An inverse relationship between hospital volume and mortality after primary angioplasty among patients with ST-segment elevation myocardial infarction was described in analyses of data from the 1990s. Kumbhani and colleagues analyzed data from a registry including patients treated between July 5, 2001, and December 31, 2007, and found that higher-volume primary angioplasty centers had shorter door-to-balloon times and used more evidence-based therapies but did not have shorter lengths of stay or lower in-hospital mortality compared with lower-volume centers.
Leveille and colleagues analyzed data from a population-based cohort of community-dwelling adults aged 70 and older and found that individuals who at baseline reported 2 or more locations of chronic musculoskeletal pain, pain in the highest tertiles of severity, or pain that interfered with daily activities had greater risks of falls during an 18-month follow-up than persons without pain or pain of lesser severity.
Intravenous (IV) access and drug administration are integral components of advanced cardiac life support (ACLS), but evidence that these improve outcomes is lacking. In a randomized trial, Olasveengen and colleagues assessed whether removing IV drug administration from an ACLS protocol would improve survival after out-of-hospital cardiac arrest. The authors found there was no difference in survival to hospital discharge among patients randomly assigned to receive ACLS with or without IV access and drugs.
Conflicts of interest (COI) can influence the conduct of research and reporting of results in the medical literature. In a 2008 cross-sectional survey of 256 high-impact medical journal Instructions for Authors and manuscript submission documents, Blum and colleagues found that 89% of the journals had policies addressing author COI policies available for public review, but definitions of COI and requirements for disclosure varied among journals.
Infants who are born very preterm and at very low birth weight (VLBW) are at risk for poor developmental outcomes. In a systematic literature review and meta-analysis, de Kieviet and colleagues Article investigated the relationship between very preterm birth and VLBW and motor development among children without congenital anomalies. The authors report that being born preterm or VLBW is associated with motor impairment that persists into adolescence. In an editorial, Msall Article discusses opportunities to improve neuromotor outcomes among these children.
The acute onset of monocular floaters and flashes is usually due to posterior vitreous detachment. Hollands and colleagues review important aspects of the history and physical examination that are associated with a high risk of progression to retinal detachment or tear, including subjective vision reduction, visual field defects, and vitreous hemorrhage.
“‘I don't know where I’m supposed to be. I don't know what I’m supposed to do. I don't know what I’m supposed to say.’” From “A Journey Beyond Imagining.”
The number of academic medical centers, hospitals, and clinics using medical simulation for clinical skills and improved patient safety has increased.
Larrabee and Hilger discuss a report on the first composite face and maxilla transplant in a patient whose facial gunshot wound required 23 reconstructive procedures before transplant.
Tax on employee health insurance
Decreased control rates and therapeutic innovation
Authors are invited to submit manuscripts for an upcoming JAMA theme issue.
How would you advise a 37-year-old man who seeks a new physician affiliated with a high-quality hospital? Go to www.jama.com to read the case, and submit your response, which may be selected for online publication. Submission deadline is November 29.
For your patients: Information about retinal detachment.
This Week in JAMA . JAMA. 2009;302(20):2179. doi:10.1001/jama.2009.1737