Among patients presenting to the emergency department (ED) with chest
pain or other symptoms suggestive of acute cardiac ischemia, some without
acute ischemia may be unnecessarily admitted to the hospital or special observation
unit, while others with acute ischemia may be inappropriately discharged from
the ED. Udelson and colleaguesArticle conducted a randomized trial among adult ED
patients with suspected acute cardiac ischemia but without initial electrocardiogram
changes diagnostic of acute ischemia to assess whether incorporating sestamibi
myocardial perfusion imaging into an ED evaluation protocol would improve
initial ED triage. Among patients with a final diagnosis of acute cardiac
ischemia based on subsequent testing, ED triage decisions using a standard
evaluation were not significantly different from those in which the standard
evaluation was supplemented with sestamibi imaging. However, among patients
without acute cardiac ischemia, the rate of hospitalization was significantly
lower in the sestamibi imaging group. In an editorial, GibbonsArticle discusses issues
to be considered before using myocardial perfusion imaging in the routine
evaluation and triage of patients with acute chest pain.
Decision aids are intended to increase patient participation in treatment
decision making. In this randomized trial among women with menorrhagia, Kennedy
and colleagues compared health status outcomes, treatment choices, and costs
in 3 study groups: an information-only group, in which women received a specially
designed booklet and complementary videotape; an interview group, in which
women received the same materials as the information group and also a structured
interview to clarify and elicit treatment preferences prior to specialist
consultation; and a control group. In general, health status outcomes measured
at 2-year follow-up were not significantly different in the 3 study groups.
Hysterectomy rates and costs were significantly lower in the interview group
compared with the information and control groups.
Metabolic syndrome is characterized by disturbed glucose and insulin
metabolism, overweight and abdominal fat distribution, mild dyslipidemia,
and hypertension. To assess the association between metabolic syndrome and
cardiovascular and overall mortality, Lakka and colleagues analyzed 11-year
follow-up data from men enrolled in the prospective Kuopio Ischaemic Heart
Disease Risk Factor Study who were aged 42 to 60 years at baseline and did
not have cardiovascular disease, cancer, or diabetes. Cardiovascular disease
mortality and all-cause mortality were significantly increased in men with
metabolic syndrome according to National Cholesterol Education Program and
World Health Organization definitions, independent of other important and
potentially confounding cardiovascular disease risk factors.
Sudden infant death syndrome (SIDS) is the leading cause of infant mortality
among American Indians. In this population-based case-control study in American
Indian communities in South Dakota, North Dakota, Nebraska, and Iowa, Iyasu
and colleagues found that 2 or more layers of clothing on the infant, periconceptual
maternal alcohol use, and maternal first-trimester binge drinking were associated
with a significantly increased risk of SIDS. Any public health nurse visit
before or after birth was associated with a significantly lower risk of SIDS.
Driven by an ever-widening HIV/AIDS pandemic, researchers are exploring
some novel stategies in their quest to develop an HIV vaccine.
Evidence on the association between Chlamydia pneumoniae infection and pathogenesis of atherosclerosis.
Perspectives on Care at the Close of LifeExcerpts
of interviews with the son of a 77-year-old woman with pulmonary fibrosis
and respiratory failure and with her physicians illustrate processes involved
in decisions to withdraw life-sustaining therapies from critically ill patients.
Berliner and Ginzberg identify factors contributing to the current nursing
shortage and discuss why this shortage is unlikely to respond solely to economic
remedies used in the past.
For your patients: Information about sudden infant death syndrome.
This Week in JAMA. JAMA. 2002;288(21):2643. doi:10.1001/jama.288.21.2643