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This Week in JAMA
JAMA. 2003;289:2905.
Ticlopidine vs Aspirin for Stroke Prevention in Blacks
Blacks are disproportionately affected by stroke, but have been underrepresented in clinical trials of stroke prevention. In this randomized trial among black patients with a recent noncardioembolic ischemic stroke, Gorelick and colleagues (SEE ARTICLE) found no statistically significant difference between ticlopidine and aspirin in the prevention of the composite end point of recurrent stroke, myocardial infarction (MI), or vascular death over a 2-year follow-up. In an editorial, Sacco (SEE ARTICLE) discusses antithrombotic therapy for prevention of recurrent stroke in black patients and the need for more effective stroke prevention strategies, especially among individuals with high stroke risk.
Neonatal Mortality of Infants Born on Weekends
In studies conducted several decades ago, births on weekends were fewer than expected, and neonatal mortality was higher, consistent with current concerns about the quality of weekend medical care. In this analysis of 1995-1997 California linked data from birth and infant death certificates, Gould and colleagues found that observed neonatal mortality increased from 2.80 per 1000 births on weekdays to 3.12 per 1000 on weekends, but after adjusting for birth weight, the increase in neonatal mortality for infants born on weekends was not statistically significant.
(SEE ARTICLE)
Computer Use and Symptoms of Carpal Tunnel Syndrome
Andersen and colleagues conducted a 1-year follow-up study of a cohort of draftsmen and machine technicians to evaluate the relationship between mouse device and keyboard use and possible carpal tunnel syndrome. At 1-year follow-up, the incidence of self-reported new or worsened tingling or numbness in the right hand was 5.5%, but only 1.2% had median nerve symptoms confirmed by clinical interview. Mouse use of 20 h/wk or more was associated with risk of possible carpal tunnel syndrome, but there was no statistically significant association with keyboard use.
(SEE ARTICLE)
Incremental Treatment Costs for Patients in Clinical Trials
The perception that participation in clinical studies increases the costs of direct patient care has impeded efforts to enroll patients in clinical trials. Goldman and colleagues assessed the additional costs of treating participants in clinical trials by comparing the direct treatment costs of patients with cancer enrolled in clinical trials sponsored by the National Cancer Institute with those of matched patients who were not trial participants. On average, the treatment costs were only 6.5% higher over 2 years for trial participants than for patients not enrolled in a clinical trial.
(SEE ARTICLE)
Therapeutic Hypothermia for Traumatic Brain Injury
McIntyre and colleagues (SEE ARTICLE) conducted a systematic review to evaluate the use of therapeutic hypothermia as a neuroprotective strategy after severe traumatic brain injury in adults. In their analysis of the results of 12 randomized controlled trials, therapeutic hypothermia was associated with a significant reduction in the risk of death and of poor neurologic outcome compared with normothermia. Outcomes were influenced by the depth and duration of hypothermia and by the rate of rewarming. In an editorial, Kochanek and Safar (SEE ARTICLE) discuss research questions that should be addressed by future clinical investigations on the use of hypothermia in patients with severe traumatic brain injury.
Contempo Updates
Ways to promote physical activity through primary care.
(SEE ARTICLE)
Medical News & Perspectives
Experts say that widespread use of carrier testing for cystic fibrosis and confusion over the interpretation of laboratory results are creating unnecessary risks.
(SEE ARTICLE)
Lipid Levels in Men With HIV Treated With HAART
Analysis of data from an ongoing prospective study of homosexual and bisexual men suggests that after about 3 years of highly active antiretroviral therapy (HAART), total cholesterol and low-density lipoprotein cholesterol levels, which decreased substantially before treatment of HIV infection, return to preseroconversion levels after accounting for expected age-related changes.
(SEE ARTICLE)
Scale for Monitoring Sedation of ICU Patients
In this prospective study of intensive care unit (ICU) patients, the Richmond Agitation-Sedation Scale, a brief structured clinical instrument to assess patient sedation in the ICU, demonstrated strong interrater reliability and criterion, construct, and face validity.
(SEE ARTICLE)
CLINICIAN'S CORNER
Nonalcoholic Fatty Liver Disease
Grand Rounds
A case of a 53-year-old man who presented with a persistent right pleural effusion and ascites illustrates this discussion of nonalcoholic fatty liver disease, a common cause of cryptogenic cirrhosis.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about traumatic brain injury.
(SEE ARTICLE)
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