Catherine D. DeAngelis, MD, MPH , is
named new Editor of JAMA and Editor-in-Chief of the AMA Scientific Information
and Multimedia Group. Dr DeAngelis is currently Vice Dean for Academic Affairs
and Faculty and professor of pediatrics at Johns Hopkins University School
of Medicine and Editor of the Archives of Pediatrics &
Using an ultrasensitive reverse transcriptase polymerase chain reaction
analysis, Dornadula and colleaguesArticle found that human immunodeficiency virus
(HIV) RNA (mean level, 17 copies/mL) was detectable in the peripheral blood
plasma of 22 patients who were receiving suppressive highly active antiretroviral
therapy (HAART) and who had fewer than 50 copies/mL of plasma HIV RNA by standard
assays. Despite the likely persistence of low-level HIV replication in patients
taking suppressive HAART, in a study of 14 patients with acquired immunodeficiency
syndrome and inactive cytomegalovirus (CMV) retinitis who were being treated
with HAART and systemic anti-CMV medications and who had CD4+cell
counts greater than 0.15 × 109/L, Whitcup and colleagues
foundArticle that all of the patients were able to discontinue maintenance anti-CMV
therapy without reactivation of retinitis during a mean follow-up of 16.4
months. In an editorialArticle, D'Aquila and Walker discuss the benefits and limitations
A prognosis for survival of less than 6 months often determines eligibility
for hospice care for patients with advanced chronic diseases. In this validation
study of prognostic criteria for hospice enrollment, however, Fox and colleagues
found that among 2607 patients with advanced chronic obstructive pulmonary
disease, congestive heart failure, or end-stage liver disease, 70% of 923
patients predicted to have a survival of 6 months or less according to broad
inclusion criteria (similar to National Hospice Organization guidelines) survived
more than 6 months after hospital discharge. In an editorial, Finucane describes
the complex and difficult transition for patients with advanced disease from
being gravely ill but fighting death to a state of dying and seeking to preserve
comfort and dignity.
See Article and editorial Article
Pregnancies complicated by placental abruption have been associated
with increased risk of low birth weight, stillbirth, preterm delivery, and
perinatal death. In this retrospective study, Ananth and colleagues found
that placental abruption complicated 530 (1%) of 53,371 pregnancies in 40,789
women. Compared with pregnancies without abruption, placental abruption had
an adjusted relative risk of 8.9 for stillbirth, 3.9 for preterm delivery,
4.6 for low birth weight, and 2.0 for fetal growth restriction. Stillbirth
was significantly associated with more severe abruption (≥50%), but preterm
delivery was significantly associated with even mild abruption.
Using data from 9215 adult respondents in the Adverse Childhood Experiences
Study mail survey questionnaire, Anda and colleagues found that exposure to
each of 8 categories of adverse psychosocial childhood events was associated
with an increased risk of early smoking initiation, ever smoking, current
smoking, and heavy smoking. The risk of each smoking behavior increased as
the reported number of categories of adverse event exposure increased.
To determine whether nonalcoholic steatohepatitis is associated with
impaired liver energy homeostasis, which may explain progression from steatohepatitis
to progressive liver fibrosis and cirrhosis, Cortez-Pinto and colleagues studied
the response of 8 adult patients with biopsy-proven nonalcoholic steatohepatitis
and 7 healthy control subjects to fructose-induced hepatic ATP depletion.
Preinfusion and minimum postinfusion liver ATP levels were similar in the
2 study groups, but liver ATP levels were significantly lower in the patient
group 1 hour after the infusion. Body mass index correlated inversely with
ATP recovery in both patient and control groups.
"If I were to die tomorrow, what stories would my child remember me
by?" From "Lisa's Stories."
Vision researchers are working on methods to avert the need for elderly
individuals to relinquish the keys to the family car.
Looking back over 70 years, Eli Ginzberg reflects on his major encounters
with the US health care sector.
A forum on the ethics of intentional diagnostic miscoding by physicians.
For your patients: Teenage smoking.
This Week in JAMA. JAMA. 1999;282(17):1601. doi:10.1001/jama.282.17.1601