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This Week in JAMA
JAMA. 2003;290:2513.
Concussion in Collegiate Football Players
In this issue of THE JOURNAL, 2 prospective cohort studies report on recovery from concussion in collegiate football players during 3 competitive seasons. Guskiewicz and colleagues, (SEE ARTICLE) in a study of football players at 25 US colleges, found that the overall incidence of concussion was 0.81 per 1000 athlete-exposures. History of previous concussion was significantly associated with increased risk of incident concussion and with slower recovery of neurological function after concussion. McCrea and colleagues (SEE ARTICLE) studied the acute effects of concussion and time to recovery after concussion in football players at 15 US colleges. Athletes who sustained a concussion exhibited the most severe symptoms, cognitive dysfunction, and balance problems immediately after the concussion, followed by a gradual course of recovery over 5 to 7 days. In an editorial, (SEE ARTICLE) McKeag discusses some of the key aspects involved in current management of sports-related concussion.
Newborn Screening for Biochemical Genetic Disorders
Expanded newborn screening using tandem mass spectrometry allows testing for more than 20 biochemical genetic disorders. Waisbren and colleagues (SEE ARTICLE) compared outcomes of children with biochemical genetic disorders identified by expanded newborn screening in Maine and Massachusetts and by a private laboratory in Pennsylvania with those identified clinically in any New England state. Children identified by expanded newborn screening had fewer hospitalizations, shorter hospital stays, fewer medical problems, and higher scores on developmental tests than did children identified clinically. Mothers in the screened group reported lower overall stress than did mothers in the clinically identified group, but mothers of children who had false-positive screening results reported greater stress and parent-child dysfunction than did mothers of children with normal screening results. In an editorial, (SEE ARTICLE) Holtzman examines whether expanded newborn screening using tandem mass spectrometry meets criteria for use in population-wide screening programs.
Extracorporeal Shock Wave for Calcific Tendonitis
Gerdesmeyer and colleagues conducted a randomized trial to assess fluoroscopy-guided extracorporeal shock wave therapy for treatment of calcific tendonitis of the shoulder. Improvement in shoulder function was significantly greater at the 6-month follow-up in patients with chronic, symptomatic calcific tendonitis who received high-energy or low-energy extracorporeal shock wave therapy than in those who received sham treatment.
(SEE ARTICLE)
Clinical Prediction Model for Heart Failure Mortality Risk
Few methods are available to clinicians for estimating heart failure mortality risk. Lee and colleagues used data from community-based patients newly hospitalized with heart failure to develop and validate a predictive model of heart failure mortality risk that uses clinical information routinely available at the time patients present to the hospital. Significant predictors of 30-day and 1-year mortality in patients with heart failure included older age, lower systolic blood pressure, higher respiratory rate, higher urea nitrogen level, hyponatremia, and the presence of comorbid conditions.
(SEE ARTICLE)
Duration of Antibiotic Therapy for Patients With VAP
Most experts recommend 14 to 21 days of antimicrobial treatment for ventilator-associated pneumonia (VAP). In this randomized trial among patients in intensive care units with microbiologically proven VAP, Chastre and colleagues found that among patients who received appropriate initial empirical therapy, mortality from any cause and rate of recurrent pulmonary infection at 28 days after onset of VAP were not significantly different in patients who received antibiotics for 8 days compared with those who received antibiotics for 15 days. The number of antibiotic-free days from day 1 to day 28 was significantly greater in those who received the 8-day regimen.
(SEE ARTICLE)
A Piece of My Mind
"For people employed in health care, having an ill family member creates a tension that defies resolution." From "Conflict of Interest."
(SEE ARTICLE)
Medical News & Perspectives
The movement of angiogenesis inhibitors from the laboratory into the clinic has fallen short of expectations, but continuing research is leading to better understanding of the process and development of new antiangiogenic agents. (Photo credit: D. M. McDonald/Nature Publishing Group)
(SEE ARTICLE)
CLINICIAN'S CORNER
Contempo Updates
Pathogenesis, diagnosis, and management of chronic graft-vs-host disease.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about concussion in sports.
(SEE ARTICLE)
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