Previous research suggests that patient dissatisfaction with care is
associated with malpractice risk. Hickson and colleaguesArticle report that risk
management experiences of physicians in a large multispecialty medical group
were significantly related to their total numbers of unsolicited patient complaints
recorded by the patient affairs office at their medical center, even after
adjustment for clinical activity. In an editorial, Sage discusses the importance
of incorporating patient perspectives into patient safety activities.
Pseudomonas aeruginosa pulmonary infection
accounts for much of the morbidity associated with cystic fibrosis (CF). Early
identification of P aeruginosa infection may increase
the likelihood of eradicating this organism before irreversible lung disease
occurs, but the temporal sequence of events that result in P aeruginosa infection has not been clear. In this longitudinal study
of 68 young children with CF considered to be free of P
aeruginosa infection at study entry, West and colleagues found that
a rise in P aeruginosa–specific antibodies,
indicative of initial P aeruginosa infection, occurred
6 to 12 months before the organism was isolated from respiratory secretions.
Clinical indicators of pulmonary infection also preceded isolation of P aeruginosa from respiratory samples.
Elective repair of abdominal aortic aneurysm (AAA) is usually deferred
in patients with high operative risk until the risk of rupture is thought
to exceed operative risk. In this prospective study, Lederle and colleagues
determined the incidence of AAA rupture in patients with AAA of at least 5.5
cm in diameter who refused repair or who had medical contraindications to
elective repair. The 1-year incidence of probable AAA rupture was 9.4% for
an initial diameter of 5.5 to 5.9 cm and increased to 32.5% for an initial
diameter of 7.0 cm or more.
In meta-analyses, investigators often use measures of trial quality
to divide high-quality from low-quality studies when assessing strength of
treatment effect. Balk and colleagues evaluated randomized controlled trials
in meta-analyses from 4 medical areas using 24 specific quality measures.
None of the individual quality measures was significantly associated with
estimates of treatment effect.
The tobacco industry has effectively used advertising and marketing
to maintain or increase sales. In their analysis of tobacco industry marketing
research reports and other documents that focused on young adult smokers,
Ling and GlantzArticle identified research and strategies that could be used to improve
clinical and public health tobacco-control interventions. Bayer and coauthorsArticle
discuss Lorillard Tobacco Co. v Reilly, a recent
Supreme Court case that struck down public health regulation of tobacco advertising
as a violation of the First Amendment, and the constitutional history of commercial
speech regulation. They propose a comprehensive system of taxation and regulation
designed to increase public appreciation and comprehension of the health risks
of cigarettes. In a commentary, MorrisonArticle discusses constitutional and practical aspects of proposed strategies to counteract cigarette advertising and of
possible funding mechanisms.
"This pregnancy was barely half its full gestation. It would take everything just to keep this child alive out of the womb,
to our table in the delivery room, back to the NICU." From "Everything."
Advances in pharmacotherapeutics, resective surgical therapies, and
other treatment strategies for epilepsy.
Cataloging the many proteins in the body and discovering how they function
in tissues may lead researchers to an understanding of protein networks in
cancer cells and foster discovery of new therapies.
This case presentation of a 79-year-old woman with temporal
arteritis highlights some of the unusual ways in which this panarteritis may
For your patients: Information about temporal arteritis.
This Week in JAMA. JAMA. 2002;287(22):2907. doi:10.1001/jama.287.22.2907