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This Week in JAMA
April 22 2009

This Week in JAMA

JAMA. 2009;301(16):1631. doi:10.1001/jama.2009.552

Procedures to insert implantable cardioverter-defibrillators (ICDs) are performed by physicians representing different specialties and training experiences. To assess whether patient outcomes following ICD implantation vary by physician training or certification, Curtis and colleagues Article analyzed data from a national ICD registry. The authors found that compared with patients whose ICDs were implanted by electrophysiologists, patients whose ICDs were implanted by either nonelectrophysiologist cardiologists or thoracic surgeons had higher risks of in-hospital procedural complications and had a lower likelihood of receiving (when clinically indicated) a defibrillator with cardiac resynchronization capability. In an editorial, Coromilas Article discusses the ICD registry data, physician training, and clinical outcomes following ICD implantation.

Continuity of care—a core component of primary care medicine—has been a focus of substantial research and attention in outpatient settings, but less is known about continuity of care in the transition from outpatient to hospital care. In a nationally representative retrospective cohort study of hospitalized Medicare patients, Sharma and colleagues examined continuity of care from outpatient to inpatient settings and compared patients hospitalized between 1996 and 2006. The authors found that between 1996 and 2006 the proportion of patients experiencing physician continuity in the transition from outpatient to inpatient settings declined significantly.

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Some data suggest that rates of solid organ transplantation are lower among patients who reside in rural vs urban areas. To assess whether access to kidney transplantation is determined by residential distance to the nearest transplant center or by rural or urban residence, Tonelli and colleagues determined time to placement on the kidney transplant waiting list and time to transplantation in an observational study of adult patients who initiated renal replacement therapy between 1995 and 2007. The authors found that time to kidney transplantation did not differ across categories of increasing distance from a transplant center and that rural residence was not associated with a longer time to transplantation.

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Most investigations of child health determinants have focused on contemporaneous factors such as maternal behaviors, nutrition, and environmental conditions, with little attention given to intergenerational factors. In an analysis of data from India's National Family Health Survey, Subramanian and colleagues examined the association between maternal adult height—a reflection of the mother's social and nutritional health in childhood—and child mortality, anthropometric failure (eg, underweight, stunting, and wasting), and anemia. In analyses that adjusted for demographic and socioeconomic variables, the authors found that maternal height was inversely associated with mortality and anthropometric failure among children aged 0 to 59 months.

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Kiser and Pronovost discuss the importance of assessing the patient's experience of disease—particularly among patients with diseases for which there are few or no treatment options.

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“Incidental injury is more pervasive than most of us realize, and it can occur even in highly capable and compassionate environments.” From “Collateral Damage.”

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Scientists are exploring potential new treatments for alcohol dependence that are based on a growing understanding of the genetic and biological roots of the disorder.

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From the Archives Journals

Factors associated with early diagnosis of melanoma.

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Deep brain stimulation

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The care of the patient

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Join Lisa A. Cooper, MD, MPH, from 2 to 3 PM eastern time on May 20 to discuss treatment adherence and hypertension control. To register, go to http://www.ihi.org/AuthorintheRoom.

How would you manage a 51-year-old woman with an acute onset of facial pressure, rhinorrhea, and tooth pain? Go to www.jama.com, read the case, and submit a response by April 29 for possible online publication.

For your patients: Information about kidney transplantation.

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