Blacks are disproportionately affected by stroke, but have been underrepresented
in clinical trials of stroke prevention. In this randomized trial among black
patients with a recent noncardioembolic ischemic stroke, Gorelick and colleaguesArticle found no statistically significant difference between
ticlopidine and aspirin in the prevention of the composite end point of recurrent
stroke, myocardial infarction (MI), or vascular death over a 2-year follow-up.
In an editorial, SaccoArticle discusses antithrombotic
therapy for prevention of recurrent stroke in black patients and the need
for more effective stroke prevention strategies, especially among individuals
with high stroke risk.
In studies conducted several decades ago, births on weekends were fewer
than expected, and neonatal mortality was higher, consistent with current
concerns about the quality of weekend medical care. In this analysis of 1995-1997
California linked data from birth and infant death certificates, Gould and
colleagues found that observed neonatal mortality increased from 2.80 per
1000 births on weekdays to 3.12 per 1000 on weekends, but after adjusting
for birth weight, the increase in neonatal mortality for infants born on weekends
was not statistically significant.
Andersen and colleagues conducted a 1-year follow-up study of a cohort
of draftsmen and machine technicians to evaluate the relationship between
mouse device and keyboard use and possible carpal tunnel syndrome. At 1-year
follow-up, the incidence of self-reported new or worsened tingling or numbness
in the right hand was 5.5%, but only 1.2% had median nerve symptoms confirmed
by clinical interview. Mouse use of 20 h/wk or more was associated with risk
of possible carpal tunnel syndrome, but there was no statistically significant
association with keyboard use.
The perception that participation in clinical studies increases the
costs of direct patient care has impeded efforts to enroll patients in clinical
trials. Goldman and colleagues assessed the additional costs of treating participants
in clinical trials by comparing the direct treatment costs of patients with
cancer enrolled in clinical trials sponsored by the National Cancer Institute
with those of matched patients who were not trial participants. On average,
the treatment costs were only 6.5% higher over 2 years for trial participants
than for patients not enrolled in a clinical trial.
McIntyre and colleaguesArticle conducted a systematic
review to evaluate the use of therapeutic hypothermia as a neuroprotective
strategy after severe traumatic brain injury in adults. In their analysis
of the results of 12 randomized controlled trials, therapeutic hypothermia
was associated with a significant reduction in the risk of death and of poor
neurologic outcome compared with normothermia. Outcomes were influenced by
the depth and duration of hypothermia and by the rate of rewarming. In an
editorial, Kochanek and SafarArticle discuss research
questions that should be addressed by future clinical investigations on the
use of hypothermia in patients with severe traumatic brain injury.
Ways to promote physical activity through primary care.
Experts say that widespread use of carrier testing for cystic fibrosis
and confusion over the interpretation of laboratory results are creating unnecessary
Analysis of data from an ongoing prospective study of homosexual and
bisexual men suggests that after about 3 years of highly active antiretroviral
therapy (HAART), total cholesterol and low-density lipoprotein cholesterol
levels, which decreased substantially before treatment of HIV infection, return
to preseroconversion levels after accounting for expected age-related changes.
In this prospective study of intensive care unit (ICU) patients, the
Richmond Agitation-Sedation Scale, a brief structured clinical instrument
to assess patient sedation in the ICU, demonstrated strong interrater reliability
and criterion, construct, and face validity.
A case of a 53-year-old man who presented with a persistent right pleural
effusion and ascites illustrates this discussion of nonalcoholic fatty liver
disease, a common cause of cryptogenic cirrhosis.
For your patients: Information about traumatic brain injury.
This Week in JAMA. JAMA. 2003;289(22):2905. doi:10.1001/jama.289.22.2905