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This Week in JAMA
June 23 2010

This Week in JAMA

JAMA. 2010;303(24):2443. doi:10.1001/jama.2010.845

The Surgical Care Improvement Project (SCIP)—a national quality partnership dedicated to reducing the rate of surgical complications—identified 6 infection prevention process-of-care measures for assessment and reporting. To examine the relationship between self-reported adherence to these measures and postoperative infection rates, Stulberg and colleagues Article analyzed data from 405 720 patients discharged from 398 regionally representative hospitals and found that SCIP adherence—measured as a global all-or-none composite score—was associated with a lower probability of postoperative infection. However, adherence to individual SCIP measures—the format of publicly reported SCIP performance data—was not associated with a lower probability of infection. In an editorial, Hawn Article discusses evidence that suggests SCIP has not improved surgical outcomes.

In the randomized placebo-controlled Study of the Effectiveness of Additional Reductions in Cholesterol and Homocysteine trial that enrolled patients with a history of myocardial infarction, the investigators assessed the effects of reducing homocysteine levels with folic acid plus vitamin B12 on vascular and nonvascular outcomes. The investigators report that compared with placebo, patients randomly assigned to receive the study vitamins experienced a mean 3.8 μmol/L (28%) reduction in homocysteine levels; however, this reduction was not associated with beneficial effects on vascular outcomes, including major coronary events, fatal or nonfatal stroke, and noncoronary revascularization during 6.7 years of follow-up.

Article

Severe sepsis—infection complicated by acute organ dysfunction—occurs more frequently in black than white individuals. Whether this is due to higher rates of infection or higher risks of acute organ dysfunction among black patients is not clear. In an analysis of data from the 2003-2007 National Ambulatory Care Survey, Mayr and colleagues found that higher rates of severe sepsis among black patients are a consequence of both higher rates of infection and higher risks of acute organ dysfunction than what white patients experience.

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Biggs and colleagues analyzed data from the Cardiovascular Health Study, a prospective cohort study of individuals aged 65 years and older, to examine the relationship between adiposity, changes in adiposity, and risk of type 2 diabetes. During a median follow-up of 12.4 years (range, 0.9-17.8 years) the authors found that overall and central adiposity and weight gain during midlife (after age 50 years) and after age 65 years were associated with the risk of incident diabetes.

Article

Primary myelofibrosis, the rarest of the myeloproliferative neoplasms, has a highly variable natural history. Stein and Moliterno discuss the case of Mrs W, a 79-year-old woman who was diagnosed with myelofibrosis with myeloid metaplasia (now called primary myelofibrosis) in 1982. The authors review the epidemiology and natural history, molecular pathogenesis, diagnosis, and management of primary myelofibrosis.

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“There are abrasions on her knees and legs. There is a pressure ulcer on her heel. I roll her over and find the lesions on her buttocks that the home health nurse was concerned about.” From “Rubbing Against the Late Day.”

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Pediatric hepatitis C infection is underestimated, leaving many children with potentially severe health consequences later in life.

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An article in the June issue of the Archives of Neurology reports the association of different dietary patterns with the risk of Alzheimer disease. Morris and Tangney discuss the advantages of dietary pattern analysis to inform health-promoting dietary recommendations.

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Health care reform and social policy

Article

Genomic analysis of mental illness

Article

Down syndrome: new prospects

Article

Join Kenneth J. Mukamal, MD, MPH, MA, Wednesday, July 21, from 2 to 3 PM eastern time to discuss advising a 42-year-old patient about whether he should drink alcohol for his health. To register, go to http://www.ihi.org/AuthorintheRoom.

For your patients: Information about postoperative infections.

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