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This Week in JAMA
JAMA. 2005;294:2669.
Adjuvant Chemotherapy for Stage III Colon Cancer
A 1990 National Institutes of Health Consensus Conference recommended that all patients with stage III colon cancer receive adjuvant therapy. Jessup and colleagues (SEE ARTICLE) reviewed national data to assess implementation of this recommendation and its effects on patient survival. They found that adjuvant therapy use increased from 39% in 1991 to 64% in 2002 and was associated with a significant 5-year survival benefit. However, black, women, and elderly patients were less likely to receive adjuvant therapy, and the survival benefit appears lower for black patients and for those with high-grade cancers. In an editorial, Van Cutsem and Costa (SEE ARTICLE) discuss new adjuvant therapies and complexities of extending treatment to all eligible patients.
Trends in Pneumonia Hospitalization
Hospitalization for pneumonia is common among elderly patients. Fry and colleagues (SEE ARTICLE) examined 1988-2002 data to assess trends in pneumonia hospitalization and comorbid diagnoses among patients aged 65 years and older. Comparing 1988-1990 with 2000-2002, they found a 20% increase in discharge diagnoses for pneumonia among persons aged 65 to 84 years but not among patients 85 years and older. The number of patients with comorbid chronic cardiac disease, pulmonary disease, or diabetes mellitus increased during the study period. In an editorial, File and Tan (SEE ARTICLE) discuss strategies to reduce the risk of pneumonia in older adults.
Postmarketing Surveillance of Intranasal Flu Vaccine
A trivalent live, attenuated influenza vaccine (LAIV-T) for intranasal administration was licensed in 2003. In a review of adverse event reports to the US Vaccine Adverse Event Reporting System for the 2003-2004 and 2004-2005 influenza seasons, Izurieta and colleagues (SEE ARTICLE) found no reports of unexpected serious risks among approximately 2.5 million vaccine recipients. There were no fatalities; there were 7 reports of possible anaphylaxis, 2 of Guillain-Barré syndrome, 1 Bell palsy, and 8 asthma exacerbations. In an editorial, Neuzil and Griffin (SEE ARTICLE) discuss the adverse events and implications for expanding use of LAIV-T.
Donor Characteristics and Transplant Survival
Kidney transplants from deceased donors who are 60 years or older or who have other comorbidities (so-called expanded criteria donors [ECD]) have a higher risk of failure than non-ECD transplants. However, it is not known whether ECD transplants may improve overall patient survival. In a retrospective cohort study using national data, Merion and colleagues compared mortality after ECD kidney transplantation with non-ECD transplantation or continuing dialysis treatment and found that patients receiving ECD kidneys had improved long-term (3-year) survival compared with the other patients.
(SEE ARTICLE)
Smallpox Vaccine Safety
Adverse events associated with smallpox vaccination are detailed in 2 articles in this issue of JAMA. First, Casey and colleagues (SEE ARTICLE) summarize data from 822 adverse event reports from vaccination of 38 885 potential first responders to a bioterrorism incident. One hundred of the adverse events were designated as serious and were more common in older revaccinees. In the second article, Sejvar and colleagues (SEE ARTICLE) reviewed 214 neurological adverse event reports following vaccination of 665 000 military personnel and civilians. Headache was most common (44%). The authors describe characteristics of 39 serious adverse events.
Medical News & Perspectives
Societies are grappling with the issue of whether the identity of sperm and egg donors should remain confidential or be revealed to offspring who seek that information for personal and medical reasons.
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(Photo credit: Phillip Hayson/www.sciencesource.com)
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(SEE ARTICLE)
CLINICIAN’S CORNER
Pregnancy and Future Disease Risk
Clinical Review
Physiologic responses during pregnancy may be harbingers of future chronic disease risk.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about kidney transplantation.
(SEE ARTICLE)
Author in the Room Teleconference
Join Matthew H. Samore, MD, on Wednesday, December 21, 2005, from 2:00 to 3:00 PM ET, to discuss new research about improving appropriateness of antibiotic prescribing, published in the November 9, 2005, issue of JAMA. To register for the Author in the Room teleconference, go to http://www.ihi.org/IHI/Programs/ConferencesAndTraining/Author+in+the+Room.htm.
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