Two articles in this issue address associations between heart failure therapies and mortality. In an analysis of registry data from 5887 patients hospitalized with heart failure and reduced ejection fraction, Hernandez and colleagues found that patients who initiated aldosterone antagonist therapy at hospital discharge had lower rates of heart failure readmission, and similar rates of all-cause mortality and cardiovascular readmissions as patients not treated with aldosterone. Lund and colleagues analyzed prospective registry data from 16 216 patients with heart failure and preserved ejection fraction and found that use of renin-angiotensin system antagonists was associated with lower rates of all-cause mortality. In an editorial, Fang discusses the implications of these findings for the treatment of heart failure.
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The appropriate duration of anticoagulation therapy after bioprosthetic aortic valve replacement is not clear. Mérie and colleagues analyzed data from 4075 patients who had bioprosthetic aortic valve replacement surgery and found that warfarin discontinuation within 3 months of surgery was associated with an increased risk of stroke, thromboembolic complications, and cardiovascular death and found that discontinuation between 3 and 6 months of surgery was associated with an increased risk of cardiovascular death. In an editorial, Mehta and Weitz discuss anticoagulation after bioprosthetic aortic valve implantation.
California has experienced a resurgence of pertussis despite high diphtheria, tetanus, and acellular pertussis vaccine (DTaP) coverage. In a case-control study involving children who were aged 4 to 10 years and living in 15 California counties in 2010, Misegades and colleagues examined the association between pertussis and receipt of the 5-dose DTaP series. The authors found that cases—children who had or were suspected of having pertussis—were less likely to have received all 5 doses of DTaP and that the odds of pertussis increased as the time since last DTaP dose lengthened. In an editorial, Shapiro discusses reasons for an apparent resurgence of pertussis.
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The incidence of gout is increasing, and comorbid conditions present patient management challenges. Using the case of Mr R, a 57-year-old man with a history of podagra, hyperuricemia, and mild renal insufficiency, Shmerling discusses the diagnosis of gout, treatment of acute attacks, and prevention of recurrent episodes.
Three months after travel in Asia and the Middle East, a patient with a history of diabetes presented with a painful, fluctuant neck mass. Outpatient incision and drainage were scheduled and empirical oral clindamycin initiated. Eight days later he returned with worsening neck pain. What would you do next?
New research suggests that using UV light to disinfect hospital rooms and that decolonizing patients in intensive care units who carry methicillin-resistant Staphylococcus may help reduce hospital-acquired infections.
Sherley v Sebelius: the future of stem cell research
Linking physician performance with payment
Medical documentation in the electronic era
Centralized conflict of interest disclosure
“The EMR created Virtual Tommy, and within the medical home model, with its emphasis on non–face-to-face interactions, he flourished.” From “Virtual Grief.”
Join Laura N. Gitlin, PhD, and coauthors December 19 from 2 to 3 PM eastern time to discuss nonpharmacologic management of behavioral symptoms in dementia. To register, go to http://www.ihi.org/AuthorintheRoom.
Dr Gaziano summarizes and comments on this week's issue. Go to www.jama.com
For your patients: Information about gout.
Theme Issue on Medical Education
This Week in JAMA. JAMA. 2012;308(20):2059. doi:10.1001/jama.2012.3348