Dual antiplatelet therapy with aspirin and clopidogrel greatly reduces cardiovascular events after percutaneous coronary intervention (PCI); however, some patients are at risk of early stent thrombosis—an unpredictable complication of PCI. In a case-control study that involved 123 patients with early stent thrombosis who were matched on age and sex to 246 patients without stent thrombosis, Cayla and colleagues analyzed genetic, clinical, and angiographic factors associated with early stent thrombosis. Among the authors' findings were that in addition to established clinical and angiographic factors, 3 genes involved in clopidogrel metabolism and platelet receptor function (CYP2C19, ABCB1, ITGB3) and 2 clopidogrel-related factors (clopidogrel loading dose and interaction with proton pump inhibitors) were independently associated with early stent thrombosis. In models developed to predict the risk of early stent thrombosis, the authors found that a model incorporating genetic and clinical factors improved risk prediction compared with models based on either genetic or clinical factors alone.
Smoking is a risk factor for chronic obstructive pulmonary disease (COPD), the onset of which can be subtle. Evidence suggests that smoking cessation may prevent the progression of COPD. Mets and colleagues hypothesized that computed tomography (CT)–based lung cancer screening might provide an opportunity to additionally detect early-stage COPD. The investigators tested their hypothesis in a cohort of 1140 men who were current and former heavy smokers, were participating in a lung cancer screening trial, and had undergone inspiratory and expiratory CT scanning and pulmonary function testing. Using pulmonary function tests as the reference standard, the authors found that 437 men (38%) had COPD. The authors report that CT scans identified participants with COPD with a sensitivity of 63% and a specificity of 88%.
Article (AUTHOR VIDEO INTERVIEW)
Ms N, a 70-year-old woman with type 2 diabetes mellitus and chronic kidney disease who lived independently, presented to a hospital emergency department with a 3-day history of hematuria. She was in acute renal failure and was admitted to the hospital to begin hemodialysis. While hospitalized, Ms N developed progressive difficulty with ambulation, needed assistance with bathing and toileting, and experienced some cognitive decline, and she was discharged to a skilled nursing facility. Covinsky and colleagues discuss risk factors for hospitalization-associated disability, interventions that may prevent its occurrence, and approaches to improve the quality of life of patients who develop new or worsening disability following hospitalization. A commentary by Ettinger discusses aspects of the hospital environment that may contribute to hospitalization-associated disability and the need to develop effective preventive interventions.
Ms C, a 68-year-old woman, is contemplating autologous blood donation before elective orthopedic surgery. How would you advise her? Go to www.jama.com to read the case. Submit your response by October 30 for possible online posting.
“When I was growing up, my family often discussed taking a trip to my father's birthplace, but it never seemed to be the right time—outbreaks of violence, infectious diseases, or political instability always made traveling to Haiti an unappealing option for a family vacation.” From “With His Hands.”
Taking into account recent advances, a coalition of leaders in the field of stroke has updated recommendations to primary stroke treatment centers for diagnosis and treatment.
Hospital readmissions and the Affordable Care Act
Readmission rates to assess hospital quality
Recruitment and retention of clinical trial participants
Can hospitalization-associated disability be prevented?
Paradoxes of nursing home policy
Join Steven Zweig, MD, MSPH, Wednesday, November 16, from 2 to 3 PM eastern time to discuss the physician's role in patients' nursing home care. To register, go to http://www.ihi.org/AuthorintheRoom.
For your patients: Information about MRSA infections.
This Week in JAMA. JAMA. 2011;306(16):1733. doi:10.1001/jama.2011.1555