Edited by Helene M. Cole, MD, and Howard Markel, MD, PhD
Retinal screening for diabetic eye disease every second or third year
may achieve a similar benefit as annual screening in most patients with type
2 diabetes mellitus. Using characteristics of individuals older than 40 years
with type 2 diabetes in the Third National Health and Nutrition Examination
Survey, Vijan and colleagues created a Markov model to estimate the cost-effectiveness
of various screening intervals for detection of diabetic retinopathy. Predicted
time spent blind according to different screening intervals (every year, every
third year, every fifth year) varied with age and level of glycemic control,
with high-risk patients gaining an average of 21 days of sight with annual
screening compared with every third year and low-risk patients gaining 3 days
of sight. Estimated cost per quality-adjusted life-year gained was $107,510
for annual screening compared with every other year and $49,760 for screening
every other year compared with every third year.
In this descriptive analysis of the presentation, management, and outcomes
of 464 patients with acute aortic dissection enrolled in the International
Registry of Acute Aortic Dissection beginning January 1, 1996, Hagan and colleagues
conclude that despite recent diagnostic and therapeutic advances, in-hospital
mortality remains high and continued improvement in diagnosis and management
is needed. The most common presenting symptom of acute aortic dissection was
sudden onset of severe sharp pain and classic physical findings of aortic
regurgitation and pulse deficit were often absent. Initial chest film was
normal in 12.4% of patients and 31.3% had a normal electrocardiogram. Overall
in-hospital mortality was 27.4%. Among patients with type A dissection, mortality
was 26% in those managed surgically and 58% in those who did not receive surgery.
Mortality among patients with type B dissection treated with surgery was 31.4%
and 10.7% among those treated medically.
The extracorporeal life support (ECLS) program at the University of
Michigan (U of M) was established in 1980. Reporting on a series of 1000 consecutive
patients between 1980 and 1998, Bartlett and coauthors describe changes in
the type of cases managed with ECLS over time and patient characteristics
and outcomes, and discuss the development and application of ECLS technology.
Conflicts between families and physicians often beset decisions to limit
treatment at the end of life. Goold and coauthors describe 3 categories of
factors that contribute to family-physician conflicts regarding life-sustaining
treatment—family features, physician features, and organizational and
social features—and present a model based on differential diagnosis
to identify underlying causes of disagreement.
Markel traces the history of the University of Michigan Medical School
from the time of its proposal to the board of regents of the university in
1847 to the present.
Jacobson and Pomfret discuss how the federal Employee Retirement Income
Security Act (ERISA), by preempting state regulation of managed care organizations
(MCOs), protects MCOs from medical liability lawsuits, influences clinical
decision making, and erodes physician autonomy.
Emergency use of magnetic resonance imaging for evaluation of acute
central nervous system conditions.
Fine-tuning a programmable patient simulator, innovations in pediatric
cardiac surgery, and a possible first treatment for Duchenne muscular dystrophy
are part of the research agenda at the University of Michigan Medical School.
The University of Michigan (U of M) Medical School responds to the financial
stress facing academic medical centers with creative organizational changes,
cost control measures, and renewed commitment to education, research, and
patient-centered health care.
For your patients: Preventive eye care.
This Week in JAMA. JAMA. 2000;283(7):841. doi:10.1001/jama.283.7.841