An observational study of 19,537 patients admitted to 94 hospitals in 14 countries found that people who used cholesterol-lowering drugs called statins before admission had better outcomes than patients who never took statins. This benefit occurred only if patients continued statins in the hospital (Article. p. 857). Researchers also found that patients who had not been taking statins but started taking statins in the hospital had far fewer deaths than those who never took statins. An editorial writer raised cautions about using observational studies to determine the effectiveness of medical therapies. In this study, physicians may have been more likely to start or continue statin therapy for patients with favorable prognoses than for those who were at high risk for death.
Study: Little Evidence on Usefulness of Bioterrorism Surveillance Systems
Although surveillance systems to detect illnesses and syndromes related to bioterrorism have proliferated, researchers found little information about how good they would be at detecting bioterrorism and emerging infections (Review, p. 910). Researchers identified 115 systems that collect various surveillance reports. Only three had been evaluated for accuracy. Only two disease surveillance systems and no environmental monitoring system had been evaluated in studies published in peer-reviewed journals. "Given the striking lack of information on the timeliness, sensitivity and specificity, and ability of systems to facilitate decision making, clinicians and public health officials deploying these systems do so with little scientific evidence to guide them," the authors say.
SUPPLEMENT ON DIABETES
Six papers in this Annals issue explore diabetes control and prevention, evolving disease burden, environmental issues in diabetes self-management education, application of economic analysis to diabetes and diabetes care and moving diabetes care from science to practice (Supplement, pp. 943-984). The ideas were presented at the CDC's Diabetes and Public Health 25th Anniversary Symposium in September 2003.
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Annals of Internal Medicine