Clinical decision aids are tools that assist patient participation in
medical decision making. Man-Son-Hing and colleagues report that among a group
of patients who had been in the aspirin cohort of the Stroke Prevention in
Atrial Fibrillation III trial, 99% of patients randomly assigned to receive
usual care and an audiobooklet decision aid at the end of trial made a choice
about continued antithrombotic therapy compared with 94% in the group that
received usual care alone. Patients in the decision aid group were more knowledgeable
about the risks and benefits of antithrombotic therapy, but decisional conflict,
satisfaction with the decision-making process, and adherence to the decision
after 6 months were similar in the intervention and control groups. In an
editorial, Edwards and Elwyn discuss the role of clinical decision aids in
the process of shared decision making.
See Article and editorial Article
Breastfeeding is the recommended method of infant feeding in many developing
countries to prevent diarrhea and other infections, but breastfeeding by women
infected with the human immunodeficiency virus (HIV) has been associated with
mother-to-infant HIV transmission. In this study in Malawi of 672 infants
who were born to women infected with HIV and who were uninfected with HIV
at the first prenatal visit, Miotti and coworkers found that 47 became infected
with HIV while breastfeeding. The risk of mother-to-child HIV transmission
was highest in the first year of life and was associated with low maternal
parity and young maternal age in a multivariate model. In an editorial, Fowler
and coauthors point out that information needed to guide breastfeeding decisions
by women in developing countries who are infected with HIV is limited.
Individuals with type 1 diabetes mellitus may decide to drive even in
the presence of blood glucose levels that have been associated with impaired
driving performance. Using data entered into handheld computers by individuals
with type 1 diabetes whenever performing self blood glucose monitoring or
experiencing symptoms of low blood glucose, Clarke and coworkers found that
subjects stated they would drive 43% to 44% of the time when they estimated
their blood glucose to be 3.3 to 3.9 mmol/L (60 to 70 mg/dL) and 38% to 47%
of the time when their actual blood glucose level was less than 2.2 mmol/L
The bombing of the Alfred P. Murrah Federal Building in Oklahoma City
in April 1995 resulted in 167 deaths, and 684 individuals were injured. In
this study of 182 adults from a registry of 1092 survivors directly exposed
to the blast, conducted 4 to 8 months after the bombing, North and colleagues
found that 82 individuals had a psychiatric disorder, 30 of whom had not had
a psychiatric disorder prior to the bombing, and 62 individuals had posttraumatic
stress disorder (PTSD) specific to the bombing. Fewer survivors fulfilled
PTSD Criterion Group C (at least 3 symptoms of avoidance and numbing as defined
in the Diagnostic and Statistical Manual of Mental Disorders) than the other PTSD criterion groups, but 94% of those meeting Criterion
Group C also fulfilled full PTSD diagnostic criteria.
Mr A is a 69-year-old man with a 27-year history of angina pectoris,
whose episodes of chest pain are often triggered by anger or emotional upset.
Williams discusses psychosocial factors associated with increased risk for
coronary heart disease and behavioral and pharmacologic interventions.
"He is calling. The man who never called on me before, who never called
on anyone—for anything." From "Stroke."
The community status of hospital emergency departments is changing,
often leading to a redesign that focuses on improved delivery of medical technology
and expanded patient services.
How to appraise trials that use surrogate end points and apply the results
to the clinical management of individual patients.
In response to the ousting of New England Journal
of Medicine editor Jerome Kassirer, Rennie comments on why the integrity
of a medical journal's reputation is critical to its success.
Should data from trials based on surrogate end points be used in the
approval process for drugs for the reduction of cardiovascular risk factors?
See Article and Article
For your patients: Safe driving for persons with diabetes mellitus.
This Week in JAMA. JAMA. 1999;282(8):709. doi:10.1001/jama.282.8.709