr.

The third-generation smallpox vaccine LC16m8 was found to be as immunogenic as existing smallpox vaccines but appeared to be safer in a study of over 3,000 Japanese adults.

The live, attenuated, tissue-cultured LC16m8 vaccine proved to be immunogenic in adults who had never received any smallpox vaccination, and it produced an adequate booster response in those who had been vaccinated.

As important, the LC16m8 vaccine produced minimal local reactions and no severe adverse events, said Dr. Tomoya Saito of the department of tropical medicine and parasitology, Keio University, Tokyo, and associates.

"Developing a vaccine that is safer than first-generation vaccines yet highly immunogenic is crucial to constructing a prevention plan in the event of a bioterrorist attack," the investigators noted.

They assessed the LC16m8 vaccine in healthy personnel in the Japan Self-Defense Forces inoculated in 2002–2005. Nearly 99% were men, and all were Asian. A total of 1,529 had never been vaccinated, and 1,692 had previously been vaccinated against smallpox (JAMA 2009;301:1025–33).

The proportion of "takes"—the visible skin reactions to a single intraepidermal scarification—was comparable to that seen with other vaccines, as were serum levels of neutralizing antibodies.

The seroconversion rate was over 90% in those who were never vaccinated and 60% in those who were previously vaccinated, Dr. Saito and colleagues wrote.

There were no severe adverse events such as autoinoculation/contact inoculation, eczema vaccinatum, progressive vaccinia, generalized vaccinia, encephalitis, or the myopericarditis that has been "a major concern" in the U.S. vaccination program. The researchers noted that while the total sample size in the study limited their ability to "conclusively confirm that absence of severe adverse events," their results support the conclusion that LC16m8 "causes minimal local manifestations and systemic adverse effects."

The study findings suggest that LC16m8 is "a viable alternative to first-, second-, and other third-generation vaccines in a smallpox preparedness program," they added.

The lesions on this patient's arm were caused by the smallpox virus, variola major. CDC/Dr. John Noble Jr.

The third-generation smallpox vaccine LC16m8 was found to be as immunogenic as existing smallpox vaccines but appeared to be safer in a study of over 3,000 Japanese adults.

The live, attenuated, tissue-cultured LC16m8 vaccine proved to be immunogenic in adults who had never received any smallpox vaccination, and it produced an adequate booster response in those who had been vaccinated.

As important, the LC16m8 vaccine produced minimal local reactions and no severe adverse events, said Dr. Tomoya Saito of the department of tropical medicine and parasitology, Keio University, Tokyo, and associates.

"Developing a vaccine that is safer than first-generation vaccines yet highly immunogenic is crucial to constructing a prevention plan in the event of a bioterrorist attack," the investigators noted.

They assessed the LC16m8 vaccine in healthy personnel in the Japan Self-Defense Forces inoculated in 2002–2005. Nearly 99% were men, and all were Asian. A total of 1,529 had never been vaccinated, and 1,692 had previously been vaccinated against smallpox (JAMA 2009;301:1025–33).

The proportion of "takes"—the visible skin reactions to a single intraepidermal scarification—was comparable to that seen with other vaccines, as were serum levels of neutralizing antibodies.

The seroconversion rate was over 90% in those who were never vaccinated and 60% in those who were previously vaccinated, Dr. Saito and colleagues wrote.

There were no severe adverse events such as autoinoculation/contact inoculation, eczema vaccinatum, progressive vaccinia, generalized vaccinia, encephalitis, or the myopericarditis that has been "a major concern" in the U.S. vaccination program. The researchers noted that while the total sample size in the study limited their ability to "conclusively confirm that absence of severe adverse events," their results support the conclusion that LC16m8 "causes minimal local manifestations and systemic adverse effects."

The study findings suggest that LC16m8 is "a viable alternative to first-, second-, and other third-generation vaccines in a smallpox preparedness program," they added.

The lesions on this patient's arm were caused by the smallpox virus, variola major. CDC/Dr. John Noble Jr.

Alcohol abuse and dependence appear to lead to major depression, rather than vice versa, according to a collection of statistical analyses reported in the Archives of General Psychiatry.

Researchers used data from the Christchurch Health and Development Study, a cohort of 635 boys and 630 girls born in urban New Zealand in 1977 and followed through age 25, to examine the well-known relationship between alcohol abuse or dependence and depression. They used several advanced statistical modeling methods to explore possible causal pathways between the two disorders, said David M. Fergusson, Ph.D., and his associates at the University of Otago, Christchurch.

At age 24-25 years, approximately 14% of the sample met DSM-IV criteria for alcohol dependence (6%) or abuse (8%), and 14% met criteria for major depression.

At all ages, there were clear and significant trends for alcohol abuse to be associated with depression, such that subjects who abused alcohol were nearly twice as likely to fulfill criteria for major depression as were those who did not abuse alcohol. In contrast, major depression did not appear to predispose subjects to alcohol abuse.

In addition, the relationship between alcohol abuse and depression was not found to arise from some common factor underlying both disorders, Dr. Fergusson and his colleagues said (Arch. Gen. Psych. 2009;66:260-6).

The researchers noted that these results contradict those of previous studies, some of which have suggested that the causal relationship moves in the opposite direction because some people with depressive symptoms self-medicate with alcohol.

Alcohol abuse and dependence appear to lead to major depression, rather than vice versa, according to a collection of statistical analyses reported in the Archives of General Psychiatry.

Researchers used data from the Christchurch Health and Development Study, a cohort of 635 boys and 630 girls born in urban New Zealand in 1977 and followed through age 25, to examine the well-known relationship between alcohol abuse or dependence and depression. They used several advanced statistical modeling methods to explore possible causal pathways between the two disorders, said David M. Fergusson, Ph.D., and his associates at the University of Otago, Christchurch.

At age 24-25 years, approximately 14% of the sample met DSM-IV criteria for alcohol dependence (6%) or abuse (8%), and 14% met criteria for major depression.

