A JAMA GLOBAL THEME ISSUEEdited by David H. Mark, MD, MPH, and
Richard M. Glass, MD
Neurologic damage associated with myelomeningocele may occur in part
because of exposure of neural tissue to the intrauterine environment, and
alteration of cerebrospinal fluid circulation by drainage through the open
defect may lead to hindbrain herniation and hydrocephalus. Bruner and colleagues
reportArticle that the incidence of both hydrocephalus requiring ventriculoperitoneal
shunt placement and hindbrain herniation was significantly reduced among 29
patients with fetal myelomeningocele surgically repaired between 24 and 30
weeks' gestation compared with 23 matched control patients, but the rate of
preterm birth increased. In a case series of 10 patients with fetal myelomeningocele,
Sutton and colleagues foundArticle that hindbrain herniation assessed by serial magnetic
resonance imaging improved within 3 weeks of myelomeningocele closure performed
at 22 to 25 weeks' gestation in 9 surviving newborns. In an editorialArticle, Simpson
comments that fetal surgery for myelomeningocele is still an experimental
procedure until associated obstetric complications are reduced and data about
long-term functional outcomes become available.
In this analysis of 35,554 in vitro fertilization (IVF) procedures,
Schieve and colleagues found that live-birth rates decreased as maternal age
increased and also varied significantly with the number of embryos transferred.
Maximum live-birth rates were achieved with fewer embryos transferred when
extra embryos were cryopreserved (an indicator of embryo quality). Multiple-birth
rates varied with maternal age and the number of embryos transferred, but
were not related to embryo quality. For any given number of embryos transferred,
the risk of multiple births increased as maternal age decreased.
By measuring the concentration of glucose that is extracted through
the skin by iontophoresis, a new device worn like a wristwatch offers the
possibility of glucose self-monitoring without frequent fingersticks by persons
with diabetes mellitus. Tamada and colleagues report that glucose measurements
by this device over 12 hours were highly correlated with conventional glucose
measurements of fingerstick blood samples among 92 adults with diabetes mellitus
and were accurate even at low glucose levels. Measurements by the device lagged
behind blood glucose measurements by about 18 minutes.
Two articles in this issue of THE JOURNAL explore the usefulness of
computer-based technologies in medicine. Effler and colleagues foundArticle that
an automated electronic reporting system significantly improved the completeness
and timeliness of reporting for 5 notifiable conditions to a state health
department by 3 clinical laboratories compared with the conventional manual
system. In a second study at 3 academic medical centers that included fourth-year
medical students, residents, and faculty, Friedman and colleagues foundArticle that
consultation with computer-based diagnostic decision support systems increased
diagnostic accuracy, especially among students.
Diaspirin cross-linked hemoglobin (DCLHb), a purified and chemically
modified human hemoglobin solution, is an oxygen-carrying fluid that could
be used immediately for resuscitation of trauma patients without cross-matching.
In this randomized trial, DCLHb infusion was used as adjunctive therapy in
the initial hospital resuscitation of patients with severe traumatic hemorrhagic
shock. Sloan and colleagues found that morbidity and mortality at 28 days
and mortality at 48 hours were significantly higher among the 52 patient who
received DCLHb compared with 46 patients who received saline infusions.
"Urine ladder-nested automated polymerase chain reaction revealed Escherichia coli that was pan-resistant to antibiotics
by segmental genomic sequencing." From "Millennial Child."
DNA microarrays, paired with sophisticated computer software, can distinguish
molecular differences between two identical-looking cancers.
Ten lessons for evidence-based technology assessment from 10 years of
experience at the Agency for Health Care Policy and Research.
A national health technology assessment (HTA) agency would improve quality,
timeliness of technology assessments.
For your patients: A primer on infertility and assisted reproductive
This Week in JAMA. JAMA. 1999;282(19):1795. doi:10.1001/jama.282.19.1795