Electron beam tomography (EBT), which visualizes calcification of the
coronary arteries, has been used as a cardiovascular disease screening tool
to motivate individuals to reduce coronary heart disease (CHD) risk factors.
O'Malley and colleaguesArticle conducted a randomized
trial among asymptomatic active-duty US army personnel aged 39 to 45 years
to assess the effects of incorporating EBT into a cardiovascular screening
program with either intensive case management or usual care. After 1 year,
change in the 10-year Framingham Risk Score, a composite measure of cardiovascular
risk, was not significantly different in the study groups that received EBT
results and those that did not. In an editorial, GreenlandArticle points
out the complexity of behavioral change necessary to reduce disease risk factors.
In previous trials of pacemaker therapy for patients with severe recurrent
vasovagal syncope, pacemaker therapy was found to reduce the risk of recurrent
syncope, but these studies were not blinded. In this double-blind trial of
pacemaker therapy for vasovagal syncope, in which all study participants underwent
dual chamber pacemaker implantation, Connolly and colleaguesArticle randomly
assigned patients to receive either dual chamber pacing with rate drop response
or only sensing without pacing. Risk of recurrent syncope at 6 months was
not significantly different in the 2 study groups. In an editorial, KapoorArticle discusses why pacemakers should not be used for treatment
of neurally mediated syncope.
Sleep-disordered breathing (SDB) is a prevalent condition that is associated
with serious chronic illness. In this analysis of data from a subgroup of
adult participants in the community-based Cleveland Family Study, Tishler
and colleagues found that the 5-year incidence of SDB was 16% or less for
mild to moderately severe SDB and 7.5% for moderately severe SDB. Incidence
of SDB was influenced independently by age, body mass index, sex, waist-hip
ratio, and serum cholesterol concentration.
To assess whether type of health insurance affects hospice use, McCarthy
and colleagues conducted a retrospective analysis of data from the last year
of life from patients dying with cancer who had Medicare managed care insurance
and from those who had Medicare fee-for-service insurance. Hospice use varied
by type of primary cancer, but patients enrolled in Medicare managed care
had consistently higher rates of hospice use than patients with Medicare fee-for-service
insurance. Overall, hospice stays were significantly longer among patients
with Medicare managed care.
Blood supply safety and donor return patterns may be affected by the
increase in blood donations that occurs in times of crisis. In this analysis
of data from 5 regional blood centers participating in the National Heart,
Lung, and Blood Institute Retrovirus Epidemiology Donor Study, Glynn and colleagues
found that the weekly number of blood donations, especially among first-time
donors, increased markedly in the week beginning with the September 11, 2001,
terrorist attacks compared with the number of donations collected weekly during
the 4 weeks preceding September 11. Screening reactivity rates for infectious
disease markers and rates of positive confirmatory tests for HIV, HCV, or
HBsAg increased during the 4 weeks after the attacks, consistent with the
increase in first-time donors. First-time donor 12-month return rates were
relatively low and were similar in 2000 and 2001.
"In a profession with constant demands from people who need me, full
of daily negotiations, the most difficult negotiation, oddly enough, may be
to learn how to be with myself." From "Time to Myself."
Evidence is accumulating that aortic stenosis, once thought to be a
degenerative condition associated with aging, is the product of an active
disease process that may be treatable.
Advances in insulin therapy for type 1 and type 2 diabetes are reviewed
in part 1 of this 2-part articleArticle. Clinical cases
in part 2 illustrate how to use new insulin strategies to improve glucose
control and overall diabetes careArticle.
Physician-assisted suicide: Issues in the ongoing legal and ethical
For your patients: Information about insulin.
This Week in JAMA. JAMA. 2003;289(17):2175. doi:10.1001/jama.289.17.2175