At all ages, there were clear and significant trends for alcohol abuse to be associated with depression, such that subjects who abused alcohol were nearly twice as likely to fulfill criteria for major depression as were those who did not abuse alcohol. In contrast, major depression did not appear to predispose subjects to alcohol abuse.

In addition, the relationship between alcohol abuse and depression was not found to arise from some common factor underlying both disorders, Dr. Fergusson and his colleagues said (Arch. Gen. Psych. 2009;66:260-6).

The researchers noted that these results contradict those of previous studies, some of which have suggested that the causal relationship moves in the opposite direction because some people with depressive symptoms self-medicate with alcohol.

Alcohol abuse and dependence appear to lead to major depression, rather than vice versa, according to a collection of statistical analyses reported in the Archives of General Psychiatry.

Researchers used data from the Christchurch Health and Development Study, a cohort of 635 boys and 630 girls born in urban New Zealand in 1977 and followed through age 25, to examine the well-known relationship between alcohol abuse or dependence and depression. They used several advanced statistical modeling methods to explore possible causal pathways between the two disorders, said David M. Fergusson, Ph.D., and his associates at the University of Otago, Christchurch.

At age 24-25 years, approximately 14% of the sample met DSM-IV criteria for alcohol dependence (6%) or abuse (8%), and 14% met criteria for major depression.

At all ages, there were clear and significant trends for alcohol abuse to be associated with depression, such that subjects who abused alcohol were nearly twice as likely to fulfill criteria for major depression as were those who did not abuse alcohol. In contrast, major depression did not appear to predispose subjects to alcohol abuse.

In addition, the relationship between alcohol abuse and depression was not found to arise from some common factor underlying both disorders, Dr. Fergusson and his colleagues said (Arch. Gen. Psych. 2009;66:260-6).

The researchers noted that these results contradict those of previous studies, some of which have suggested that the causal relationship moves in the opposite direction because some people with depressive symptoms self-medicate with alcohol.

Rheumatoid arthritis patients who are taking monoclonal anti-tumor necrosis factor-alpha agents such as infliximab and adalimumab may be at increased risk for developing herpes zoster, according to a report.

An analysis of data from the German RABBIT (Rheumatoid Arthritis Observation of Biologic Therapy) registry, initiated in 2001 to track the long-term safety and effectiveness of biologic agents in rheumatoid arthritis (RA), showed a significant association between reactivation of latent varicella zoster virus and treatment with this class of anti-TNF-alpha drugs, said Dr. Anja Strangfeld of the German Rheumatism Research Centre Berlin and her associates.

The investigators examined data on 5,040 patients who were treated in 2001-2006 at more than 150 German outpatient clinics and private practices specializing in rheumatology.

A total of 82 patients developed 86 cases of herpes zoster, including 12 cases that required hospitalization. Of these, 39 were temporally linked to adalimumab or infliximab, compared with 23 cases linked to etanercept and 24 linked to conventional RA therapies.

The incidence of herpes zoster was 11.1 per 1,000 patient-years in patients who were taking the monoclonal anti-TNF-alpha antibodies, compared with 8.9 per 1,000 patient-years for etanercept and 5.6 per 1,000 patient-years for conventional therapies.

After the data were adjusted, the risk for herpes zoster remained elevated only for patients taking adalimumab or infliximab. In a subgroup of patients who switched from conventional therapies to these anti-TNF-alpha rugs, the risk for herpes zoster increased after the switch, the investigators said (JAMA 2009;301:737-44).

The database used in this study has been supported by an unconditional joint grant from Essex Pharma, Wyeth Pharma, Amgen, Abbott, F. Hoffmann-La Roche Ltd., and Bristol-Myers Squibb Co.

Rheumatoid arthritis patients who are taking monoclonal anti-tumor necrosis factor-alpha agents such as infliximab and adalimumab may be at increased risk for developing herpes zoster, according to a report.

An analysis of data from the German RABBIT (Rheumatoid Arthritis Observation of Biologic Therapy) registry, initiated in 2001 to track the long-term safety and effectiveness of biologic agents in rheumatoid arthritis (RA), showed a significant association between reactivation of latent varicella zoster virus and treatment with this class of anti-TNF-alpha drugs, said Dr. Anja Strangfeld of the German Rheumatism Research Centre Berlin and her associates.

The investigators examined data on 5,040 patients who were treated in 2001-2006 at more than 150 German outpatient clinics and private practices specializing in rheumatology.

A total of 82 patients developed 86 cases of herpes zoster, including 12 cases that required hospitalization. Of these, 39 were temporally linked to adalimumab or infliximab, compared with 23 cases linked to etanercept and 24 linked to conventional RA therapies.

The incidence of herpes zoster was 11.1 per 1,000 patient-years in patients who were taking the monoclonal anti-TNF-alpha antibodies, compared with 8.9 per 1,000 patient-years for etanercept and 5.6 per 1,000 patient-years for conventional therapies.

After the data were adjusted, the risk for herpes zoster remained elevated only for patients taking adalimumab or infliximab. In a subgroup of patients who switched from conventional therapies to these anti-TNF-alpha rugs, the risk for herpes zoster increased after the switch, the investigators said (JAMA 2009;301:737-44).

The database used in this study has been supported by an unconditional joint grant from Essex Pharma, Wyeth Pharma, Amgen, Abbott, F. Hoffmann-La Roche Ltd., and Bristol-Myers Squibb Co.

Rheumatoid arthritis patients who are taking monoclonal anti-tumor necrosis factor-alpha agents such as infliximab and adalimumab may be at increased risk for developing herpes zoster, according to a report.

An analysis of data from the German RABBIT (Rheumatoid Arthritis Observation of Biologic Therapy) registry, initiated in 2001 to track the long-term safety and effectiveness of biologic agents in rheumatoid arthritis (RA), showed a significant association between reactivation of latent varicella zoster virus and treatment with this class of anti-TNF-alpha drugs, said Dr. Anja Strangfeld of the German Rheumatism Research Centre Berlin and her associates.

The investigators examined data on 5,040 patients who were treated in 2001-2006 at more than 150 German outpatient clinics and private practices specializing in rheumatology.

