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This Week in JAMA
March 10, 2010

This Week in JAMA

JAMA. 2010;303(10):913. doi:10.1001/jama.2010.255

Children likely play an important role in the transmission of influenza. To examine whether vaccinating children against influenza can prevent virus transmission and protect unvaccinated community contacts, Loeb and colleagues conducted a cluster randomized trial in which children aged 3 to 15 years from Hutterite colonies—tightly knit rural communities of approximately 60 to 120 individuals of the Anabaptist faith in western Canada—were randomly assigned by community to receive either inactivated trivalent influenza vaccine or hepatitis A vaccine (control) in the fall of 2008. The authors report that immunizing children with inactivated influenza vaccine protected unimmunized community residents against influenza, with approximately half as many cases of influenza in the colonies where children received the influenza vaccine compared with the control colonies during the 2008-2009 influenza season.

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Increased funding for comparative effectiveness studies of existing therapies was recently approved by the US Congress, but little is known about the types of comparative effectiveness research that are most needed. Hochman and McCormick Article performed a literature review to assess the prevalence and characteristics (eg, funding source, design, and outcomes) of comparative effectiveness studies and noncomparative effectiveness studies (involving novel therapies or using an inactive control) published in 6 high-impact general medical journals between June 1, 2008, and September 30, 2009. The authors identified 328 studies evaluating medications, of which 104 were comparative effectiveness studies. Among their findings were that most studies were funded by noncommercial entities and most compared different medications or different pharmacologic strategies. Few studies compared medications with nonpharmacologic interventions, and few studies examined safety or cost-effectiveness. In an editorial, Article Conway and Clancy discuss the importance of comparative effectiveness research for patient-centered care.

An increasing number of individuals undergo nephrectomy for the purposes of live donation; however, there are limited data on donors' perioperative mortality and long-term outcomes. In an analysis of national registry data (1994-2009), Segev and colleagues estimated the live donor perioperative mortality rate and compared long-term death rates among live kidney donors with death rates of healthy individuals (nondonors) who participated in a nationally representative health survey. The authors report that surgical mortality was low (3.1 per 10 000; 95% confidence interval, 2.0-4.6), with no change in the last 15 years, despite differences in surgical practice and donor selection criteria. Long-term mortality was similar among live donors and the age- and comorbidity-matched reference cohort.

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Ms Q is a 31-year-old woman who has undergone 3 surgical resections of an oligodendroglioma. The tumor had an initial histopathological classification of World Health Organization (WHO) grade II; however, examination of the third resection revealed malignant transformation to WHO grade III. Warnke discusses the epidemiology, natural history, and management of glial cell tumors of the brain.

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“What happens to our moral responsibilities as physicians when such unforgiving triage becomes part of the standard of care? What is the ethics of triage? What is the ethics of population triage?” From “The Line.”

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Scientists are probing complex genetic interactions to help explain why glioblastomas are so deadly and resistant to current treatments.

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Getting it right when things go wrong

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“Better than placebo” is not good enough

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Occupational disease and injury surveillance

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Promoting science education

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Join Mary E. Tinetti, MD, Wednesday, April 21, from 2 to 3 PM eastern time to discuss the evaluation of and treatment for patients who fall. 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.

Theme Issue on Cancer

For your patients: Information about gliomas.

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