 |
|
This Week in JAMA
JAMA. 2005;293:1701.
Racial Differences in BRCA1/2 Testing
Racial disparities in health care are well documented, but little is known about racial differences in genetic susceptibility testing. Armstrong and colleagues (SEE ARTICLE) investigated the relationship between race and use of BRCA1/2 counseling among women with a family history of breast or ovarian cancer and assessed the contributions of socioeconomic factors, probability of carrying a BRCA1/2 mutation, cancer risk perceptions and worry, attitudes about genetic testing, and physician recommendations to the counseling decision. They found that African American women were significantly less likely than white women to undergo genetic counseling, with much of the disparity unexplained by the potential confounders considered. In an editorial, Hall and Olopade (SEE ARTICLE) discuss factors contributing to race- and ethnicity-related disparities in cancer prevention and general preventive care.
Predicting Cardiovascular Mortality in Kidney Disease
Elderly patients with chronic kidney disease are at increased risk of cardiovascular mortality, but the relative importance of traditional vs novel risk factors in predicting risk has not been evaluated. Shlipak and colleagues assessed the predictive value of traditional and novel risk factors in a longitudinal study of patients with and without chronic kidney disease. Among patients with chronic kidney disease, traditional risk factors including left ventricular hypertrophy, current smoking, physical inactivity, systolic hypertension, diabetes, and nonuse of alcohol were better predictors of cardiovascular mortality than novel risk factors.
(SEE ARTICLE)
Fibrinolytic Therapy Dosing Errors
Incorrect dosing of fibrinolytic therapy has been associated with adverse clinical outcomes, but whether the adverse events are related to the dosing errors or patient factors is not clear. Mehta and colleagues analyzed data from a randomized trial in which patients with an ST-segment elevation myocardial infarction were assigned to either a bolus of tenecteplase (with alteplase placebo) or a bolus of alteplase (with tenecteplase placebo) to examine the relationships between fibrinolytic therapy dose, patient factors, and adverse outcomes. In their analyses, adverse outcomes were as likely in patients with alteplase placebo dosing errors as in patients with alteplase dosing errors, suggesting that patient-related factors, not fibrinolytic dosing errors, are responsible for the adverse outcomes.
(SEE ARTICLE)
Combination Pneumococcal-Meningococcal Vaccine
Buttery and colleagues report results of a randomized trial assessing the safety and immunogenicity of a combination 9-valent pneumococcal–group C meningococcal conjugate candidate vaccine (Pnc9-MnC) compared with a monovalent group C meningococcal conjugate (MenC) in infants. Reports of increased irritability and decreased activity were higher in the Pnc9-MnC group, and infants receiving the Pnc9-MnC vaccine had reduced group C meningococcal immunogenicity compared with those receiving the MenC vaccine.
(SEE ARTICLE)
Abciximab Therapy in STEMI
To better establish the role of abciximab as adjunctive therapy to reperfusion in ST-segment elevation myocardial infarction (STEMI), De Luca and colleagues conducted a meta-analysis of data from 11 randomized trials of abciximab in STEMI. They found that compared with patients in the control group, patients undergoing primary angioplasty and receiving abciximab had significant reductions in 30-day and 6- to 12-month mortality, and the 30-day reinfarction rate was reduced in patients receiving abciximab and treated with either fibrinolysis or primary angioplasty. Major bleeding complications were more common in patients receiving fibrinolytics and abciximab compared with those among control patients.
(SEE ARTICLE)
Medical News & Perspectives
Researchers are exploring the use of transcranial magnetic stimulation, a technique that uses a magnetic field to induce small electrical currents in the brain, as a potential treatment for depression and other brain conditions.
(SEE ARTICLE)
HIPAA and Patient Care
Guidance for understanding when incidental disclosures of patient information are ethically permissible under US federal health privacy regulations.
(SEE ARTICLE)
CLINICIAN’S CORNER
A Woman With Primary Hyperparathyroidism
Clinical Crossroads
Ms Q is a 64-year-old woman with a history of hypercalcemia. Strewler discusses the evaluation of patients with hyperparathyroidism, end-organ effects, and treatment options.
(SEE ARTICLE)
Child Health
Accurate assessment of child health requires data on biological, behavioral, environmental, and social factors.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about hyperparathyroidism.
(SEE ARTICLE)
|
