Table of Contents

Changes in thrombogenic and inflammatory biomarkers might predict near-term cardiovascular disease events. The authors measured d-dimer, amyloid A protein, and C-reactive protein annually for 3.4 years in 377 patients with peripheral arterial disease. Elevated levels were associated with all-cause and cardiovascular disease–related deaths occurring 1 to 2 years after their measurement but not with deaths occurring after 2 years. A similar pattern occurred after increases in these levels: increased risk for death for a few years but not later. This observation requires confirmation in a larger sample.

Although outpatient, emergency department, and hospital visits have been used as indicators of sickle cell disease severity, the relationship between painful episodes and subsequent use of health care is unclear. In this study, 232 patients with sickle cell disease completed a daily diary for 6 months, providing 31 017 patient-days of observation. Patients reported pain on 56% of total patient-days, crises on 15%, and health care utilization on 4%. Patients usually managed increased pain without assistance from the health care system.

Identifying normotensive adults who have a high probability of developing hypertension could help target nonpharmacologic preventive measures. Using data from the Framingham cohort study, the investigators devised a simple risk score that identified adults without diabetes who had low (10%) probability of developing hypertension within 4 years. If this risk score gives similar results in other populations, it could help clinicians identify high-risk patients who could benefit from preventive interventions.

Public reporting of health care system performance might cause patients to migrate to high-performing systems, creating a business case for quality improvement programs. The authors synthesized the current evidence that requirements to publicly report performance data are associated with quality improvement programs. They found 45 peer-reviewed, English-language articles that evaluated the impact of public reporting on quality improvement efforts and quality of care. Evidence suggests that public release of performance data stimulates quality improvement activity at the hospital level. The effect in other settings and on effectiveness, safety, and patient-centeredness remains uncertain.

This Update in Palliative Care features 7 recent articles of interest to palliative care practitioners. Topics include pain management, nonpain symptom management, nursing home care, prognosis, and quality of care.

This systematic review sought to determine which disease-modifying antirheumatic drugs (DMARDs) best reduce symptoms, improve function, and prevent radiographic progression in patients with rheumatoid arthritis. The authors found few head-to-head comparisons of different agents. They also found that synthetic DMARDs were similar to one another. Anti–tumor necrosis factor drugs were more effective than synthetic DMARDs in reducing radiographic joint damage. Combination therapy improved response rates and functional outcomes in patients who did not benefit from monotherapy. Short-term adverse events were similar among DMARDs.

This American College of Physicians guideline presents the available evidence to improve palliative care at the end of life. The target audience is all clinicians caring for patients who need end-of-life care, and the target patient population is everyone with seriously disabling or symptomatic chronic conditions at the end of life.

This systematic evidence review supports the American College of Physicians guideline on palliative care at the end of life. Strong to moderate evidence supports use of various treatments for cancer pain, dyspnea from chronic lung disease, and cancer-associated depression; multicomponent interventions to improve continuity in heart failure; advance care planning; and interventions to alleviate caregiver burden. Evidence was weak for cancer-related dyspnea management and reducing caregiver burden in caring for patients with cancer.

In this issue, Fung and colleagues research the impact of public reports on quality improvement, assessing the impact on consumer selection, quality improvement efforts, and improved effectiveness. Their findings show that public reports of hospital performance appear to stimulate hospitals to make efforts to improve quality and have a moderate impact on consumers' selection of a health plan. The evidence for all other potential impacts was mixed. While the findings do not uphold the theory that drives public reporting, they are consistent with the conventional wisdom that inconsistent execution yields variable results.

Clinicians need an up-to-date, comprehensive summary of the evidence to help them choose 1 disease-modifying antirheumatic drug (DMARD) over another or to decide which combinations of DMARDs to consider for patients with rheumatoid arthritis. In this issue, Donahue and colleagues systematically review the literature comparing the benefits and harms associated with different DMARDs, used alone or in combination. Their findings are well supported by the evidence, are clinically useful, and seem generally consistent with the American College of Rheumatology guidelines for managing rheumatoid arthritis.

Cultures all over the world understand the importance of naming. It is said that being able to name an object bestows power over it. Naming my nemesis has given me a power with lifelong implications for better and more comprehensive care.