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This Week in JAMA
November 26, 2008

This Week in JAMA

JAMA. 2008;300(20):2341. doi:10.1001/jama.2008.736

Allocation of donor livers for transplantation has been based on objective laboratory criteria incorporated in the Model for End-Stage Liver Disease (MELD) score since 2002. In a retrospective analysis of national data, Moylan and colleagues Article assessed the association between race, sex, and liver transplantation before and after introduction of the MELD score organ allocation system. The authors found that after the MELD score became effective, race was no longer associated with receiving a liver or with death on the transplantation waiting list; however, sex differences in liver allocation remain. In an editorial, Axelrod and Pomfret Article discuss progress and challenges in achieving equal access to liver transplantation.

Patients with depressive symptoms have an increased risk of cardiovascular events. In the Heart and Soul Study, a prospective cohort study of 1017 outpatients with stable coronary heart disease, Whooley and colleagues evaluated the extent to which the association of depressive symptoms with subsequent cardiovascular events was explained by differences in comorbid conditions, baseline cardiac disease severity, and potential biological and behavioral mediators. The authors found that compared with patients without depressive symptoms at baseline, patients with depressive symptoms had an increased risk of incident cardiovascular events, which was largely explained by behavioral factors—in particular, physical inactivity.

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A common allele on chromosome 9p21 (SNP rs2382306) is associated with coronary artery disease (CAD) in the general population. Doria and colleagues assessed whether the 9p21 variant is associated with CAD among individuals with type 2 diabetes and evaluated its interaction with poor glycemic control in a case-control study and a prospective cohort study. In analyses of data from the 2 studies, the authors found that the presence of the 9p21 variant is associated with a significantly increased risk of angiographically documented CAD, particularly among patients with poor glycemic control.

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Medicare coverage of ventricular assist devices as therapy for end-stage heart failure was expanded in 2003. In a retrospective analysis of 2000 through 2006 inpatient claims from the Centers for Medicare & Medicaid Services, Hernandez and colleagues examined the acute and long-term outcomes and costs among patients who received a ventricular assist device as a primary therapy or as rescue therapy after open-heart surgery. The authors found high rates of early mortality and morbidity, including prolonged lengths of stay and high rates of readmission among Medicare recipients who received ventricular assist devices as well as high 1-year costs of care.

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In a systematic and quantitative review of randomized controlled trials comparing inhaled corticosteroid therapy with nonsteroid inhaled therapy among patients with stable chronic obstructive pulmonary disease (COPD), Drummond and colleagues found that inhaled corticosteroid therapy did not affect 1-year all-cause mortality but was associated with an increased risk of pneumonia.

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“His son's diagnosis made him so angry he was the most feared and despised parent on the unit.” From “Bodies and Spirit.”

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Critics of a ruling that requires nonprescription cold medicine labels cautioning against use for children younger than 4 years urge extending the warning to protect older children.

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Benefits and risks of drug treatments

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Testing for the fragile X gene throughout the lifespan

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Current and future nursing workforce

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Call for Papers

Authors are invited to submit manuscripts for an upcoming JAMA theme issue.

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Join Brett D. Thombs, PhD, and Roy Ziegelstein, MD, December 17 from 2 to 3 PM eastern time to discuss depression screening for patients with cardiovascular disease. To register, go to http://www.ihi.org/AuthorintheRoom.

How would you manage a 24-year-old woman with intractable seizures since age 10? Go to www.jama.com, read the case, and submit your response, which may be selected for online publication. Submission deadline is November 26.

For your patients: Information about chronic obstructive lung disease.

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