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This Week in JAMA
July 2, 2008

This Week in JAMA

JAMA. 2008;300(1):9. doi:10.1001/jama.300.1.9

Human immunodeficiency virus (HIV)–related deaths have declined in countries where patients have good access to treatment. In an analysis of data from the Concerted Action on Seroconversion to AIDS and Death in Europe (CASCADE) study, Bhaskaran and colleagues evaluated changes over time in the mortality of HIV-infected individuals compared with expected mortality in the general uninfected population, a reflection of excess mortality associated with HIV infection. The authors report that the excess mortality rate (per 1000 person-years) decreased from 40.8 (95% confidence interval [CI], 38.5-43.0) before the introduction of highly active antiretroviral therapy (pre-1996) to 6.1 (95% CI, 4.8-7.4) in 2004-2006. By 2004-2006 among persons who had been infected through sexual transmission, no excess mortality was observed in the first 5 years after HIV seroconversion; however, excess mortality was evident among persons infected for 10 years or more.

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Neonates receiving treatment in intensive care units (ICUs) often undergo invasive procedures. To characterize the epidemiology and management of procedural pain in neonates, Carbajal and colleagues conducted the multicenter Epidemiology of Procedural Pain in Neonates Study, which enrolled 430 neonates admitted to tertiary care center ICUs, and involved bedside data collection during all procedures causing pain, stress, or discomfort. Among the authors' findings is that during a mean (SD) ICU stay of 8.4 (4.6) days, each neonate experienced a median of 115 (range, 4-613) procedures, of which 75 (range, 3-364) were categorized as painful. The majority of these procedures were not accompanied by analgesia.

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Invasive treatment is common in patients with non–ST-elevation acute coronary syndromes (ACS), but some data have suggested this strategy may be associated with higher risks of death or myocardial infarction in women. In a meta-analysis of data from 8 randomized trials that compared invasive vs conservative treatment of patients with non–ST-elevation ACS, O’Donoghue and colleagues found that men and high-risk, biomarker-positive women received comparable benefit from an invasive strategy, which, compared with conservative treatment, was associated with a significant reduction in a composite end point of death, myocardial infarction, or rehospitalization with ACS.

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Mr V, a 70-year-old man with a history of severe symptomatic coronary artery disease and peripheral vascular disease, presented to the hospital several hours after acute-onset slurred speech and left facial droop. A computed tomography angiogram of the neck showed a long region of internal carotid artery stenosis, and a magnetic resonance imaging scan showed areas of acute brain infarction. Caplan discusses the epidemiology and pathophysiology of transient ischemic attacks (TIAs) and outlines evaluation and treatment options for patients with severe systemic atherosclerosis who experience a TIA.

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“The current trend toward noncommunication has grave consequences for the future of the patient-physician relationship.” From “Physicians Behaving Badly.”

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The National Institutes of Health's newly launched Undiagnosed Diseases Program is using sophisticated molecular tools to help patients with disorders that have eluded diagnosis.

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Population health and economic development

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Accountable care systems in health care reform

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Correspondence course: tips for getting a letter published in JAMA.

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Join Sherita Hill Golden, MD, MHS, July 16 from 2 to 3 PM eastern time to discuss the bidirectional association between depressive symptoms and diabetes. To register, go to http://www.ihi.org/AuthorintheRoom.

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

For your patients: Information about acute coronary syndromes.

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