A total of 82 patients developed 86 cases of herpes zoster, including 12 cases that required hospitalization. Of these, 39 were temporally linked to adalimumab or infliximab, compared with 23 cases linked to etanercept and 24 linked to conventional RA therapies.

The incidence of herpes zoster was 11.1 per 1,000 patient-years in patients who were taking the monoclonal anti-TNF-alpha antibodies, compared with 8.9 per 1,000 patient-years for etanercept and 5.6 per 1,000 patient-years for conventional therapies.

After the data were adjusted, the risk for herpes zoster remained elevated only for patients taking adalimumab or infliximab. In a subgroup of patients who switched from conventional therapies to these anti-TNF-alpha rugs, the risk for herpes zoster increased after the switch, the investigators said (JAMA 2009;301:737-44).

The database used in this study has been supported by an unconditional joint grant from Essex Pharma, Wyeth Pharma, Amgen, Abbott, F. Hoffmann-La Roche Ltd., and Bristol-Myers Squibb Co.

Adhering to a Mediterranean diet appears to lower the risk of progressing from mild cognitive impairment to Alzheimer's disease and may cut the risk of developing MCI as well, according to a recent study.

There may also be a dose-response effect, with greater adherence to the Mediterranean diet conferring greater protection from cognitive decline, said Dr. Nikoloaos Scarmeas and his associates at Columbia University Medical Center, New York.

The researchers assessed the association between diet and MCI and AD using data from the Washington Heights-Inwood Columbia Aging Project.

The WHICAP study included comprehensive neuropsychological testing of probability samplings of Medicare beneficiaries residing in Manhattan in 1992 and 1999.

A total of 1,800 subjects who were cognitively normal at baseline were followed for approximately 4 years for the development of MCI. The investigators also followed 564 patients with MCI at baseline for the progression to AD (Arch. Neurol. 2009;66:216–25).

The Mediterranean diet is characterized by high intake of fish, vegetables, legumes, fruits, cereals, and unsaturated fatty acids, mostly in the form of olive oil; low intake of dairy products, meat, and saturated fatty acids; and regular but moderate intake of alcohol.

Greater adherence to this type of diet was associated with “a borderline trend for lower risk of developing MCI,” Dr. Scarmeas and his associates said. Compared with subjects who did not adhere to the Mediterranean diet, those who reported intermediate adherence had a 17% lower risk of developing MCI; those who reported greatest adherence had a 28% lower risk.

Greater adherence to the Mediterranean diet also was associated with a lower risk of progressing to AD.

Compared with subjects who did not adhere to this type of diet, those who reported intermediate adherence had a 45% lower risk of progressing to AD; those who reported greatest adherence had a 48% lower risk, the investigators said.

The findings did not change when the data were adjusted to account for several potential confounders such as subject age, gender, ethnicity, level of education, apolipoprotein E genotype, caloric intake, and body mass index.

The investigators received support for the study through grants from the National Institute on Aging.

Adhering to a Mediterranean diet appears to lower the risk of progressing from mild cognitive impairment to Alzheimer's disease and may cut the risk of developing MCI as well, according to a recent study.

There may also be a dose-response effect, with greater adherence to the Mediterranean diet conferring greater protection from cognitive decline, said Dr. Nikoloaos Scarmeas and his associates at Columbia University Medical Center, New York.

The researchers assessed the association between diet and MCI and AD using data from the Washington Heights-Inwood Columbia Aging Project.

The WHICAP study included comprehensive neuropsychological testing of probability samplings of Medicare beneficiaries residing in Manhattan in 1992 and 1999.

A total of 1,800 subjects who were cognitively normal at baseline were followed for approximately 4 years for the development of MCI. The investigators also followed 564 patients with MCI at baseline for the progression to AD (Arch. Neurol. 2009;66:216–25).

The Mediterranean diet is characterized by high intake of fish, vegetables, legumes, fruits, cereals, and unsaturated fatty acids, mostly in the form of olive oil; low intake of dairy products, meat, and saturated fatty acids; and regular but moderate intake of alcohol.

Greater adherence to this type of diet was associated with “a borderline trend for lower risk of developing MCI,” Dr. Scarmeas and his associates said. Compared with subjects who did not adhere to the Mediterranean diet, those who reported intermediate adherence had a 17% lower risk of developing MCI; those who reported greatest adherence had a 28% lower risk.

Greater adherence to the Mediterranean diet also was associated with a lower risk of progressing to AD.

Compared with subjects who did not adhere to this type of diet, those who reported intermediate adherence had a 45% lower risk of progressing to AD; those who reported greatest adherence had a 48% lower risk, the investigators said.

The findings did not change when the data were adjusted to account for several potential confounders such as subject age, gender, ethnicity, level of education, apolipoprotein E genotype, caloric intake, and body mass index.

The investigators received support for the study through grants from the National Institute on Aging.

Adhering to a Mediterranean diet appears to lower the risk of progressing from mild cognitive impairment to Alzheimer's disease and may cut the risk of developing MCI as well, according to a recent study.

There may also be a dose-response effect, with greater adherence to the Mediterranean diet conferring greater protection from cognitive decline, said Dr. Nikoloaos Scarmeas and his associates at Columbia University Medical Center, New York.

The researchers assessed the association between diet and MCI and AD using data from the Washington Heights-Inwood Columbia Aging Project.

The WHICAP study included comprehensive neuropsychological testing of probability samplings of Medicare beneficiaries residing in Manhattan in 1992 and 1999.

A total of 1,800 subjects who were cognitively normal at baseline were followed for approximately 4 years for the development of MCI. The investigators also followed 564 patients with MCI at baseline for the progression to AD (Arch. Neurol. 2009;66:216–25).

The Mediterranean diet is characterized by high intake of fish, vegetables, legumes, fruits, cereals, and unsaturated fatty acids, mostly in the form of olive oil; low intake of dairy products, meat, and saturated fatty acids; and regular but moderate intake of alcohol.

