Honor Roll

U.S. News put 5,462 medical centers through progressively finer screens to create the 16 specialties rankings in the 2007 edition of America’s Best Hospitals. Just 173 hospitals made it into the rankings, and of those, a mere 18 displayed the marked breadth of expertise, with high scores in at least six specialties, that qualified them for the Honor Roll. They are ordered by total points—a hospital got 2 points if it ranked at or close to the top in a specialties and 1 point if it ranked slightly lower (View 2007 Methodology).

1

Johns
Hopkins Hospital, Baltimore

30 points in 15 specialties

2

Mayo
Clinic, Rochester, Minn.

29 points in 15 specialties

3

UCLA
Medical Center, Los Angeles

25 points in 15 specialties

4

Cleveland
Clinic

25 points in 13 specialties

5

Massachusetts
General Hospital, Boston

23 points in 12 specialties

6

New
York-Presbyterian Univ. Hosp. of Columbia and Cornell

21 points in 11 specialties

7

Duke
University Medical Center, Durham, N.C.

18 points in 10 specialties

7

University
of California, San Francisco Medical Center

18 points in 10 specialties

9

Barnes-Jewish
Hospital/Washington University, St. Louis

17 points in 11 specialties

10

Brigham
and Women’s Hospital, Boston

16 points in 10 specialties

11

University
of Washington Medical Center, Seattle

15 points in 9 specialties

12

Hospital
of the University of Pennsylvania, Philadelphia

11 points in 8 specialties

13

University
of Pittsburgh Medical Center

10 points in 7 specialties

14

University
of Michigan Hospitals and Health Centers, Ann Arbor

9 points in 7 specialties

15

Stanford
Hospital and Clinics, Stanford, Calif.

8 points in 6 specialties

15

Yale-New
Haven Hospital, New Haven, Conn.

8 points in 6 specialties

17

Cedars-Sinai
Medical Center, Los Angeles

7 points in 6 specialties

17

University
of Chicago Medical Center

7 points in 6 specialties

CHICAGO, Aug. 6, 2007—Adults with attention-deficit/hyperactivity disorder (ADHD) show a blunted response to the drug methylphenidate (Ritalin), which increases brain dopamine levels, according to a report in the August issue of

Archives of General Psychiatry, one of the JAMA/Archives journals. This suggests that dopamine dysfunction may be involved with ADHD symptoms and may contribute to substance abuse that often occurs simultaneously.

ADHD is the most prevalent psychiatric disorder among children, according to background information in the article. “Despite decades of research, the specific neurobiological mechanisms underlying this disorder still remain unclear,” the authors write. “Genetic, clinical and imaging studies point to a disruption of the brain dopamine system, which is corroborated by the clinical effectiveness of stimulant drugs (methylphenidate hydrochloride and amphetamine), which increase extracellular dopamine in the brain.”

Nora D. Volkow, M.D., of the National Institute on Drug Abuse, Bethesda, Md., and colleagues studied 19 adults with ADHD (average age 32) who had never received medication and 24 healthy controls (average age 30). Brain scans were performed using positron emission tomography (PET) and a drug known as raclopride labeled with carbon 11 ([11C]raclopride), which binds with dopamine receptors. Scans were performed twice, after injections of placebo and of methylphenidate; the participants did not know which drug they had received. Participants also were asked to report the severity of their ADHD symptoms, whether they could detect the drug, if they liked or disliked it, and if it made them feel “high,” tired, alert, anxious or restless.

In individuals with ADHD, methylphenidate caused less of a decrease in the amount of [11C]raclopride that bound to dopamine receptors in areas of the brain associated with attention than it did in those without ADHD. Since levels of methylphenidate in the blood were the same in both groups, this suggests that those with ADHD released less dopamine in response to the drug than controls. This blunted response was associated with symptoms of inattention. Exploratory analyses also found evidence of reduced [11C]raclopride binding in the hippocampus and amygdala in those with ADHD. These areas of the brain are part of the limbic system, involved in emotional responses as well as consolidating and retrieving memories.

“The findings of reduced dopamine release in subjects with ADHD are consistent with the notion that the ability of stimulant medications to enhance extracellular dopamine underlies their therapeutic effects in ADHD,” the authors write.

Individuals with ADHD also reported liking methylphenidate more than individuals without ADHD, the authors note. “The reinforcing responses to methylphenidate were negatively correlated with the dopamine increases, suggesting that decreased dopaminergic activity may also be involved in modulating the magnitude of the reinforcing effects of methylphenidate,” they continue. “This suggests that dopamine dysfunction is involved with symptoms of inattention but may also contribute to substance abuse comorbidity in ADHD.”
(Arch Gen Psychiatry. 2007;64(8):932-940. Available to the media pre-embargo at www.jamamedia.org).

Note: This research was supported in part by the Intramural Research Program of the National Institutes of Health, a contract from the Department of Energy, and by a grant from the National Institute of Mental Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations@jama-archives.org

Science Daily, Aug 12, 2007, — As people lose the ability to walk unaided, they tend to suffer further deterioration that can interfere with other daily living activities. As the U.S. population ages, it becomes increasingly important to identify and target interventions for those people who are at risk for further disabilities and illness.

In a paper published in the September issue of the American Journal of Preventive Medicine, researchers closely examined the factors that affected Health-Related Quality-of-Life for a group of older Americans. The study revealed that mobility is a key factor impacting quality of life for older adults.

Lifestyle Interventions and Independence for Elders–Pilot study (LIFE–P) was a randomized, controlled trial that compared a physical activity intervention to a non-exercise educational intervention with 424 older adults at risk for disability. Baseline information included demographics, medical history, the Quality of Well-Being Scale (QWB-SA), a timed 400 m walk, and the Short Physical Performance Battery (SPPB). Using these data, the authors looked for those factors that affected HRQOL.

The mean QWB-SA score for a sample of older adults considered at risk for disability was 0.634, below the 0.704 score found for healthy older adults. According to Erik J. Groessl, PhD, of the VA San Diego Healthcare System and University of California San Diego, the difference of 0.070 is “more than the amount attributed to a variety of diseases including colitis, migraine, arthritis, stroke, ulcer, asthma, and anxiety….Surprisingly, however, mobility was a stronger correlate of HRQOL than an index of comorbidity, suggesting that interventions addressing mobility limitations may provide significant health benefits to this population. …Taken together with past research, which has demonstrated that loss of mobility predicts loss of independence, mortality, and nursing home admission, it is clear that interventions that can preserve or improve mobility in older adults could produce increases in both quantity and quality of life.”

These results highlight the need to develop effective interventions for older adults at risk for disability.