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This Week in JAMA
March 20, 2013

This Week in JAMA

JAMA. 2013;309(11):1069. doi:10.1001/jama.2012.145307

Among patients with heart failure, rates of early rehospitalization and mortality are high. In a randomized, placebo-controlled trial that enrolled 1639 patients hospitalized for heart failure with reduced left ventricular ejection fraction, Gheorghiade and colleagues investigated whether adding aliskiren—a direct renin inhibitor—to standard therapy would decrease the rate of cardiovascular mortality or rehospitalization for heart failure. The authors report that the addition of aliskiren to standard therapy did not improve these outcomes at 6 months after discharge.

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Approximately 10% of strokes occur in patients younger than 50 years; however, only limited data exist on long-term prognosis following stroke in younger adults. In an analysis of data from 959 consecutive Dutch patients aged 18 through 50 years with a first-ever acute stroke or transient ischemic attack, Rutten-Jacobs and colleagues assessed long-term mortality during a mean follow-up of 11.1 years. The authors compared all-cause mortality in the stroke cohort with expected mortality in the general population (age and sex matched) and found that for each stroke type, observed 20-year mortality among 30-day survivors exceeded mortality in the general population. In an editorial, Hankey discusses stroke in younger adults and implications for long-term follow-up.

SEE Article, EDITORIAL, and Author Audio Interview

To reduce emergency department (ED) utilization and potential health care costs, denial of payment if a discharge diagnosis appears to reflect a nonurgent condition has been considered. In an analysis of 34 942 ED visits included in the 2009 National Hospital Ambulatory Medical Care Survey, Raven and colleagues determined that based on the discharge diagnosis, an estimated 6.3% of visits were likely “primary care treatable diagnoses.” However, the chief complaints reported for these visits were the same as those reported for 88.7% of all visits, a substantial proportion of which required immediate emergency care or hospital admission. In an editorial, Adams discusses solutions to ED overuse for nonacute conditions.

SEE Article, EDITORIAL, and

Lipopolysaccharide—a cell membrane component of gram-negative bacteria—triggers the inflammatory response in gram-negative sepsis through activation of the MD2:Toll-like receptor 4 (TLR4). In a randomized, placebo-controlled trial that enrolled 1961 patients with severe sepsis, Opal and colleagues found that use of eritoran—a TLR4 antagonist—did not significantly improve sepsis-related mortality rates at 28 days.

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Ms L, a 64-year-old woman whose father died of lung cancer and who accumulated 30 pack-years of smoking before successfully quitting, is considering lung cancer screening. Boiselle discusses the lack of evidence for chest radiography in lung cancer screening; the evidence and current guidelines for use of computed tomography for screening, and the associated risks and costs.

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Strains of Mycobacterium tuberculosis in South Africa resistant to 10 drugs have raised concerns about infections that might be impossible to treat.

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Clinician-led health services innovation

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Educating physicians about responsible resource management

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Improving cardiovascular health: balancing discovery and delivery

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Can ACOs improve population health?

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Bridging the divide between population health and health care

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“A single medical record that is accessible to both caregivers and patients challenges us to communicate in language that is clear and accurate but free of judgment and bias.” From “278.00 Obesity, Not Otherwise Specified.”

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Dr Fontonarosa summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl

www.jama.com

Join Phillip Boiselle, MD, April 17, from 2 to 3 PM eastern time to discuss computed tomography for lung cancer screening. To register, go to http://www.ihi.org/AuthorintheRoom.

For your patients: Information about screening tests.

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