Greater adherence to this type of diet was associated with “a borderline trend for lower risk of developing MCI,” Dr. Scarmeas and his associates said. Compared with subjects who did not adhere to the Mediterranean diet, those who reported intermediate adherence had a 17% lower risk of developing MCI; those who reported greatest adherence had a 28% lower risk.

Greater adherence to the Mediterranean diet also was associated with a lower risk of progressing to AD.

Compared with subjects who did not adhere to this type of diet, those who reported intermediate adherence had a 45% lower risk of progressing to AD; those who reported greatest adherence had a 48% lower risk, the investigators said.

The findings did not change when the data were adjusted to account for several potential confounders such as subject age, gender, ethnicity, level of education, apolipoprotein E genotype, caloric intake, and body mass index.

The investigators received support for the study through grants from the National Institute on Aging.

All major low-trauma fractures, not just hip and vertebral fractures, are associated with increased mortality after age 60.

Moreover, even minor fractures—those that do not involve the pelvis, distal femur, proximal tibia, proximal humerus, or three or more ribs—raise mortality risk in the oldest patients, reported Dr. Dana Bliuc of St. Vincent's Hospital, Sydney, and associates.

The researchers assessed outcomes after low-trauma fractures in a population-based study of 4,005 men and women aged 60 years and older who were followed from 1989 through 2007. This population was almost entirely white, so the findings may not be generalizable to other ethnic groups.

A total of 952 women and 343 men sustained at least one low-trauma fracture. Death followed closely in 461 of the women and 197 of the men.

At any age, mortality was consistently higher in subjects who had sustained fractures than in the general population. Mortality was 2–4 times higher than normal for both sexes after hip fracture, approximately 2 times higher after vertebral fracture, approximately 1.5 times higher after major fracture, and approximately 1.3 times higher after minor fracture.

Mortality remained elevated for a full 5 years before returning to normal levels following all fractures. The exception was hip fractures, in which mortality remained high for up to 10 years, the investigators said (JAMA 2009;301:513–21).

Patients who sustained one fracture were at twofold to fourfold higher risk for subsequent fractures, and mortality risk rose the same amount again for another 5 years with every subsequent fracture they sustained.

“Nonhip, nonvertebral fractures, [which are] generally not even considered in these types of studies, not only constituted almost 50% of the fractures studied, but also were associated with 29% of the premature mortality,” Dr. Bluic and colleagues wrote.

“This study was not specifically designed to examine the underlying causes of mortality; however, examination of death certificates suggested no difference between causes of death in the fracture group and the general population, with cardiac, respiratory, cerebrovascular, and malignancy being the major causes.

It still remains to be determined exactly what is responsible for the increased mortality following fracture,” they added.

This study was supported in part by grants from Amgen Inc., Merck Sharp & Dohme, Sanofi-Aventis, Servier Laboratories, and Novartis.

All major low-trauma fractures, not just hip and vertebral fractures, are associated with increased mortality after age 60.

Moreover, even minor fractures—those that do not involve the pelvis, distal femur, proximal tibia, proximal humerus, or three or more ribs—raise mortality risk in the oldest patients, reported Dr. Dana Bliuc of St. Vincent's Hospital, Sydney, and associates.

The researchers assessed outcomes after low-trauma fractures in a population-based study of 4,005 men and women aged 60 years and older who were followed from 1989 through 2007. This population was almost entirely white, so the findings may not be generalizable to other ethnic groups.

A total of 952 women and 343 men sustained at least one low-trauma fracture. Death followed closely in 461 of the women and 197 of the men.

At any age, mortality was consistently higher in subjects who had sustained fractures than in the general population. Mortality was 2–4 times higher than normal for both sexes after hip fracture, approximately 2 times higher after vertebral fracture, approximately 1.5 times higher after major fracture, and approximately 1.3 times higher after minor fracture.

Mortality remained elevated for a full 5 years before returning to normal levels following all fractures. The exception was hip fractures, in which mortality remained high for up to 10 years, the investigators said (JAMA 2009;301:513–21).

Patients who sustained one fracture were at twofold to fourfold higher risk for subsequent fractures, and mortality risk rose the same amount again for another 5 years with every subsequent fracture they sustained.

“Nonhip, nonvertebral fractures, [which are] generally not even considered in these types of studies, not only constituted almost 50% of the fractures studied, but also were associated with 29% of the premature mortality,” Dr. Bluic and colleagues wrote.

“This study was not specifically designed to examine the underlying causes of mortality; however, examination of death certificates suggested no difference between causes of death in the fracture group and the general population, with cardiac, respiratory, cerebrovascular, and malignancy being the major causes.

It still remains to be determined exactly what is responsible for the increased mortality following fracture,” they added.

This study was supported in part by grants from Amgen Inc., Merck Sharp & Dohme, Sanofi-Aventis, Servier Laboratories, and Novartis.

All major low-trauma fractures, not just hip and vertebral fractures, are associated with increased mortality after age 60.

Moreover, even minor fractures—those that do not involve the pelvis, distal femur, proximal tibia, proximal humerus, or three or more ribs—raise mortality risk in the oldest patients, reported Dr. Dana Bliuc of St. Vincent's Hospital, Sydney, and associates.

The researchers assessed outcomes after low-trauma fractures in a population-based study of 4,005 men and women aged 60 years and older who were followed from 1989 through 2007. This population was almost entirely white, so the findings may not be generalizable to other ethnic groups.

A total of 952 women and 343 men sustained at least one low-trauma fracture. Death followed closely in 461 of the women and 197 of the men.

At any age, mortality was consistently higher in subjects who had sustained fractures than in the general population. Mortality was 2–4 times higher than normal for both sexes after hip fracture, approximately 2 times higher after vertebral fracture, approximately 1.5 times higher after major fracture, and approximately 1.3 times higher after minor fracture.

Mortality remained elevated for a full 5 years before returning to normal levels following all fractures. The exception was hip fractures, in which mortality remained high for up to 10 years, the investigators said (JAMA 2009;301:513–21).

