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This Week in JAMA
JAMA. 2000;284:803.
A New Risk Score for Acute Coronary Syndromes
In clinical practice, risk stratification schemes can facilitate therapeutic decision making, especially in heterogeneous patient populations in which outcomes vary widely. Antman and colleagues (SEE ARTICLE) developed and validated a 7-item risk score for patients with non–ST elevation acute coronary syndromes using data from 2 trials comparing enoxaparin therapy with unfractionated heparin. Increasing risk scores were associated with increased rates of all-cause mortality, new or recurrent myocardial infarction, or recurrent ischemia requiring revascularization through 14 days after trial randomization. In a commentary, Ohman and coauthors (SEE ARTICLE) discuss risk stratification based on analyses of results of other trials and emphasize the importance of clinical scoring systems for decision making for patients with acute coronary syndromes.
Mild and Moderate Prematurity and Infant Mortality
Infants born between 32 and 36 weeks' gestational age (mild to moderate prematurity) have a lower risk of mortality and morbidity than infants born very prematurely, but may contribute more to infant mortality at the population level. Kramer and colleagues analyzed linked birth and mortality data for singleton births in 2 US birth cohorts, 1985 and 1995, and in 2 Canadian birth cohorts, 1985-1987 and 1992-1994. Compared with term births, relative risk of death during the first year of life among mild and moderate preterm births ranged from 2.9 to 6.6 in the United States and 4.5 to 15.2 in Canada, and was highest in the neonatal period. Mild and moderate preterm births accounted for a greater proportion of infant deaths than births at 28 through 31 gestational weeks.
(SEE ARTICLE)
Cochlear Implantation in Children Cost-effective
Cochlear implantation may help children with profound deafness who do not benefit from conventional hearing aids, but cost-effectiveness data on cochlear implantation in children are not available. Cheng and colleagues conducted a cross-sectional survey of parents of profoundly deaf children to determine changes in health status after implantation, and estimated lifetime direct medical costs and indirect costs of the implant. Cochlear implantation improved quality of life on 3 different measures of health utility. Direct medical costs per quality-adjusted life-year ranged from $5197 to $9207, and the estimated net savings to society, including indirect costs, was $53,198 per child.
(SEE ARTICLE)
APC Gene Mutation and Colorectal Polyps
The I1307K mutation in the adenomatous polyposis coli (APC) gene has been associated with increased risk of colorectal cancer in Ashkenazi Jewish patients. In this study of Ashkenazi Jewish patients with colorectal polyps who did not have colorectal cancer, Syngal and colleagues found that the carrier rate of the I1307K mutation in Ashkenazi Jewish patients with adenomatous polyps significantly exceeded the reported prevalence of the mutation among control populations of Ashkenazi Jewish individuals without colorectal cancer, but the carrier rate in Ashkenazi Jewish patients with hyperplastic polyps was not increased. Among patients with adenomatous polyps, characteristics of the polyps and family history of colorectal cancer, other cancer, and polyps were similar in carriers and noncarriers.
(SEE ARTICLE)
Aging, Sleep Regulation, and Neuroendocrine Function
Sleep, which affects the regulation of growth hormone and cortisol secretion in young adults, decreases in duration and diminishes in quality with normal aging. In this cross-sectional study of 149 healthy men aged 16 to 83 years, Van Cauter and colleagues (SEE ARTICLE) found that from early to mid-adulthood, deep slow wave sleep and growth hormone secretion decreased markedly, but total sleep, sleep fragmentation, REM sleep, and cortisol secretion did not change. From midlife to late life, REM sleep decreased, wake time increased, and nocturnal cortisol release increased. In an editorial, Blackman (SEE ARTICLE) reviews the effects of aging on sleep regulation, age-related changes in neuroendocrine function, and their interrelationship.
A Piece of My Mind
"The ‘e' in ‘e-mail,' originally meant to designate ‘electronic,' also stands for ‘enslavement.'" From "Ten e-pistles for the e-fficient trimillennial physician."
(SEE ARTICLE)
Medical News & Perspectives
Nutrition is on the table: A new CME course offers to teach physicians about the Mediterranean diet on site, and a global network aims to reverse the worldwide trend toward obesity.
(SEE ARTICLE)
Users' Guides to the Medical Literature
How to identify good evidence about the clinical manifestations of disease to guide clinical diagnosis.
(SEE ARTICLE)
Controversies
Screening for Melanoma
Disparate views by Edman and Klaus (SEE ARTICLE) and by Weinstock (SEE ARTICLE) on the early detection of melanoma highlight the diagnostic complexities of this disease; the uncertain role of patients, families, primary care physicians, and dermatologists; and the risks of misdiagnosis.
JAMA Patient Page
For your patients: A primer on angina.
(SEE ARTICLE)
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