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17 March 2009 Annals of Internal Medicine Tip Sheet

Below is information about three studies being published in the March 17 issue of Annals of Internal Medicine. The information is not intended to substitute for articles as sources of information. Annals of Internal Medicine attribution is required for all coverage. For an embargoed copy of an article, contact Angela Collom at or 215-351-2653.

1. USPSTF Recommends Taking Aspirin to Prevent Heart Attack and Stroke in At-risk Patients

Physicians Should Weigh Aspirin Benefits Against Risk for Serious Bleeding Events
Cardiovascular disease is the leading cause of death in the United States. For patients who have had a cardiovascular event, aspirin has been known to decrease the chances of a heart attack or stroke recurring. In 2002, the USPSTF recommended that adults who have risk factors for heart attack but who have not yet had one should discuss the benefits and harms of aspirin with their doctors. However, doctors have been cautious about recommending a preventive dose of aspirin because it can cause rare but serious bleeding events. Since its last report, the USPSTF has reviewed newly published research. The Task Force found good evidence that aspirin decreases first heart attacks in men without known cardiovascular disease, but does not reduce stroke. In women without known cardiovascular disease, aspirin reduces first strokes, but not heart attack. They also found that aspirin prevents more heart attacks and strokes in groups of people with higher numbers of risk factors for cardiovascular disease. Therefore, the USPSTF recommends that at-risk men age 45 to 79 should take aspirin if the chances of preventing first heart attack outweigh the chances of bleeding in the digestive tract. At-risk women age 55 to 79 years should take aspirin if the chances of reducing first ischemic stroke outweigh the bleeding risks.

2. Older Patients May Not Regain Mobility Following Hospitalization

Life space is a measure of where a person goes, how often, and how independently. Life space is considered an accurate measure of mobility in older adults because it reflects participation in society as well as physical ability. Researchers looked at 687 community-dwelling Medicare beneficiaries to assess the effects of surgical and non-surgical hospitalization on life space. They found that hospitalization decreases life space in older adults. Surgical hospitalizations were associated with immediate marked life space declines followed by rapid recovery. Non-surgical hospitalizations were associated with more modest immediate declines. However, while patients with surgical hospitalizations made significant recoveries in life space mobility over time, those with non-surgical hospitalizations did not return to pre-hospitalization life space status even after two years of follow up.

3. Could Nursing Home Physician Specialty Remedy Workforce Crisis in Long-term Care?

More than 1.6 million Americans live in nursing homes. Nursing home residents are frail, and often suffer from medically complex issues. However, according to researchers, the quality of care in nursing homes remains inconsistent and suboptimal. The authors propose that creating a nursing home medical specialty could help to remedy some of these significant care issues. The researchers suggest that a nursing home specialist should be characterized in three dimensions: the degree of physicians’ commitment to caring for nursing home patients; the physicians’ practice competencies; and the structure of the medical staff organization in which they practice. The authors recognize significant challenges associated with developing such a specialty. Currently, mainstream medicine does not recognize the nursing home as a legitimate practice site. In addition, policymakers would need to appreciate the links between physician practice and quality of care. And, finally, the specialty would need to have financial viability in order for doctors to seriously consider it as a career. However, this issue may take on increased urgency if the nursing home population continues to increase over time as anticipated.

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