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This Week in JAMA
JAMA. 1999;282:107.
JAMA-EXPRESS
Live, Attenuated Intranasal Flu Vaccine Effective
Annual influenza immunization is not routinely recommended for healthy adults younger than 65 years, but in addition to individual medical risks, the number of days lost from work and use of health care resources associated with influenza infection are substantial. Nichol and colleagues report (SEE ARTICLE) that severe febrile illnesses and febrile upper respiratory tract illnesses, work absenteeism, health care visits, and medication use were reduced during the 1997-1998 influenza season in healthy adults who received intranasal trivalent, live, attenuated influenza virus vaccine compared with subjects who received placebo. In an editorial (SEE ARTICLE) , Poland and Couch point out that the effectiveness of inactivated influenza vaccine is similar to that of the live, attenuated intranasal vaccine, but the intranasal vaccine may offer several advantages, including self-administration.
Adverse Events While Awaiting Coronary Angiography
To determine the frequency of adverse cardiac outcomes in patients waiting for elective coronary angiography, Rosanio and colleagues studied a cohort of 381 adult outpatients on a waiting list for elective coronary angiography at a tertiary care hospital. Adverse events occurred in 36 patients during a mean follow-up of 8.4 months. The most frequent adverse event was the occurrence of unstable angina requiring hospitalization, and most events occurred between 3 and 13 weeks after referral for angiography. In an editorial, Graboys questions the indications for invasive cardiovascular and therapeutic procedures, including coronary angiography, and contends that the large number of available facilities for coronary angiography in the United States should obviate any need for waiting lists.
(SEE ARTICLE) and editorial (SEE ARTICLE)
Population Prevalence of Carpal Tunnel Syndrome
In this population-based epidemiologic study of individuals aged 25 to 74 years, Atroshi and colleagues found that 354 (14.4%) of 2466 survey respondents reported symptoms of carpal tunnel syndrome (CTS). One hundred twenty (45.8%) of 262 symptomatic subjects and 23 (18.4%) of 125 control (asymptomatic) subjects who underwent nerve conduction testing had median neuropathy. Ninety-four of 262 symptomatic subjects had clinically certain CTS on physical examination and 66 symptomatic subjects had both clinical and electrophysiological evidence of CTS (population prevalence, 2.7%). In an editorial, Franzblau and Werner suggest that measurement of intracarpal canal pressure and noninvasive imaging of the median nerve may improve diagnostic accuracy.
(SEE ARTICLE) and editorial (SEE ARTICLE)
Quality of Care in Investor-Owned HMOs
Based on an analysis of 1996 quality-of-care data in the Health Plan Employer Data and Information Set (HEDIS), Himmelstein and colleagues found that investor-owned health maintenance organizations (HMOs), which now comprise the majority of plans in the managed care market, reported lower rates for all 14 quality-of-care indicators (routine preventive services and care for specific medical conditions) than not-for-profit HMOs. The largest differences in quality-of-care rates were in 2 indicators of quality of care for patients with serious medical illnesses—myocardial infarction and diabetes mellitus.
(SEE ARTICLE)
Reporting Requirements for Diseases, Conditions
Recommendations for notifiable diseases and conditions for national public health surveillance are determined annually by the Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists, but reporting requirements for health care providers and laboratories are mandated by state and territorial governments. Roush and coworkers present a comprehensive listing of reporting requirements compiled from a survey of state and territorial epidemiologists conducted in 1997 and updated in 1999.
(SEE ARTICLE)
A Piece of My Mind
"Is it possible that sorrow can remain unresolved not only for the one who bears it but also for he who rejects its telling?" From "To Whom Shall I Tell My Grief?"
(SEE ARTICLE)
Contempo 1999
Beneficial drug therapies may be underprescribed for elderly patients.
(SEE ARTICLE)
Medical News & Perspectives
Should physicians prescribe drugs to reduce the risk of breast cancer in healthy women with above-average risk of the disease? Experts consider the latest evidence.
(SEE ARTICLE)
Special Communication
Resolving ethical issues that arise from discontinuity of care imposed by hospitalist systems.
(SEE ARTICLE)
The Rational Clinical Examination
A review of studies on the accuracy and precision of the clinical examination for the diagnosis of meningitis in adults.
(SEE ARTICLE)
Public Opinion and Health Care
Voters' views on health care issues in the 1998 congressional elections: a synthesis of data from voter surveys.
(SEE ARTICLE)
JAMA Patient Page
For your patients: A primer on carpal tunnel syndrome.
(SEE ARTICLE)
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