In the Treat Angina With Aggrastat and Determine Cost of Therapy with
an Invasive or Conservative Strategy (TACTICS)–Thrombolysis in Myocardial
Infarction (TIMI) 18 trial, patients with either unstable angina or non–ST-segment
elevation myocardial infarction treated with aspirin, heparin, and a platelet
glycoprotein IIb/IIIa inhibitor who were treated with an early invasive strategy
(catheterization within 4-48 hours of randomization and revascularization
as appropriate) had a significantly reduced rate of major cardiac events at
6 months compared with those who were treated with a conservative strategy.
In this economic analysis of the TACTICS-TIMI 18 trial, Mahoney and colleaguesArticle
found that initial hospitalization costs, which were significantly higher
in the invasive strategy group, were largely offset by greater costs primarily
for rehospitalization in the conservative strategy group during 6 months of
follow-up. The estimated cost per year of life gained for the invasive strategy
ranged from $8371 to $25 769. In an editorial, CohenArticle notes that the early
invasive management strategy appears to be both clinically and economically
advantageous for patients at higher risk of ischemic complications, but not
for patients at low risk.
Certificate of need regulation, which began in 1974, was designed to
control health care costs by preventing unnecessary expansion of medical facilities.
To examine the relationship between certificate of need regulation and quality
of care, Vaughan-Sarrazin and colleagues compared risk-adjusted hospital mortality
rates for coronary artery bypass graft (CABG) surgery and the proportion of
patients undergoing CABG surgery in low-volume hospitals in states with and
without certificate of need regulation. Risk-adjusted mortality for CABG surgery
was significantly higher in states without certificate of need regulation
compared with states with continuous certificate of need regulation from 1994
through 1999. Average hospital volumes for CABG surgery in states without
certificate of need regulation were significantly lower than in states with
regulation, and more patients in states without certificate of need regulation
underwent CABG surgery in low-volume hospitals.
Both folate deficiency and folic acid supplementation have been associated
with increased risk of spontaneous abortion. In this population-based case-control
study conducted in Sweden, where folic acid food fortification has not been
introduced, George and colleagues found that risk of early spontaneous abortion
was greater among women with low plasma folate levels (≤2.19 ng/mL) than
among women with plasma folate levels between 2.20 and 3.95 ng/mL. Risk of
spontaneous abortion was not increased among women with higher folate levels.
Wolchik and colleagues conducted a 6-year follow-up evaluation of adolescents
aged 15 to 19 years who had participated in a randomized controlled trial
of 2 interventions designed to prevent mental health problems in children
with divorced parents. Compared with participants who received the control
condition, adolescents who participated in the intervention programs had a
lower rate of diagnosed mental disorders, fewer sexual partners, and less
alcohol, marijuana, and other drug use.
Part 1Article of this article reviews evidence about the value of various clinical
applications of bone densitometry. Discussion of clinical situations presented
in part 2Article addresses who should be tested with bone densitometry, what test
to use, how to do follow-up testing, and how to improve screening.
"The most powerful therapy I have to offer my patients is me, and I
have tried that prescription as much as possible." From "What Will I Do Without
The next generation of experimental eye implants will use neurotransmitters
to stimulate individual neurons in the retina.
The new report from the National High Blood Pressure Education Program
Coordinating Committee on the primary prevention of hypertension emphasizes
a population-based strategy to achieve a downward shift in the distribution
of blood pressure in the general population and an intensive targeted strategy
to decrease blood pressure in those at high risk of developing hypertension.
Neff and coauthors review data from the 1960s on transmission of vaccinia
virus from smallpox vaccinees to contacts, assess the present risk of transmission
of contact vaccinia, and discuss implications for current smallpox vaccination
Part 2 of a 2-part article on a chronic care model developed to improve the management of patients
with chronic illness in primary care evaluates the extent to which the chronic
care model improves care and whether it reduces health care costs.
For your patient: Information about miscarriage.
This Week in JAMA. JAMA. 2002;288(15):1813. doi:10.1001/jama.288.15.1813