Patients who sustained one fracture were at twofold to fourfold higher risk for subsequent fractures, and mortality risk rose the same amount again for another 5 years with every subsequent fracture they sustained.

“Nonhip, nonvertebral fractures, [which are] generally not even considered in these types of studies, not only constituted almost 50% of the fractures studied, but also were associated with 29% of the premature mortality,” Dr. Bluic and colleagues wrote.

“This study was not specifically designed to examine the underlying causes of mortality; however, examination of death certificates suggested no difference between causes of death in the fracture group and the general population, with cardiac, respiratory, cerebrovascular, and malignancy being the major causes.

It still remains to be determined exactly what is responsible for the increased mortality following fracture,” they added.

This study was supported in part by grants from Amgen Inc., Merck Sharp & Dohme, Sanofi-Aventis, Servier Laboratories, and Novartis.

The use of brain natriuretic peptide levels to guide heart failure therapy did not reduce hospitalizations or improve quality of life in a study comparing that intensified approach against standard symptom-guided treatment.

In the Trial of Intensified vs. Standard Medical Therapy in Elderly Patients With Congestive Heart Failure (TIMECHF), researchers found that contrary to their hypothesis, the new strategy was not helpful overall and was actually harmful in the subgroup of the oldest patients.

The findings indicate that despite the “undisputed diagnostic and prognostic importance” of brain natriuretic peptide (BNP) levels, they are no better than clinical symptom-based judgment for managing heart failure, said Dr. Matthias Pfisterer of University Hospital Basel (Switzerland) and his associates.

The investigators compared the two treatment approaches in 622 outpatients aged 60 and older who were followed for 18 months at 15 medical centers in Switzerland and Germany. Compared with symptom-guided treatment, intensified therapy guided by centrally obtained BNP levels did not improve survival free of hospitalization, the primary end point of the study. The rates of hospitalization-free survival were 41% and 40%, respectively.

Overall survival also did not differ significantly between patients who received BNP-guided therapy (84%) and those who received standard treatment (78%).

Patients aged 60–74 years showed some benefit with the intensified treatment approach, while those aged 75 and older did not (JAMA 2009;301:383–92).

BNP levels are no better than clinical symptom-based judgment for managing heart failure. DR. PFISTERER

The use of brain natriuretic peptide levels to guide heart failure therapy did not reduce hospitalizations or improve quality of life in a study comparing that intensified approach against standard symptom-guided treatment.

In the Trial of Intensified vs. Standard Medical Therapy in Elderly Patients With Congestive Heart Failure (TIMECHF), researchers found that contrary to their hypothesis, the new strategy was not helpful overall and was actually harmful in the subgroup of the oldest patients.

The findings indicate that despite the “undisputed diagnostic and prognostic importance” of brain natriuretic peptide (BNP) levels, they are no better than clinical symptom-based judgment for managing heart failure, said Dr. Matthias Pfisterer of University Hospital Basel (Switzerland) and his associates.

The investigators compared the two treatment approaches in 622 outpatients aged 60 and older who were followed for 18 months at 15 medical centers in Switzerland and Germany. Compared with symptom-guided treatment, intensified therapy guided by centrally obtained BNP levels did not improve survival free of hospitalization, the primary end point of the study. The rates of hospitalization-free survival were 41% and 40%, respectively.

Overall survival also did not differ significantly between patients who received BNP-guided therapy (84%) and those who received standard treatment (78%).

Patients aged 60–74 years showed some benefit with the intensified treatment approach, while those aged 75 and older did not (JAMA 2009;301:383–92).

BNP levels are no better than clinical symptom-based judgment for managing heart failure. DR. PFISTERER

The use of brain natriuretic peptide levels to guide heart failure therapy did not reduce hospitalizations or improve quality of life in a study comparing that intensified approach against standard symptom-guided treatment.

In the Trial of Intensified vs. Standard Medical Therapy in Elderly Patients With Congestive Heart Failure (TIMECHF), researchers found that contrary to their hypothesis, the new strategy was not helpful overall and was actually harmful in the subgroup of the oldest patients.

The findings indicate that despite the “undisputed diagnostic and prognostic importance” of brain natriuretic peptide (BNP) levels, they are no better than clinical symptom-based judgment for managing heart failure, said Dr. Matthias Pfisterer of University Hospital Basel (Switzerland) and his associates.

The investigators compared the two treatment approaches in 622 outpatients aged 60 and older who were followed for 18 months at 15 medical centers in Switzerland and Germany. Compared with symptom-guided treatment, intensified therapy guided by centrally obtained BNP levels did not improve survival free of hospitalization, the primary end point of the study. The rates of hospitalization-free survival were 41% and 40%, respectively.

Overall survival also did not differ significantly between patients who received BNP-guided therapy (84%) and those who received standard treatment (78%).

Patients aged 60–74 years showed some benefit with the intensified treatment approach, while those aged 75 and older did not (JAMA 2009;301:383–92).

BNP levels are no better than clinical symptom-based judgment for managing heart failure. DR. PFISTERER

An estimated 2 million children under age 5 years require medical attention for respiratory syncytial virus each year, a “much larger burden than previously recognized,” according to an analysis of surveillance data on more than 5,000 children.

Recent data from the Centers for Disease Control and Prevention's New Vaccine Surveillance Network show that respiratory syncytial virus (RSV) infection prompts 1 of every 13 visits to primary care physicians in the United States, as well as 1 of every 38 emergency department visits and 1 of every 334 hospitalizations, in this age group. Hospitalization rates for children who prove to have RSV are three times higher than those for children whose illness is caused by influenza or parainfluenza, even in populations where the rate of flu vaccination is quite low.

The virus's major burden on health care resources occurs in healthy children who are not considered at risk and many of whom are well beyond infancy, said Dr. Caroline Breese Hall, professor of pediatrics and medicine at the University of Rochester (N.Y.), and her associates.

The heavy outpatient burden in particular “is probably not fully recognized by health care providers and by public health officials, since only 3% of outpatients with confirmed RSV infection received the specific diagnosis of RSV infection; bronchiolitis was diagnosed in 20% of such children,” and other missed diagnoses included simple upper respiratory tract infection (32%), asthma (13%), and pneumonia (8%).

