Autopsies of US service members killed in the Korean and Vietnam wars demonstrated that subclinical coronary atherosclerosis was present in the second and third decades of life. To estimate the current prevalence of coronary and aortic atherosclerosis in members of the US armed forces, Webber and colleagues reviewed cardiovascular autopsy reports from 3832 individuals who died of combat or unintentional injuries during military deployment, October 2001-August 2011. The authors report that the mean prevalence of any coronary atherosclerosis was 8.5% and varied by age and cardiovascular risk factors. In an editorial, Levy discusses trends in cardiovascular health and implications for prevention of heart disease.
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Patients with chronic hepatitis C virus (HCV) infection who receive interferon-based therapy and achieve a sustained virological response—defined as absence of viremia 24 weeks after cessation of all antiviral medication—have lower risks of liver failure and liver-related death. In long-term follow-up of 530 patients with chronic HCV infection who initiated interferon-based treatment between 1990 and 2003, van der Meer and colleagues found that a sustained virological response to interferon-based therapy was associated with lower all-cause mortality.
Guidelines for authors reporting findings from noninferiority and equivalence trials and guidance for clinicians applying results from noninferiority trials are the focus of 2 articles in this issue. In the first article, Piaggio and colleagues present an updated extension of the CONSORT (Consolidated Standards of Reporting Trials) 2010 statement to include noninferiority and equivalence trials. The authors discuss the rationale for noninferiority and equivalence trials, provide empirical evidence of trial quality, describe the CONSORT updating process, and provide examples of changes to the CONSORT checklist for reporting noninferiority and equivalence trials. In the second article—a Users' Guides to the Medical Literature—Mulla and colleagues highlight issues related to the validity and interpretation of noninferiority trials and the applicability of trial results to individual patients.
Varicose veins and other manifestations of chronic venous insufficiency are common in middle-aged and older adults, and signs and symptoms can range from cosmetic to clinically significant. Treatment may be conservative—such as compression stockings, lifestyle changes, and medications—or involve minimally invasive or invasive surgical procedures. In a discussion of the case of a 68-year-old woman with recurrent varicose veins, Hamdan reviews the epidemiology, pathophysiology, and natural history of varicose veins; typical symptoms; patient evaluation; and treatment options.
A 31-year-old woman with a family history of recurrent pneumothorax presents with a 10-year history of facial and upper body papules. Her brother and father have similar skin lesions. Skin biopsy confirms fibrofolliculomas. What would you do next?
Over the past decade, failure to adhere to safe injection practices, particularly at outpatient facilities, has led to at least 48 outbreaks of infectious diseases and placed many thousands of patients at risk.
Restructuring SNAP to reduce child hunger and obesity
Emergency preparedness: lessons of Hurricane Sandy
Mental health effects of Hurricane Sandy
Mobility to prevent falls in older patients
“Bravo, Doctor. You knocked it out of the ballpark.” From “Warning Shot.”
Dr Bauchner summarizes and comments on this week's issue. Go to www.jama.com.
Join Robert H. Shmerling, MD, January 16, from 2 to 3 PM eastern time to discuss the management of gout. To register, go to http://www.ihi.org/AuthorintheRoom.
For your patients: Information about varicose veins.
This Week in JAMA. JAMA. 2012;308(24):2541. doi:10.1001/jama.2012.3408