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This Week in JAMA
JAMA. 2003;289:519.
Prevention of Acute Nephropathy After Angiography
Acetylcysteine is an antioxidant that has been shown to prevent acute contrast nephrotoxicity in patients with impaired renal function exposed to contrast agents during computed tomography. In this randomized placebo-controlled trial, Kay and colleagues (SEE ARTICLE) assessed whether acetylcysteine prevents acute deterioration in renal function in patients with moderate chronic renal insufficiency undergoing elective coronary angiography. Significantly more patients experienced greater than a 25% rise in serum creatinine in the placebo group than in the acetylcysteine group within 48 hours after contrast administration. Serum creatinine was lower in the acetylcysteine group than in the placebo group during the first 48 hours after angiography, and creatinine clearance increased significantly in the acetylcysteine group 2 days after contrast administration, but not in the placebo group. In an editorial, Curhan (SEE ARTICLE) discusses clinical measures for reducing risk of contrast nephropathy in patients undergoing coronary angiography and when they should be used.
Natural History of Late-Onset Idiopathic Scoliosis
Serious cardiopulmonary compromise and disability from back pain have been reported in previous long-term studies of idiopathic scoliosis, but these studies have included patients with scoliosis of other etiologies, including congenital, neuromuscular, or early-onset scoliosis. In this 50-year follow-up study, Weinstein and colleagues (SEE ARTICLE) found that untreated patients with late-onset idiopathic scoliosis did not have an increased rate of mortality in general or of mortality from cardiac or pulmonary conditions possibly related to the spine curvature compared with control patients. Significantly more patients with scoliosis complained of back pain than did control patients, but among those with back pain, most reported little or moderate pain. Overall function was not significantly different in the 2 groups, but patients with scoliosis had lower body satisfaction scores. In an editorial, Sponseller (SEE ARTICLE) discusses the use of this information for discussing treatment options with patients with idiopathic scoliosis.
Prevention of Injury in Youth Baseball
Safety balls and faceguards are widely used in youth baseball. In this analysis of data from a national database of compensated insurance claims maintained by Little League Baseball Incorporated, Marshall and colleagues found that use of reduced-impact balls and faceguards was associated with reduced risk of injury in youth baseball during the 1997-1999 seasons.
(SEE ARTICLE)
Supply of Pneumococcal Vaccine During a Shortage
In August 2001, a serious shortage of the heptavalent pneumococcal conjugate vaccine (PCV7) developed in 34 state immunization programs in the United States. The vaccine had recently been recommended for universal administration to all children younger than 2 years. Freed and colleagues interviewed office staff responsible for ordering vaccine at private practices in 12 states to determine the nature and extent of the PCV7 shortage at the practice level. Overall, more than half of practices reported at least 1 episode during the shortage of being out of stock of PCV7 from both public and private supply sources, with marked state-to-state variation. Few practices altered their PCV7 administration policy in accordance with revised recommendations to prioritize PCV7 to specific groups of children.
(SEE ARTICLE)
Medical News & Perspectives
The Environmental Protection Agency is considering whether to end a self-imposed moratorium on using human toxicity studies to help determine safe levels of pesticide use.
(SEE ARTICLE)
Alcohol Intake and Stroke Risk
In this meta-analysis of observational studies on alcohol consumption and stroke risk, heavy alcohol consumption was associated with increased relative risk of total, ischemic, and hemorrhagic stroke. Light or moderate alcohol consumption was associated with reduced relative risk of total and ischemic stroke.
(SEE ARTICLE)
CLINICIAN'S CORNER
Violence Against Women
Scientific Review/Clinical Applications
In part 1 (SEE ARTICLE) , evidence on the effectiveness of interventions aimed at preventing abuse or reabuse of women is reviewed. Hypothetical cases in the primary care setting presented in part 2 (SEE ARTICLE) illustrate clinical approaches to intimate partner violence.
MSJAMA
Medical narratives: a collection of creative writing.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about baseball safety.
(SEE ARTICLE)
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