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This Week in JAMA
JAMA. 2008;300(21):2455.
Alcohol Consumption and Atrial Fibrillation in Women
Previous studies suggest a relationship between alcohol consumption and risk of atrial fibrillation in men. In an analysis of data from the Women's Health Study, Conen and colleagues assessed the association between regular alcohol consumption and incident atrial fibrillation in women. The authors report that consumption of up to 2 drinks per day was not associated with an increased risk of incident atrial fibrillation over a median follow-up of 12.4 years. However, a small but statistically significant increased risk was found among women who reported daily consumption of 2 or more alcoholic beverages.
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Temporal Lobe Epilepsy Surgery
Patients with epilepsy are at increased risk of premature mortality. In a decision analysis that incorporated possible surgical complications and seizure status, Choi and colleagues compared the effects of anterior temporal lobe resection vs continued medical management on life expectancy and quality of life among patients with pharmacoresistant temporal lobe epilepsy. The authors found that among surgically eligible patients, resection of the epileptogenic zone is likely to provide significant gains in life expectancy and quality-adjusted life expectancy compared with continued medical management. In an editorial, Engel discusses benefits of early surgical treatment for epilepsy.
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Code Rates, Mortality, and Rapid Response Teams
Rapid response teams—medical emergency teams that evaluate, triage, and treat patients who have signs of clinical deterioration but are outside of the intensive care unit (ICU)—have been associated with reduced rates of cardiopulmonary arrest (codes). To assess the effect of rapid response teams on hospital-wide code rates and mortality, Chan and colleagues compared code rates and mortality before and after implementation of a rapid response team at a tertiary care academic hospital. The authors report that rates of non-ICU codes were lower after implementation of the rapid response team, but hospital-wide code rates and mortality rates were similar before and after rapid response team implementation.
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Clinical Equivalence of Generic and Brand-Name Drugs
Generic drugs are bioequivalent to brand-name drugs; however, some patients and physicians have concerns that generic drugs are not clinically equivalent to brand-name drugs. In a systematic review and meta-analysis, Kesselheim and colleagues summarized the clinical evidence comparing generic and brand-name drugs used in cardiovascular disease and assessed editorialists' perspectives on generic substitution. The authors found no evidence that brand-name drugs used in cardiovascular disease are superior to their generic counterparts. Among 43 editorials addressing generic substitution, 23 (53%) expressed a negative view of generic drug substitution.
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CLINICIAN'S CORNER
A Woman With Intractable Seizures
Clinical Crossroads
Ms H is a 24-year-old woman who has had medically intractable seizures since age 10 years. The seizures have caused her to stop working and prevent her engagement in physical activities that she would like to pursue. Schomer and Black discuss the pathophysiology of seizures and the treatment of medically intractable seizures, particularly the benefits and risks of surgical treatment.
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A Piece of My Mind
"As I have begun to immerse myself in the hospital, there is so much I see that I wish I could change." From "Teach Us How."
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Medical News & Perspectives
Researchers are exploring the interaction between oral health and diabetes.
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Commentaries
Male circumcision for HIV prevention: sociolegal barriers
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Closing the evidence gap in the use of new testing technologies
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JAMA Classics
Framingham Study insights on the hazards of elevated blood pressure
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Author in the Room Teleconference
Join Brett D. Thombs, PhD, and Roy Ziegelstein, MD, December 17 from 2 to 3 PM eastern time to discuss depression screening for patients with cardiovascular disease. To register, go to http://www.ihi.org/AuthorintheRoom.
Readers Respond
How would you manage a 41-year-old woman with recurrent uterine fibroids? Go to www.jama.com, read the case, and submit your response, which may be selected for online publication. Submission deadline is December 31.
JAMA Patient Page
For your patients: Information about epilepsy surgery.
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