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.
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
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
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.
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.
"The ‘e' in ‘e-mail,' originally meant to designate ‘electronic,'
also stands for ‘enslavement.'" From "Ten e-pistles for the e-fficient
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.
How to identify good evidence about the clinical manifestations of disease
to guide clinical diagnosis.
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.
For your patients: A primer on angina.
This Week in JAMA. JAMA. 2000;284(7):803. doi:10.1001/jama.284.7.803