The investigators analyzed surveillance data gathered from November through April in each year from 2000 to 2004 on acute respiratory infections among children under age 5 years in three geographically diverse U.S. populations. The children enrolled in the study were hospitalized, treated in outpatient emergency departments, or seen in pediatricians' offices.

This study involved 5,067 children, of whom 919 (18%) were found by culture and/or reverse transcriptase polymerase chain reaction to have RSV infection. RSV was associated with 20% of hospitalizations, 18% of outpatient visits to the emergency department, and 15% of office visits for acute respiratory infections in this population. (New Engl. J. Med. 2009;360:588–98).

“If we extrapolate from our population-based data to the entire U.S. population, an estimated 2.1 million children under 5 years of age with RSV infection would require medical attention each year.” Nearly three-fourths of the affected children would be treated in private practices, 3% would be hospitalized, and the remaining 24% would be treated in emergency departments.

Fully 78% of RSV-infected children would be older than 1 year. Most would have no coexisting medical conditions or traits that would identify them as being at risk, the investigators said.

Dr. Hall reports receiving grant support and consulting fees from MedImmune Inc.

An estimated 2 million children under age 5 years require medical attention for respiratory syncytial virus each year, a “much larger burden than previously recognized,” according to an analysis of surveillance data on more than 5,000 children.

Recent data from the Centers for Disease Control and Prevention's New Vaccine Surveillance Network show that respiratory syncytial virus (RSV) infection prompts 1 of every 13 visits to primary care physicians in the United States, as well as 1 of every 38 emergency department visits and 1 of every 334 hospitalizations, in this age group. Hospitalization rates for children who prove to have RSV are three times higher than those for children whose illness is caused by influenza or parainfluenza, even in populations where the rate of flu vaccination is quite low.

The virus's major burden on health care resources occurs in healthy children who are not considered at risk and many of whom are well beyond infancy, said Dr. Caroline Breese Hall, professor of pediatrics and medicine at the University of Rochester (N.Y.), and her associates.

The heavy outpatient burden in particular “is probably not fully recognized by health care providers and by public health officials, since only 3% of outpatients with confirmed RSV infection received the specific diagnosis of RSV infection; bronchiolitis was diagnosed in 20% of such children,” and other missed diagnoses included simple upper respiratory tract infection (32%), asthma (13%), and pneumonia (8%).

The investigators analyzed surveillance data gathered from November through April in each year from 2000 to 2004 on acute respiratory infections among children under age 5 years in three geographically diverse U.S. populations. The children enrolled in the study were hospitalized, treated in outpatient emergency departments, or seen in pediatricians' offices.

This study involved 5,067 children, of whom 919 (18%) were found by culture and/or reverse transcriptase polymerase chain reaction to have RSV infection. RSV was associated with 20% of hospitalizations, 18% of outpatient visits to the emergency department, and 15% of office visits for acute respiratory infections in this population. (New Engl. J. Med. 2009;360:588–98).

“If we extrapolate from our population-based data to the entire U.S. population, an estimated 2.1 million children under 5 years of age with RSV infection would require medical attention each year.” Nearly three-fourths of the affected children would be treated in private practices, 3% would be hospitalized, and the remaining 24% would be treated in emergency departments.

Fully 78% of RSV-infected children would be older than 1 year. Most would have no coexisting medical conditions or traits that would identify them as being at risk, the investigators said.

Dr. Hall reports receiving grant support and consulting fees from MedImmune Inc.

An estimated 2 million children under age 5 years require medical attention for respiratory syncytial virus each year, a “much larger burden than previously recognized,” according to an analysis of surveillance data on more than 5,000 children.

Recent data from the Centers for Disease Control and Prevention's New Vaccine Surveillance Network show that respiratory syncytial virus (RSV) infection prompts 1 of every 13 visits to primary care physicians in the United States, as well as 1 of every 38 emergency department visits and 1 of every 334 hospitalizations, in this age group. Hospitalization rates for children who prove to have RSV are three times higher than those for children whose illness is caused by influenza or parainfluenza, even in populations where the rate of flu vaccination is quite low.

The virus's major burden on health care resources occurs in healthy children who are not considered at risk and many of whom are well beyond infancy, said Dr. Caroline Breese Hall, professor of pediatrics and medicine at the University of Rochester (N.Y.), and her associates.

The heavy outpatient burden in particular “is probably not fully recognized by health care providers and by public health officials, since only 3% of outpatients with confirmed RSV infection received the specific diagnosis of RSV infection; bronchiolitis was diagnosed in 20% of such children,” and other missed diagnoses included simple upper respiratory tract infection (32%), asthma (13%), and pneumonia (8%).

The investigators analyzed surveillance data gathered from November through April in each year from 2000 to 2004 on acute respiratory infections among children under age 5 years in three geographically diverse U.S. populations. The children enrolled in the study were hospitalized, treated in outpatient emergency departments, or seen in pediatricians' offices.

This study involved 5,067 children, of whom 919 (18%) were found by culture and/or reverse transcriptase polymerase chain reaction to have RSV infection. RSV was associated with 20% of hospitalizations, 18% of outpatient visits to the emergency department, and 15% of office visits for acute respiratory infections in this population. (New Engl. J. Med. 2009;360:588–98).

“If we extrapolate from our population-based data to the entire U.S. population, an estimated 2.1 million children under 5 years of age with RSV infection would require medical attention each year.” Nearly three-fourths of the affected children would be treated in private practices, 3% would be hospitalized, and the remaining 24% would be treated in emergency departments.

Fully 78% of RSV-infected children would be older than 1 year. Most would have no coexisting medical conditions or traits that would identify them as being at risk, the investigators said.

Dr. Hall reports receiving grant support and consulting fees from MedImmune Inc.

Women with bulimia nervosa appear to have deficient activity in frontostriatal regulatory circuits of the anterior cingulate cortex, as assessed on functional MRI.

