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Outcome
of Myocardial Infarction in Veterans Health Administration Patients
as Compared with Medicare Patients
Some believe that the quality of care is not as high at Veterans
Health Administration (VHA) hospitals as at other hospitals. This
study found that, among older patients with acute myocardial infarction,
30-day and 1-year mortality rates were the same in VHA and non-VHA
hospitals where Medicare patients were treated. However, the VHA
patients had more coexisting conditions, such as hypertension, chronic
obstructive pulmonary disease or asthma, and stroke.
This study
refutes the belief that the quality of care, in this case for myocardial
infarction, is inferior at VHA hospitals, as compared with non-VHA
hospitals. Even though VHA patients as a group have a higher burden
of coexisting illnesses than non-VHA patients, the mortality rate
for this serious condition is the same as that among Medicare beneficiaries
treated in non-VHA hospitals.
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This study addressed the question of whether regular use of inhaled triamcinolone
slows the decline in lung function that occurs in patients with chronic
obstructive pulmonary disease (COPD). The 1116 participants received either
an inhaled corticosteroid or a placebo for a mean of 40 months. Although
inhaled triamcinolone improved airway reactivity and respiratory symptoms,
it did not slow the decline in lung function. Its use, however, was associated
with a greater loss of bone mineral density.
This
prospective study of patients colonized with vancomycin-resistant enterococci
examined changes in the density of these organisms in stool in relation
to treatment with antibiotics. The number of vancomycin-resistant enterococci
in stool increased by a factor of more than 10 in 10 of 13 patients who
began treatment with antianaerobic antibiotics, whereas overall, the density
decreased slightly in 10 patients who received antibiotics with minimal
antianaerobic activity.
