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This Week in JAMA
JAMA. 1998;280:1383.
Mortality After First MI Higher in Women
In a prospective cohort study of more than 1400 patients hospitalized with a first acute myocardial infarction, Marrugat and colleagues found that women had higher mortality rates at 28 days and at 6 months after infarction than men. Increased severity of myocardial infarction, but not differences in coronary risk factors, comorbidity, or therapy, explained in large part the higher mortality and readmission rates at 6 months in women.
(SEE ARTICLE)
Molecular Assays Improve Prognostic Cancer Staging
The clinical importance of detecting submicroscopic metastases using molecular assays was assessed by Shivers and colleagues who prospectively evaluated 114 patients with malignant melanoma without clinical evidence of metastatic disease. Biopsy specimens from sentinel lymph nodes were studied by routine histology and by a reverse transcriptase–polymerase chain reaction assay for tyrosinase messenger RNA as a marker for the presence of melanoma cells. Combining histological findings with molecular assay results improved the prediction of melanoma recurrence and patient survival.
(SEE ARTICLE)
Reporting of HIV Test Results Poses Policy Dilemma
Confidential but identifiable reporting of HIV test results may improve the surveillance of HIV infection, but people at risk may be reluctant to be tested unless testing is anonymous. Bindman and colleagues (SEE ARTICLE) report that persons residing in states with both anonymous and confidential HIV testing who tested anonymously were more likely to have early testing and medical treatment than those who tested confidentially. Nakashima and colleagues (SEE ARTICLE) , however, did not find a significant decline in the number of HIV tests at publicly funded HIV counseling and testing sites after the sites changed from anonymous to confidential reporting.
NIH Panel Proposes Plan to Increase Clinical Research
The National Institutes of Health (NIH) Director's Panel on Clinical Research (SEE ARTICLE) proposes a multifaceted approach to revitalize clinical research programs. In related commentaries, Schechter (SEE ARTICLE) calls for more aggressive remedies and Shine (SEE ARTICLE) emphasizes the importance of encouraging clinical research by physician investigators.
A 29-Year-Old Man With Multiple Sclerosis
Mr J has had multiple sclerosis for about 1 year, with slowly progressive weakness of his right leg. He wonders whether to begin disease-modifying therapy. In this Clinical Crossroads, Rudick emphasizes that brain inflammation and irreversible neuronal damage occur in patients with multiple sclerosis in the absence of clinical symptoms, an understanding that supports beginning therapy early in the course of the disease.
(SEE ARTICLE)
Patient Safety Programs to Reduce Medical Error
Systems that are proactive and preventive are more likely to reduce medical error than those that are reactive and punitive. In an editorial, Leape and colleagues describe 4 bold initiatives that incorporate the management of medical error into comprehensive strategies to promote patient safety.
(SEE ARTICLE)
The Cover
". . . remarkable opportunities for combining the resources of science and art to study human history." Mummy mask of a noblewoman, Egyptian, New Kingdom, early 19th dynasty, c 1290-1224 BC.
(SEE ARTICLE)
A Piece of My Mind
"Cancer talk. You can't teach it. It is more than words. It can only be learned through experience." From "Don't Call Me ‘Larry'."
(SEE ARTICLE)
Medical News & Perspectives
Correctional health experts decry the practice of licensing and employing impaired physicians in jails and prisons.
(SEE ARTICLE)
Contempo 1998
Advances in techniques to improve the appearance of aged skin.
(SEE ARTICLE)
The Patient-Physician Relationship
Caring for patient volunteers in clinical research studies presents physician investigators with complex ethical issues.
(SEE ARTICLE)
JAMA Patient Page
For your patients: A woman's guide to prevention of heart disease.
(SEE ARTICLE)
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