This subnormal activation likely contributes to their greater than normal impulsivity in eating and other behaviors, said Dr. Rachel Marsh and associates at the New York State Psychiatric Institute, New York (Arch. Gen. Psych. 2009;66:51–63).

They assessed 20 women recruited from an eating disorders clinic and 20 healthy control subjects matched for body mass index and age (average, 26 years). All underwent fMRI imaging while performing the Simon spatial incompatibility task to compare differences between the group in brain activation patterns associated with self-regulatory control.

The bulimia patients made significantly more errors on the task than did controls, and their accuracy decreased further over time. Those with the most severe bulimia symptoms made the most errors.

Compared with controls, bulimia patients showed deficits in the activation of circuits in the brain's left side (the inferolateral prefrontal cortex and the left lenticular nucleus) and in the right side (the ventral and dorsal anterior cingulate cortex, the putamen, and the caudate nucleus).

“Deficient cortical activation likely accounted for their more impulsive, error-prone performances, compared with controls,” the authors wrote. “These deficits may be caused by previously reported decreases in serotonin metabolism in frontal cortices in [bulimics].”

The differences between the groups were independent of IQ, depression, and ADHD rating instruments.

Women with bulimia nervosa appear to have deficient activity in frontostriatal regulatory circuits of the anterior cingulate cortex, as assessed on functional MRI.

This subnormal activation likely contributes to their greater than normal impulsivity in eating and other behaviors, said Dr. Rachel Marsh and associates at the New York State Psychiatric Institute, New York (Arch. Gen. Psych. 2009;66:51–63).

They assessed 20 women recruited from an eating disorders clinic and 20 healthy control subjects matched for body mass index and age (average, 26 years). All underwent fMRI imaging while performing the Simon spatial incompatibility task to compare differences between the group in brain activation patterns associated with self-regulatory control.

The bulimia patients made significantly more errors on the task than did controls, and their accuracy decreased further over time. Those with the most severe bulimia symptoms made the most errors.

Compared with controls, bulimia patients showed deficits in the activation of circuits in the brain's left side (the inferolateral prefrontal cortex and the left lenticular nucleus) and in the right side (the ventral and dorsal anterior cingulate cortex, the putamen, and the caudate nucleus).

“Deficient cortical activation likely accounted for their more impulsive, error-prone performances, compared with controls,” the authors wrote. “These deficits may be caused by previously reported decreases in serotonin metabolism in frontal cortices in [bulimics].”

The differences between the groups were independent of IQ, depression, and ADHD rating instruments.

Women with bulimia nervosa appear to have deficient activity in frontostriatal regulatory circuits of the anterior cingulate cortex, as assessed on functional MRI.

This subnormal activation likely contributes to their greater than normal impulsivity in eating and other behaviors, said Dr. Rachel Marsh and associates at the New York State Psychiatric Institute, New York (Arch. Gen. Psych. 2009;66:51–63).

They assessed 20 women recruited from an eating disorders clinic and 20 healthy control subjects matched for body mass index and age (average, 26 years). All underwent fMRI imaging while performing the Simon spatial incompatibility task to compare differences between the group in brain activation patterns associated with self-regulatory control.

The bulimia patients made significantly more errors on the task than did controls, and their accuracy decreased further over time. Those with the most severe bulimia symptoms made the most errors.

Compared with controls, bulimia patients showed deficits in the activation of circuits in the brain's left side (the inferolateral prefrontal cortex and the left lenticular nucleus) and in the right side (the ventral and dorsal anterior cingulate cortex, the putamen, and the caudate nucleus).

“Deficient cortical activation likely accounted for their more impulsive, error-prone performances, compared with controls,” the authors wrote. “These deficits may be caused by previously reported decreases in serotonin metabolism in frontal cortices in [bulimics].”

The differences between the groups were independent of IQ, depression, and ADHD rating instruments.

Greater automation of a hospital information system appears to be associated with substantial reductions in mortality, complications, and costs for many patients, according to a report.

In a study of 72 general urban hospitals across Texas, a random sample of physicians who provided inpatient care rated the degree to which the hospitals had effectively computerized four information technology (IT) domains: medical notes and records, test results, entry of medical orders, and support for clinical decision making.

These results were correlated with patient outcomes at the hospitals, said Dr. Ruben Amarasingham of the University of Texas Southwestern Medical Center, Dallas, and his associates.

The more than 7,400 physicians who participated in the study practiced internal medicine (including 9 subspecialties), general surgery (including 10 subspecialties), or family practice. Patients older than age 50 years who were being treated for four clinical conditions—myocardial infarction, heart failure, coronary artery bypass grafting, or pneumonia—were assessed.

The study statistically controlled for the likelihood that medical centers with more IT tend to have more resources available and better performance on quality-of-care measures to start with, the researchers noted.

They found “impressive” associations between several information technologies and beneficial outcomes.

For example, hospitals that scored well for computerized entry of medical orders showed a 9% reduction in MI mortality and a 55% reduction in CABG mortality. Those that scored high for computerized support for medical decision making—such as easy online access to treatment guidelines—showed a 21% decrease in complications.

Hospitals that scored high for automation of medical notes and records showed a 15% decrease in all-cause fatalities. “This would suggest that for every 1,000 patients, 5 fewer patients die at hospitals with the highest notes and records scores,” Dr. Amarasingham and his colleagues said (Arch. Intern. Med. 2009;169:108-14).

Hospitals with effective IT also had substantially lower costs.

Length of stay was the only outcome that did not show any relation with effective IT. Given that length of stay already is extremely low because of payer scrutiny of hospital stays, “this measure may already be so low as to be resistant to the efficiencies introduced by IT,” the investigators noted.

In an editorial comment accompanying this report, Dr. David W. Bates of Brigham and Women's Hospital, Boston, termed this study a “landmark” because it assessed physicians' everyday use of IT across numerous hospitals with a diverse array of patient populations.

“Hospital IT is expensive, and there have been serious doubts about the extent to which it will actually be beneficial,” Dr. Bates noted (Arch. Intern. Med. 2009;169:105-7).

