MEDICAL NEWS & PERSPECTIVES
belief structure out there, where fam- to improve the uptake in behavior
ily members and a lot of providers be-
lieve that antipsychotic medications are
effective and necessary, Gifford said.
The early literature suggested [such
medication] was effective in demen-
tia, but as the evidence grew, we dis-
covered it can cause some harm, just
like any medication, and its effective-
ness was probably not as strong as
believed.
An emphasis on nonpharmacologi-
cal methods for treating residents
with dementia calls for a better skilled
and deployed nursing home staff.
Weve partnered with the actual par-
ticipants caring for these residents
to provide the skill sets and training
Study: Acute Coronary
Events Linked With PTSD
Rebecca Voelker
O
NE OF EVERY 8 PATIENTS WHO
have a myocardial infarction
or other acute coronary event
develops clinical symptoms of post-
traumatic stress disorder (PTSD) an-
nually in the United States, according
to recent research.
In a meta-analysis, researchers ex-
amined data from 24 studies that in-
cluded 2383 patients with acute coro-
nary events worldwide. The study also
showed that developing PTSD doubles
the risk of having another acute epi-
sode or dying within 1 to 3 years, com-
pared with cardiac patients who didnt
develop PTSD. Given that some 1.4 mil-
lion patients are hospitalized annually
with an acute coronary event, the in-
vestigators estimated that 12%, or
168 000 patients, will develop PTSD
(Edmondson D et al. PLoS ONE. 2012;
7[6]:e38915).
PTSD is most commonly perceived
as resulting from exposure to such dis-
turbing events as military combat,
sexual assault, and man-made or natu-
ral disasters. Common symptoms in-
2012 American Medical Association. All rights reserved.
Downloaded From: http://jamanetwork.com/ by a American Medical Association User on 12/16/2016
interventions in nursing homes, said
Ling.
And while some believe that would
add costs to facilities that feel under-
funded to begin with, Gifford dis-
agrees. The knee-jerk response is to
say we need more resources, Gifford
said. If you can use some of these
nonpharmacological approaches and
prevent behaviors happening in the
first place, in some circumstances,
you might need less staff. That is why
we are pushing for consistent assign-
ment. If you know what a residents
likes and dislikes are, you can avoid
inadvertently putting them in a dan-
gerous situation.
clude intrusive thoughts, nightmares,
elevated heart rate and blood pres-
sure, and avoiding reminders of the trig-
gering event. It is also quite common
among patients who have had a severe
coronary event, said lead author Don-
ald Edmondson, PhD, of the Colum-
bia University Medical Center in New
York, NY, in a statement.
In fact, Edmondson said evidence
shows that psychological disorders are
underrecognized and undertreated in
heart patients. Underdiagnosis may be
even more pronounced in cardiac prac-
tices than in other types of medical
practices, he said.
The study noted that the cost to the
US health care system of recurrent acute
coronary events linked with PTSD
could be in the hundreds of millions of
dollars. Effective treatment is avail-
able for PTSD, but Edmondson said
physicians and patients first must be-
come aware of the link with acute coro-
nary events. The next step is research
to determine whether treating PTSD
symptoms can reduce recurrences
of acute heart problems and related
mortality.
news@JAMA
From JAMAs Daily News Site
Induced Hypothermia Benefit
Cooling the body temperature of infants born
with oxygen deficiencies improves their
chances of surviving into early childhood, re-
searchers recently reported.
An earlier study showed that reducing an
oxygen-deprived infants temperature to as
low as 91.4F for 72 hours improved sur-
vival at 18 to 22 months of age compared with
usual care. In the latest study, the research-
ers reported on 190 of the original 208 in-
fants at age 6 or 7 years. Of the 97 children
in the hypothermia group, 27 died (28%)
compared with 41 deaths among 93 chil-
dren (44%) in the usual care group. No in-
creases in disability were reported in the hy-
pothermia group.
http://tinyurl.com/72bz4w4
Projected 75% Cancer Increase
Cancer rates world-
wide are expected to
increase by 75% by
2030, according to a
recent study.
The analysis was
the first to examine
global cancer pat- Don Bayley/iStockphoto.com
terns according to
individual coun-
tries development levels. Researchers re-
ported that as living standards improve in
some low-development nations, rates of in-
fection-related cancers such as cervical can-
cer and Kaposi sarcoma will decrease, only
to be replaced by cancers more commonly
linked with Western lifestylesbreast, pros-
tate, and colorectal cancers.
In some of the worlds poorest countries,
the analysis indicated that cancer rates could
increase by more than 90%.
http://tinyurl.com/bvjqmp8
Not Ready for Prime Time
Optimismthathometelemonitoringdevicesmay
be able to reduce time in the hospital for older,
sicker adults may be premature.
In a recent study, researchers random-
ized 205 adults with an average age of 80 years
and multiple chronic health problems to a te-
lemonitoring program or usual care at 4 Mayo
Clinic sites in Minnesota. After 12 months,
the researchers found no difference in hos-
pitalization rates or emergency department
visits between the 2 groups.
Telemonitoring will become a bigger part
of medicine . . . but the question is when is the
appropriate time to use it, said Mayo Clinic
researcher Paul Y. Takahashi, MD, MPH.
http://tinyurl.com/7hq4s2q
For more on these stories and other medical
news, visit http://newsatjama.jama.com/.
JAMA, July 11, 2012Vol 308, No. 2 121