Computed tomographic pulmonary angiography (CTPA) is an alternative to ventilation- perfusion (/) lung scanning to evaluate patients with suspected pulmonary embolism, but whether CTPA is as reliable and safe as / scanning for the initial patient evaluation is not clear. To examine this question, Anderson and colleaguesArticle randomly assigned patients with symptoms or signs associated with a high pretest probability of an acute pulmonary embolism to either CTPA or / scanning. Patients in whom pulmonary embolism was excluded by either procedure did not receive antithrombotic therapy, and the patients were followed up for 3 months to assess subsequent development of symptomatic pulmonary embolism or proximal deep vein thrombosis. The authors found that CTPA was not inferior to / scanning in ruling out pulmonary embolism. However,
more patients were diagnosed with pulmonary embolism using CTPA. In an editorial, GlassrothArticle discusses clinical implications of the study findings and issues for further investigation.
Rapid activation of the cardiac catheterization laboratory based on an assessment of the initial diagnostic electrocardiogram by the emergency department physician can reduce door-to-balloon times in patients with ST-segment elevation myocardial infarction (STEMI).
However, rapid catheterization laboratory activation may result in some patients undergoing angiography who do not need acute reperfusion therapy (“false-positives”). To determine the prevalence of false-positive catheterization laboratory activation—defined as no culprit coronary artery, no significant coronary artery disease,
or negative cardiac biomarker results—Larson and colleaguesArticle reviewed regional registry data from 1335 patients with suspected STEMI who had undergone angiography. The authors found that the frequency of false-positive catheterization laboratory activation was common, ranging from 9.2% to 14%, depending on the definition used. In an editorial, MasoudiArticle discusses the need to assess both the positive and negative consequences of quality improvement efforts.
Women with low bone mineral density (BMD) and prevalent vertebral fractures are at increased risk of incident vertebral fractures, but the absolute risk of fractures over the long-term is not known. Cauley and colleagues analyzed data from the longitudinal Study of Osteoporotic Fractures to assess the absolute risk of incident vertebral fracture by BMD and prevalent vertebral fracture status. In their analysis of data from 2680 women who attended the 15th-year visit and who had a mean age at baseline of 68.8 years, the authors found that women with a prevalent vertebral fracture and osteoporosis by BMD had an absolute risk of incident vertebral fracture of 56%. Among women without prevalent vertebral fractures and normal BMD, the absolute risk of incident vertebral fracture was 9%.
Symptoms, pathophysiology, and catheter ablation treatment of supraventricular arrhythmias.
“I have never been particularly close to my father, but the process of sharing an organ with him changed our relationship dramatically.” From “Giving Back.”
Community-based efforts to curb obesity are enlisting schools,
businesses, families, restaurants, grocery stores, and local government to play a role in encouraging healthful behaviors.
Lethal injection and physicians
Nonpayment for hospital-acquired harms
Market distortions in health care
Authors are invited to submit manuscripts for an upcoming theme issue.
Exploring the dangerous trades with Dr Alice Hamilton
How would you manage a 39-year-old man with erythema and swelling of a finger? Go to www.jama.com to read the case and submit your response by December 26. Your response may be selected for online publication.
For your patients: Information about atrial fibrillation.
This Week in JAMA . JAMA. 2007;298(23):2711. doi:10.1001/jama.298.23.2711