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This Week in JAMA
JAMA. 2003;289:2175.
Electron Beam Tomography for CHD Risk Reduction
Electron beam tomography (EBT), which visualizes calcification of the coronary arteries, has been used as a cardiovascular disease screening tool to motivate individuals to reduce coronary heart disease (CHD) risk factors. O'Malley and colleagues (SEE ARTICLE) conducted a randomized trial among asymptomatic active-duty US army personnel aged 39 to 45 years to assess the effects of incorporating EBT into a cardiovascular screening program with either intensive case management or usual care. After 1 year, change in the 10-year Framingham Risk Score, a composite measure of cardiovascular risk, was not significantly different in the study groups that received EBT results and those that did not. In an editorial, Greenland (SEE ARTICLE) points out the complexity of behavioral change necessary to reduce disease risk factors.
Pacing Therapy to Prevent Recurrent Vasovagal Syncope
In previous trials of pacemaker therapy for patients with severe recurrent vasovagal syncope, pacemaker therapy was found to reduce the risk of recurrent syncope, but these studies were not blinded. In this double-blind trial of pacemaker therapy for vasovagal syncope, in which all study participants underwent dual chamber pacemaker implantation, Connolly and colleagues (SEE ARTICLE) randomly assigned patients to receive either dual chamber pacing with rate drop response or only sensing without pacing. Risk of recurrent syncope at 6 months was not significantly different in the 2 study groups. In an editorial, Kapoor (SEE ARTICLE) discusses why pacemakers should not be used for treatment of neurally mediated syncope.
Incidence of Sleep-Disordered Breathing
Sleep-disordered breathing (SDB) is a prevalent condition that is associated with serious chronic illness. In this analysis of data from a subgroup of adult participants in the community-based Cleveland Family Study, Tishler and colleagues found that the 5-year incidence of SDB was 16% or less for mild to moderately severe SDB and 7.5% for moderately severe SDB. Incidence of SDB was influenced independently by age, body mass index, sex, waist-hip ratio, and serum cholesterol concentration.
(SEE ARTICLE)
Hospice Use With Managed Care vs Fee for Service
To assess whether type of health insurance affects hospice use, McCarthy and colleagues conducted a retrospective analysis of data from the last year of life from patients dying with cancer who had Medicare managed care insurance and from those who had Medicare fee-for-service insurance. Hospice use varied by type of primary cancer, but patients enrolled in Medicare managed care had consistently higher rates of hospice use than patients with Medicare fee-for-service insurance. Overall, hospice stays were significantly longer among patients with Medicare managed care.
(SEE ARTICLE)
Effect of a National Disaster on Blood Supply and Safety
Blood supply safety and donor return patterns may be affected by the increase in blood donations that occurs in times of crisis. In this analysis of data from 5 regional blood centers participating in the National Heart, Lung, and Blood Institute Retrovirus Epidemiology Donor Study, Glynn and colleagues found that the weekly number of blood donations, especially among first-time donors, increased markedly in the week beginning with the September 11, 2001, terrorist attacks compared with the number of donations collected weekly during the 4 weeks preceding September 11. Screening reactivity rates for infectious disease markers and rates of positive confirmatory tests for HIV, HCV, or HBsAg increased during the 4 weeks after the attacks, consistent with the increase in first-time donors. First-time donor 12-month return rates were relatively low and were similar in 2000 and 2001.
(SEE ARTICLE)
A Piece of My Mind
"In a profession with constant demands from people who need me, full of daily negotiations, the most difficult negotiation, oddly enough, may be to learn how to be with myself." From "Time to Myself."
(SEE ARTICLE)
Medical News & Perspectives
Evidence is accumulating that aortic stenosis, once thought to be a degenerative condition associated with aging, is the product of an active disease process that may be treatable.
(SEE ARTICLE)
CLINICIAN'S CORNER
Insulin Use in Diabetes
Scientific Review/Clinical Applications
Advances in insulin therapy for type 1 and type 2 diabetes are reviewed in part 1 of this 2-part article (SEE ARTICLE) . Clinical cases in part 2 illustrate how to use new insulin strategies to improve glucose control and overall diabetes care (SEE ARTICLE) .
MSJAMA
Physician-assisted suicide: Issues in the ongoing legal and ethical debate.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about insulin.
(SEE ARTICLE)
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