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This Week in JAMA
JAMA. 2004;291:663.
Patient Satisfaction With Dialysis
Patients with end-stage renal disease can be treated with either hemodialysis or peritoneal dialysis, but whether one modality offers a survival advantage over the other is unknown. If survival is relatively equivalent, patient preference can weigh more heavily in treatment choice. Rubin and colleagues (SEE ARTICLE) assessed satisfaction with dialysis care among new dialysis patients who had undergone an average of 7 weeks' treatment. Compared with patients who received hemodialysis at the same centers, those receiving peritoneal dialysis rated their overall care as excellent and expressed more satisfaction on all 23 care-related items investigated. In an editorial, Heaf (SEE ARTICLE) highlights advantages of peritoneal dialysis and offers recommendations for increasing its use.
C-Reactive Protein and Macular Degeneration
Similarities in several risk factors for both cardiovascular disease and age-related macular degeneration (AMD) have led some researchers to suggest the existence of common biological precursors, including inflammation. Elevated levels of C-reactive protein (CRP), a marker of systemic inflammation, are seen in patients with cardiovascular disease, and it has been hypothesized that similar elevations might be observed in patients with AMD. To test this hypothesis, Seddon and colleagues examined the relationship between CRP levels and AMD in a subset of participants enrolled in the Age-Related Eye Disease Study. While controlling for established risk factors for AMD, they found significantly elevated CRP levels in patients with intermediate and advanced AMD vs those in patients with no AMD, suggesting inflammation may have a role in AMD development.
(SEE ARTICLE)
Iron and Diabetes Risk
Patients with hemochromatosis may develop type 2 diabetes, but whether moderate elevations in body iron are associated with diabetes risk in healthy individuals is an open question. In a nested case-control study within the Nurses' Health Study, Jiang and colleagues examined the association of baseline plasma ferritin concentration and the ratio of transferrin receptors to ferritin with development of type 2 diabetes. Controlling for body mass index, C-reactive protein level, and other risk factors for diabetes; alcohol consumption; and menopausal status, they found that women who developed diabetes in a 10-year follow-up had significantly higher baseline serum ferritin levels and a significantly lower ratio of transferrin receptors to ferritin than women who did not.
(SEE ARTICLE)
Genetic Links in Colorectal Cancer
Gene mutations linked to increased cancer risk are typically identified in relatively small, homogeneous populations. When a common mutation is found in diverse populations, counseling and clinical surveillance of individuals at risk are facilitated. Lynch and colleagues determined the prevalence of a founder mutation associated with hereditary nonpolyposis colorectal cancer (HNPCC) in members of 9 presumably unrelated families in the United States. Detailed genealogic studies of the 9 families revealed that 3 of the families share common ancestry traced to a couple who migrated from Germany to Pennsylvania in the early 1700s; an additional 5 families had common time and geographic connections to the progenitor couple. The authors suggest this mutation may account for a significant number of cases of HNPCC in the white US population.
(SEE ARTICLE)
Tertiary Contact Vaccinia
Recent resumption of a smallpox immunization program in the United States brought renewed concerns about inadvertent inoculation and transmission to household contacts. Garde and colleagues report the first case of inadvertent contact vaccinia transmission to a breastfeeding infant whose mother developed areolar vaccinia lesions several weeks after primary vaccination of her spouse.
(SEE ARTICLE)
A Piece of My Mind
"The tears start again. How does he do this every day? How can he stand this?" From "The Chronicity of Chronic Disease."
(SEE ARTICLE)
Medical News & Perspectives
New research is providing insights into how mitochondria influence brain health and disease.
(SEE ARTICLE) and online video
Controversies: Organ Donation
Members of the UCLA Medical Center Ethics Committee and Renal Transplant Program (SEE ARTICLE) discuss a case of surrogate consent for living related organ donation prior to withdrawal of life support from a permanently comatose patient. Wendler and Emanuel (SEE ARTICLE) review ethical and practical considerations relative to surrogate consent for living organ donation in patients presumed to be near death.
CLINICIAN'S CORNER
Contempo Updates
Advances in interventions for acute myocardial infarction.
(SEE ARTICLE)
Appreciation
Words of appreciation for JAMA's peer reviewers.
(SEE ARTICLE) | (SEE ARTICLE)
JAMA Patient Page
For your patients: Information about percutaneous coronary intervention.
(SEE ARTICLE)
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