Among patients surgically treated for colon cancer, better survival has been associated with more extensive lymph node evaluation—presumably through improved disease staging. In an observational cohort of 86 394 patients undergoing colon cancer surgery from 1988 through 2008, Parsons and colleagues Article examined the association between more extensive lymph node evaluation and the identification of lymph node–positive cancers and risk of death. They found that the number of lymph nodes evaluated in colon cancer specimens markedly increased in the past 2 decades, but this was not associated with an overall shift toward higher-staged, node-positive cancers. In an editorial, Wong Article discusses the complex relationships between quality indicators, quality care, and patient outcomes.
Graduated driver licensing programs are designed to ensure that young beginning drivers accrue considerable low-risk driving experience before “graduation” to riskier driving conditions. Masten and colleagues Article examined the relationship between graduated licensing programs and fatal crashes among 16- to 19-year-old drivers in a pooled cross-sectional time series analysis of 1986-2007 fatal crashes in the United States. The authors found that compared with no program, stronger programs that restrict both nighttime driving and passengers were associated with lower fatal crash incidence among 16-year-old drivers but a higher incidence of fatal crashes among 18-year-olds. In an editorial, McCartt and Teoh Article discuss the effects of graduated driver licensing programs on crash rates among teenagers.
In a cohort of 416 consecutive patients with bicuspid aortic valves who were followed up for a mean 16 years, Michelena and colleagues assessed the incidence of aortic dissection, aortic aneurysm, and aortic surgery. The authors found that the incidence of aortic dissection was low (2 of 416 patients), but the risk of dissection was significantly higher than in the general population. Patients in the cohort had a high incidence of aortic aneurysm, often warranting elective surgical repair.
Experimental data suggest that cathepsin S—a cysteine protease associated with inflammatory activity—may be a factor in the development of cardiovascular disease and cancer. In an analysis of data from 2 independent prospective cohort studies that included 1996 elderly men and women, Jobs and colleagues found that higher levels of serum cathepsin S were associated with an increased risk of mortality.
Mr J, an older man with multiple medical problems, has limited health literacy—the capacity to obtain, process, and understand the health information, skills, and services needed to make informed health decisions and to take action. Paasche-Orlow discusses essential components of health literacy and the effects of poor health literacy for patients, and he outlines a method to assess and improve patients' understanding of critical self-care needs.
“ ‘I felt that if you could learn to play the piano, it would help you as a doctor.’ ” From “Piano Lessons.”
Shortages of pharmaceutical drugs in the United States appear to be getting worse, forcing some patients to take less-effective medications or to delay treatment.
Censorship of the patient-physician relationship
Health consequences of the World Trade Center disaster
Public reporting of assisted reproductive technology outcomes
Maryland's hospital cost review commission at 40
Join Laura Mosqueda, MD, Wednesday, September 21, from 2 to 3 PM eastern time to discuss identification of and intervention for elder mistreatment. To register, go to http://www.ihi.org/authorintheroom.
Ms J, a 46-year-old woman with a history of iron deficiency anemia and 3 miscarriages, was recently diagnosed with celiac disease. How would you treat her illness, and what follow-up would you recommend for Ms J and her family? Go to www.jama.com to read the case. Submit your response by October 9 for possible online posting.
For your patients: Information about health literacy.
This Week in JAMA. JAMA. 2011;306(10):1055. doi:10.1001/jama.2011.1287