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This Week in JAMA
JAMA. 2002;287:1899.
JAMA-EXPRESS
PCI vs Thrombolytic Therapy for Acute MI
Although clinical trials suggest that primary percutaneous coronary intervention (PCI) for the treatment of patients with acute myocardial infarction (MI) is superior to thrombolytic therapy, PCI has generally been limited in clinical trials and in practice to patients treated at hospitals with on-site cardiac surgery. In this randomized trial, Aversano and colleagues (SEE ARTICLE) compared PCI and thrombolytic therapy at 11 community hospitals without on-site cardiac surgery or existing PCI programs after first establishing a formal primary PCI program at each hospital. Consistent with results of previous trials, clinical outcomes in patients with acute MI were significantly better at 6 weeks and 6 months after the index MI in the primary PCI group compared with those in the thrombolytic therapy group. In an editorial, Cannon (SEE ARTICLE) discusses the implications of these results for the emergency triage of patients with acute MI.
Outcomes of Children With Prenatal Cocaine Exposure
Few longitudinal studies have evaluated the developmental outcomes of children with prenatal cocaine exposure. Singer and colleagues (SEE ARTICLE) evaluated cognitive and motor development in a cohort of cocaine-exposed and unexposed infants recruited at birth from a high-risk population and followed up until 2 years of age. Cocaine-exposed children had significant cognitive deficits and an increased rate of cognitive developmental delay during the first 2 years of life. In an editorial, Zuckerman and coauthors (SEE ARTICLE) explore why this study, in contrast to other comparable studies, found a negative association between prenatal cocaine exposure and developmental test scores in early childhood and caution against using these findings to perpetuate misperceptions about cocaine-exposed children.
Improving the Quality of Hemodialysis Treatment
Among patients with end-stage renal disease receiving chronic hemodialysis treatment, inadequate dialysis dose is associated with increased mortality, increased hospitalizations, and high inpatient costs. In this community-based trial, Sehgal and colleagues randomly assigned nephrologists and randomly selected patients among those in their practices receiving inadequate hemodialysis to an intervention group with patient-specific education and feedback designed to address 3 common barriers to adequate dialysis or to a control group with usual care. After 6 months, patients in the intervention group had significantly larger increases in dialysis dose compared with patients in the control group.
(SEE ARTICLE)
Transfusion-Related Acute Lung Injury
Transfusion-related acute lung injury (TRALI) is a clinical syndrome associated with transfusion of blood products and is characterized by dyspnea, hypoxemia, hypotension, bilateral pulmonary edema, and fever. Kopko and colleagues conducted a retrospective chart review of patients who had received blood components from a donor who was linked to a fatal case of TRALI. Transfusion reactions consistent with TRALI were reported in the charts of 13 of 36 transfusion recipients, but TRALI was rarely diagnosed, and reactions were infrequently reported to the hospital transfusion service or to the regional blood collection facility.
(SEE ARTICLE)
Medical News & Perspectives
Women's health researchers who met recently at the National Institutes of Health highlighted a comprehensive, multiyear project to summarize the epidemiology, etiology, and treatment prospects for age-related disorders.
(SEE ARTICLE)
CLINICIAN'S CORNER
Scientific Review and Clinical Applications
In Part 1 (SEE ARTICLE) , evidence linking gastroesophageal reflux disease (GERD) and Barrett esophagus to esophageal adenocarcinoma is reviewed, and the usefulness of upper endoscopy screening for adenocarcinoma in individuals with GERD is evaluated. In Part 2 (SEE ARTICLE) , clinical vignettes illustrate common questions encountered when caring for patients with GERD, particularly how to address cancer risk.
Controversies
Recent reports have emphasized the importance of improving patient safety. Layde and coauthors (SEE ARTICLE) propose an approach to address patient safety that focuses on medical injury, based on a public health model of injury prevention. In contrast, McNutt and coauthors (SEE ARTICLE) assert that patient safety is best addressed through the detection of medical error at the policy-making, organizational, and technical levels of the medical care delivery system.
JAMA Patient Page
For your patients: Information about blood donation.
(SEE ARTICLE)
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