Paying individuals to donate organs has been proposed or justified as
a way to increase the supply of organs for transplantation and to benefit
donors by improving their economic status. In this survey of individuals who
sold a kidney in Chennai, India, Goyal and colleaguesArticle found that almost all
respondents had sold a kidney to pay off debt, but at an average of 6 years
after nephrectomy, three fourths of respondents were still in debt, average
annual family income had declined by one third, and the percentage of respondents
living below the poverty line had increased. Most respondents reported a deterioration
in their health status after nephrectomy. In a commentary, RothmanArticle discusses
economic implications of selling organs for transplantation, noting how commerce
in organs hinders organ donation.
In this randomized controlled trial, Weinberger and colleaguesArticle compared
a pharmaceutical care program in community pharmacies with a peak expiratory
flow rate (PEFR) monitoring control group and a usual care control group for
patients with asthma or chronic obstructive pulmonary disease. The pharmaceutical
care program provided pharmacists with patient-specific clinical data and
included pharmacist training, patient education materials, and program support.
Patients receiving pharmaceutical care had significantly higher peak flow
rates than patients in the usual care group, but not compared with patients
in the PEFR monitoring control group. Differences in medication compliance
and health-related quality of life were not significant among the 3 groups.
Patients with asthma in the pharmaceutical care group had significantly more
breathing-related emergency department or hospital visits than those in the
usual care group. In an editorial, Strom and HennessyArticle emphasize the importance
of evaluating programmatic interventions in clinical care with rigorous, controlled
Minority children have higher rates of substantiated maltreatment than
do white children, but it is not clear whether minority children are abused
more frequently or whether their cases are more likely to be reported. Lane
and colleagues conducted a retrospective chart review at an urban US children's
hospital among children younger than 3 years hospitalized for treatment of
an acute primary skull or long bone fracture. Abusive fractures occurred more
commonly among minority children than among white children, but minority children
were also more likely to be evaluated and reported for suspected abuse even
after controlling for the likelihood of abusive injury.
Hysteroscopy is used extensively for the evaluation of uterine bleeding
disorders. Clark and colleagues conducted a quantitative systematic review
to estimate the diagnostic accuracy of hysteroscopy for endometrial cancer
and hyperplasia in women with abnormal uterine bleeding. Diagnostic accuracy
of hysteroscopy was high for endometrial cancer, but only moderate for endometrial
disease (cancer and/or hyperplasia).
In this literature review, Stewart identifies plausible mechanisms by
which exercise training may improve the cardiovascular health of persons with
type 2 diabetes and hypertension. Evidence for an exercise training benefit
was strongest for improvements in endothelial vasodilator function and left
ventricular diastolic function. Stewart proposes general guidelines for exercise
prescriptions for patients with diabetes and hypertension.
A case linking West Nile virus and organ transplantation has spurred
attempts to discover whether the infection can be transmitted through blood
and ignited interest in developing a screening test.
Grand Rounds at the Johns Hopkins Hospital
Stone discusses the evaluation and treatment of a 30-year-old man with
a 12-year illness diagnosed as Still disease who had persistent symptoms despite
treatment with high doses of corticosteroids.
Approaches to challenges in international health.
For your patients: Information about endometrial cancer.
This Week in JAMA. JAMA. 2002;288(13):1557. doi:10.1001/jama.288.13.1557