In a prospective cohort study of more than 1400 patients hospitalized
with a first acute myocardial infarction, Marrugat and colleagues found that
women had higher mortality rates at 28 days and at 6 months after infarction
than men. Increased severity of myocardial infarction, but not differences
in coronary risk factors, comorbidity, or therapy, explained in large part
the higher mortality and readmission rates at 6 months in women.
The clinical importance of detecting submicroscopic metastases using
molecular assays was assessed by Shivers and colleagues who prospectively
evaluated 114 patients with malignant melanoma without clinical evidence of
metastatic disease. Biopsy specimens from sentinel lymph nodes were studied
by routine histology and by a reverse transcriptase–polymerase chain
reaction assay for tyrosinase messenger RNA as a marker for the presence of
melanoma cells. Combining histological findings with molecular assay results
improved the prediction of melanoma recurrence and patient survival.
Confidential but identifiable reporting of HIV test results may improve
the surveillance of HIV infection, but people at risk may be reluctant to
be tested unless testing is anonymous. Bindman and colleaguesArticle report that
persons residing in states with both anonymous and confidential HIV testing
who tested anonymously were more likely to have early testing and medical
treatment than those who tested confidentially. Nakashima and colleaguesArticle,
however, did not find a significant decline in the number of HIV tests at
publicly funded HIV counseling and testing sites after the sites changed from
anonymous to confidential reporting.
The National Institutes of Health (NIH) Director's Panel on Clinical
ResearchArticle proposes a multifaceted approach to revitalize clinical research
programs. In related commentaries, SchechterArticle calls for more aggressive remedies
and ShineArticle emphasizes the importance of encouraging clinical research by physician
Mr J has had multiple sclerosis for about 1 year, with slowly progressive
weakness of his right leg. He wonders whether to begin disease-modifying therapy.
In this Clinical Crossroads, Rudick emphasizes that brain inflammation and
irreversible neuronal damage occur in patients with multiple sclerosis in
the absence of clinical symptoms, an understanding that supports beginning
therapy early in the course of the disease.
Systems that are proactive and preventive are more likely to reduce
medical error than those that are reactive and punitive. In an editorial,
Leape and colleagues describe 4 bold initiatives that incorporate the management
of medical error into comprehensive strategies to promote patient safety.
". . . remarkable opportunities for combining the resources of science
and art to study human history." Mummy mask of a noblewoman, Egyptian, New
Kingdom, early 19th dynasty, c 1290-1224 BC.
"Cancer talk. You can't teach it. It is more than words. It can only
be learned through experience." From "Don't Call Me ‘Larry'."
Correctional health experts decry the practice of licensing and employing
impaired physicians in jails and prisons.
Advances in techniques to improve the appearance of aged skin.
Caring for patient volunteers in clinical research studies presents
physician investigators with complex ethical issues.
For your patients: A woman's guide to prevention of heart disease.
This Week in JAMA. JAMA. 1998;280(16):1383. doi:10.1001/jama.280.16.1383