At a time when many hospitals are losing money, most “have been nervous about making large investments in technology that is difficult to implement, creates major issues with change management, carries a substantial risk of failure, and has uncertain benefits,” Dr. Bates said.

The findings of this study demonstrate that the negative effects of implementing hospital IT do not “overwhelm or wash out the positive ones, as some have suggested,” Dr. Bates added.

Dr. Amarasingham is also affiliated with the center for knowledge translation and clinical innovation at Parkland Health and Hospital System, Dallas.

Greater automation of a hospital information system appears to be associated with substantial reductions in mortality, complications, and costs for many patients, according to a report.

In a study of 72 general urban hospitals across Texas, a random sample of physicians who provided inpatient care rated the degree to which the hospitals had effectively computerized four information technology (IT) domains: medical notes and records, test results, entry of medical orders, and support for clinical decision making.

These results were correlated with patient outcomes at the hospitals, said Dr. Ruben Amarasingham of the University of Texas Southwestern Medical Center, Dallas, and his associates.

The more than 7,400 physicians who participated in the study practiced internal medicine (including 9 subspecialties), general surgery (including 10 subspecialties), or family practice. Patients older than age 50 years who were being treated for four clinical conditions—myocardial infarction, heart failure, coronary artery bypass grafting, or pneumonia—were assessed.

The study statistically controlled for the likelihood that medical centers with more IT tend to have more resources available and better performance on quality-of-care measures to start with, the researchers noted.

They found “impressive” associations between several information technologies and beneficial outcomes.

For example, hospitals that scored well for computerized entry of medical orders showed a 9% reduction in MI mortality and a 55% reduction in CABG mortality. Those that scored high for computerized support for medical decision making—such as easy online access to treatment guidelines—showed a 21% decrease in complications.

Hospitals that scored high for automation of medical notes and records showed a 15% decrease in all-cause fatalities. “This would suggest that for every 1,000 patients, 5 fewer patients die at hospitals with the highest notes and records scores,” Dr. Amarasingham and his colleagues said (Arch. Intern. Med. 2009;169:108-14).

Hospitals with effective IT also had substantially lower costs.

Length of stay was the only outcome that did not show any relation with effective IT. Given that length of stay already is extremely low because of payer scrutiny of hospital stays, “this measure may already be so low as to be resistant to the efficiencies introduced by IT,” the investigators noted.

In an editorial comment accompanying this report, Dr. David W. Bates of Brigham and Women's Hospital, Boston, termed this study a “landmark” because it assessed physicians' everyday use of IT across numerous hospitals with a diverse array of patient populations.

“Hospital IT is expensive, and there have been serious doubts about the extent to which it will actually be beneficial,” Dr. Bates noted (Arch. Intern. Med. 2009;169:105-7).

At a time when many hospitals are losing money, most “have been nervous about making large investments in technology that is difficult to implement, creates major issues with change management, carries a substantial risk of failure, and has uncertain benefits,” Dr. Bates said.

The findings of this study demonstrate that the negative effects of implementing hospital IT do not “overwhelm or wash out the positive ones, as some have suggested,” Dr. Bates added.

Dr. Amarasingham is also affiliated with the center for knowledge translation and clinical innovation at Parkland Health and Hospital System, Dallas.

Greater automation of a hospital information system appears to be associated with substantial reductions in mortality, complications, and costs for many patients, according to a report.

In a study of 72 general urban hospitals across Texas, a random sample of physicians who provided inpatient care rated the degree to which the hospitals had effectively computerized four information technology (IT) domains: medical notes and records, test results, entry of medical orders, and support for clinical decision making.

These results were correlated with patient outcomes at the hospitals, said Dr. Ruben Amarasingham of the University of Texas Southwestern Medical Center, Dallas, and his associates.

The more than 7,400 physicians who participated in the study practiced internal medicine (including 9 subspecialties), general surgery (including 10 subspecialties), or family practice. Patients older than age 50 years who were being treated for four clinical conditions—myocardial infarction, heart failure, coronary artery bypass grafting, or pneumonia—were assessed.

The study statistically controlled for the likelihood that medical centers with more IT tend to have more resources available and better performance on quality-of-care measures to start with, the researchers noted.

They found “impressive” associations between several information technologies and beneficial outcomes.

For example, hospitals that scored well for computerized entry of medical orders showed a 9% reduction in MI mortality and a 55% reduction in CABG mortality. Those that scored high for computerized support for medical decision making—such as easy online access to treatment guidelines—showed a 21% decrease in complications.

Hospitals that scored high for automation of medical notes and records showed a 15% decrease in all-cause fatalities. “This would suggest that for every 1,000 patients, 5 fewer patients die at hospitals with the highest notes and records scores,” Dr. Amarasingham and his colleagues said (Arch. Intern. Med. 2009;169:108-14).

Hospitals with effective IT also had substantially lower costs.

Length of stay was the only outcome that did not show any relation with effective IT. Given that length of stay already is extremely low because of payer scrutiny of hospital stays, “this measure may already be so low as to be resistant to the efficiencies introduced by IT,” the investigators noted.

In an editorial comment accompanying this report, Dr. David W. Bates of Brigham and Women's Hospital, Boston, termed this study a “landmark” because it assessed physicians' everyday use of IT across numerous hospitals with a diverse array of patient populations.

“Hospital IT is expensive, and there have been serious doubts about the extent to which it will actually be beneficial,” Dr. Bates noted (Arch. Intern. Med. 2009;169:105-7).

At a time when many hospitals are losing money, most “have been nervous about making large investments in technology that is difficult to implement, creates major issues with change management, carries a substantial risk of failure, and has uncertain benefits,” Dr. Bates said.

The findings of this study demonstrate that the negative effects of implementing hospital IT do not “overwhelm or wash out the positive ones, as some have suggested,” Dr. Bates added.

Dr. Amarasingham is also affiliated with the center for knowledge translation and clinical innovation at Parkland Health and Hospital System, Dallas.