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This Week in JAMA
August 16, 2000

This Week in JAMA

JAMA. 2000;284(7):803. doi:10.1001/jama.284.7.803
A New Risk Score for Acute Coronary Syndromes

In clinical practice, risk stratification schemes can facilitate therapeutic decision making, especially in heterogeneous patient populations in which outcomes vary widely. Antman and colleaguesArticle developed and validated a 7-item risk score for patients with non–ST elevation acute coronary syndromes using data from 2 trials comparing enoxaparin therapy with unfractionated heparin. Increasing risk scores were associated with increased rates of all-cause mortality, new or recurrent myocardial infarction, or recurrent ischemia requiring revascularization through 14 days after trial randomization. In a commentary, Ohman and coauthorsArticle discuss risk stratification based on analyses of results of other trials and emphasize the importance of clinical scoring systems for decision making for patients with acute coronary syndromes.

Mild and Moderate Prematurity and Infant Mortality

Infants born between 32 and 36 weeks' gestational age (mild to moderate prematurity) have a lower risk of mortality and morbidity than infants born very prematurely, but may contribute more to infant mortality at the population level. Kramer and colleagues analyzed linked birth and mortality data for singleton births in 2 US birth cohorts, 1985 and 1995, and in 2 Canadian birth cohorts, 1985-1987 and 1992-1994. Compared with term births, relative risk of death during the first year of life among mild and moderate preterm births ranged from 2.9 to 6.6 in the United States and 4.5 to 15.2 in Canada, and was highest in the neonatal period. Mild and moderate preterm births accounted for a greater proportion of infant deaths than births at 28 through 31 gestational weeks.

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Cochlear Implantation in Children Cost-effective

Cochlear implantation may help children with profound deafness who do not benefit from conventional hearing aids, but cost-effectiveness data on cochlear implantation in children are not available. Cheng and colleagues conducted a cross-sectional survey of parents of profoundly deaf children to determine changes in health status after implantation, and estimated lifetime direct medical costs and indirect costs of the implant. Cochlear implantation improved quality of life on 3 different measures of health utility. Direct medical costs per quality-adjusted life-year ranged from $5197 to $9207, and the estimated net savings to society, including indirect costs, was $53,198 per child.

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Gene Mutation and Colorectal Polyps

The I1307K mutation in the adenomatous polyposis coli (APC) gene has been associated with increased risk of colorectal cancer in Ashkenazi Jewish patients. In this study of Ashkenazi Jewish patients with colorectal polyps who did not have colorectal cancer, Syngal and colleagues found that the carrier rate of the I1307K mutation in Ashkenazi Jewish patients with adenomatous polyps significantly exceeded the reported prevalence of the mutation among control populations of Ashkenazi Jewish individuals without colorectal cancer, but the carrier rate in Ashkenazi Jewish patients with hyperplastic polyps was not increased. Among patients with adenomatous polyps, characteristics of the polyps and family history of colorectal cancer, other cancer, and polyps were similar in carriers and noncarriers.

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Aging, Sleep Regulation, and Neuroendocrine Function

Sleep, which affects the regulation of growth hormone and cortisol secretion in young adults, decreases in duration and diminishes in quality with normal aging. In this cross-sectional study of 149 healthy men aged 16 to 83 years, Van Cauter and colleaguesArticle found that from early to mid-adulthood, deep slow wave sleep and growth hormone secretion decreased markedly, but total sleep, sleep fragmentation, REM sleep, and cortisol secretion did not change. From midlife to late life, REM sleep decreased, wake time increased, and nocturnal cortisol release increased. In an editorial, BlackmanArticle reviews the effects of aging on sleep regulation, age-related changes in neuroendocrine function, and their interrelationship.

A Piece of My Mind

"The ‘e' in ‘e-mail,' originally meant to designate ‘electronic,' also stands for ‘enslavement.'" From "Ten e-pistles for the e-fficient trimillennial physician."

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Medical News & Perspectives

Nutrition is on the table: A new CME course offers to teach physicians about the Mediterranean diet on site, and a global network aims to reverse the worldwide trend toward obesity.

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Users' Guides to the Medical Literature

How to identify good evidence about the clinical manifestations of disease to guide clinical diagnosis.

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Controversies

Disparate views by Edman and KlausArticle and by WeinstockArticle on the early detection of melanoma highlight the diagnostic complexities of this disease; the uncertain role of patients, families, primary care physicians, and dermatologists; and the risks of misdiagnosis.

JAMA Patient Page

For your patients: A primer on angina.

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