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This Week in JAMA
JAMA. 2001;285:979.
Prohibiting Purchase of Handguns by Misdemeanants
Since 1991, California has prohibited the purchase or possession of handguns by persons convicted of violent misdemeanor crimes for 10 years following the conviction. Wintemute and colleagues (SEE ARTICLE) report that misdemeanants who purchased a handgun in 1989-1990 were more likely to be arrested for new gun-related or violent crimes during a 3-year follow-up period than misdemeanants who were denied the purchase of a gun in 1991. In an editorial, Cole (SEE ARTICLE) discusses how combining different approaches to firearm injury prevention—strategies that target high-risk individuals, population-based strategies, and strategies that decrease supply of guns or demand—may reduce the incidence of firearm injury.
Physician Specialty and Dialysis Recommendation
In the United States, only 13% to 17% of adult patients with end-stage renal disease receiving dialysis are treated with peritoneal dialysis, whereas 45% to 65% of children and adolescents receiving dialysis are treated with this dialysis method. Using case vignettes in a survey of adult and pediatric nephrologists, Furth and colleagues found that pediatric nephrologists were 60% more likely than adult nephrologists to recommend peritoneal dialysis rather than hemodialysis for identical hypothetical patients with renal failure.
(SEE ARTICLE)
Predicting Outcomes of Stem Cell Transplantation
Prior to stem cell transplantation for hematologic diseases, Lee and colleagues measured patient and physician estimates of the chance of cure with and without transplantation and treatment-related mortality, and compared these estimates with each other and with actual treatment-related mortality and disease-free survival after transplantation. Patients were significantly more optimistic than physicians on all measures. When actual mortality was less than 30%, both patients and physicians were fairly accurate in estimating treatment-related mortality; but when mortality was higher than 30%, physician expectations were lower while patients remained optimistic.
(SEE ARTICLE)
Isolation of Tropheryma whippelii
Culture of Tropheryma whippelii, the bacterium that causes Whipple disease, has been established only once, from a heart valve inoculum. Raoult and colleagues report the isolation and genotyping of a second strain of T whippelii from the duodenal biopsy specimen of a patient with typical relapsing Whipple disease with intestinal involvement using a novel method for culture and detection.
(SEE ARTICLE)
Liver Transplantation and Opioid Dependence
Hepatitis C and alcoholic liver disease are the leading causes of liver transplantation in the United States. In this survey of adult US liver transplantation programs that belong to the United Network of Organ Sharing, Koch and Banys found that all responding programs accept applicants with a history of alcoholism or other drug addictions, including heroin. Most programs require at least 6 months of abstinence. Patients receiving methadone maintenance are accepted by 56% of the responding programs, but 32% require that methadone be discontinued.
(SEE ARTICLE)
Contempo Updates
Choosing a revascularization method for treatment of patients with coronary artery disease.
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Medical News & Perspectives
Former injection drug users receiving methadone maintenance therapy who are infected with hepatitis C virus face barriers to getting treatment for their illness.
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Prenatal Diagnosis of Down Syndrome
Meta-analysis of data from 56 articles indicates that second-trimester ultrasonographic markers are not sufficiently sensitive for detection of fetuses with Down syndrome to be useful as a screening test.
(SEE ARTICLE)
Botulinum Toxin as a Biological Weapon
This fourth article in a series of consensus statements from the Working Group on Civilian Biodefense discusses medical and public health management following the use of botulinum toxin as a bioweapon.
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Thank You to Authors and Peer Reviewers
JAMA acknowledges with gratitude (SEE ARTICLE) the authors of the 4366 manuscripts received in 2000 and the scholarly contributions of the 3613 peer reviewers (SEE ARTICLE) .
JAMA Patient Page
For your patients: Information about Down syndrome.
(SEE ARTICLE)
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