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This Week in JAMA
JAMA. 2001;286:1415.
Racial Disparity in Managed Care vs Fee-for-Service Plans
Racial disparities in the use of health care resources have been well documented. In this analysis of data from the 1996 Medicare Current Beneficiary Survey, Schneider and colleagues (SEE ARTICLE) report that rates of influenza vaccination were higher among both blacks and whites enrolled in Medicare managed care than in fee-for-service insurance, but the racial disparity in vaccination rates was similar in the 2 health plan groups. In a commentary, Katz (SEE ARTICLE) considers how factors that influence patient preferences may contribute to racial disparity.
Lifespan of Clinical Practice Guidelines
Practice guidelines must be both valid and up-to-date to be clinically useful. Shekelle and colleagues (SEE ARTICLE) assessed the current validity of 17 guidelines developed between 1990 and 1996 and found that 13 required updating. About half of the guidelines were outdated in 5.8 years. In an editorial, Browman (SEE ARTICLE) suggests frequent updating as a method to maintain guidelines that is both pragmatic and likely to preserve the validity of the original document.
LDL Particle Size and Coronary Events
Evidence suggesting an association between low-density lipoprotein (LDL) particle size and coronary heart disease has been inconsistent and contradictory. Campos and colleagues investigated whether LDL particle size was an independent predictor of recurrent coronary events in patients with known coronary heart disease who participated in a randomized placebo-controlled trial of pravastatin. The mean LDL particle size was identical in case patients—those who experienced a coronary death or myocardial infarction during the trial follow-up period—and controls. Large LDL particle size was an independent predictor of coronary events only among patients in the placebo group.
(SEE ARTICLE)
Blood Donors With Hereditary Hemochromatosis
The use of blood from donors with hereditary hemochromatosis has been restricted by regulatory policies, in part because of the perceived risk associated with possible financial incentives related to therapeutic phlebotomy. In this survey of blood donors from 8 US blood centers, Sanchez and colleagues found that almost half of donors with hemochromatosis reported donating for therapeutic reasons, but the prevalence of unreported deferrable risks for transfusion-transmissible viral infections and positive screening test results was similar in donors with hemochromatosis and non–health-related donors.
(SEE ARTICLE)
Cost-effectiveness of AEDs on Commercial Aircraft
The Federal Aviation Administration has issued a ruling requiring all commercial aircraft with at least 1 flight attendant to carry automated external defibrillators (AEDs) by 2004. In this cost-effectiveness analysis of different options for AED deployment in commercial aircraft, Groeneveld and colleagues found that the incremental cost per quality-adjusted life-year gained of placing AEDs on mid-sized and large-capacity commercial aircraft compared favorably with other accepted health care and transportation safety interventions.
(SEE ARTICLE)
A Woman With an Extremely Premature Newborn
After an uneventful pregnancy until the 24th week of gestation, Mrs C delivered an 830-g infant at 25 weeks' gestation by emergency cesarean delivery. Richardson discusses the survival, early complications, and long-term outcomes of very low-birth-weight infants.
(SEE ARTICLE)
A Piece of My Mind
"It has been six months since he died, master of the garden, master of everything. His garden personifies him—vivid, unpredictable, maverick, cynical, nuanced in every aspect. Beautiful." From "Futility."
(SEE ARTICLE)
Contempo Updates
Type 2 diabetes mellitus in children.
(SEE ARTICLE)
Medical News & Perspectives
A scientific meeting meant to clarify issues surrounding cloning generated more heat than light, but studies by experts in epigenetics are resulting in answers to some basic questions about this novel method of reproduction.
(SEE ARTICLE)
Subcutaneous Ovarian Transplantation
Transplantation of ovarian cortical strips to the forearm preserved endocrine function in women undergoing sterilizing cancer therapy or surgery.
(SEE ARTICLE)
Calculating Adjusted Survival Curves
The mean of covariates method to calculate adjusted survival curves, commonly used despite questionable validity, is compared with the corrected group prognosis method.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about type 2 diabetes mellitus in children.
(SEE ARTICLE)
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