Childhood cancer and its treatment are associated with risk of adverse
medical and psychosocial sequelae and early mortality in adult survivors.
In this analysis of data from adult participants in the Childhood Cancer Survivor
Study, a cohort of long-term survivors of childhood cancer, Hudson and colleaguesArticle found that most survivors perceived their overall
health as good, but compared with their siblings, survivors were significantly
more likely to report adverse general health and mental health outcomes, activity
limitations, and functional impairment. Forty-four percent of survivors reported
at least 1 adversely affected health status domain. In an editorial,Article Schwartz urges development of long-term programs
to support survivors of childhood cancer as they mature and through adulthood.
Patients with unstable coronary syndromes often receive antithrombotic
treatment prior to catheter intervention. In this randomized trial, however,
Neumann and colleagues found that the 30-day incidence of large nonfatal myocardial
infarction or death from any cause was significantly higher among patients
with unstable coronary syndromes who received 3 to 5 days of antithrombotic
treatment before catheter intervention than among those who received less
than 6 hours of antithrombotic pretreatment. The difference in the incidence
of the composite primary outcome was attributable to events occurring before
The value of using exercise testing to screen asymptomatic women for
cardiovascular risk is uncertain. Mora and colleagues analyzed data from a
cohort of women without known cardiovascular disease at baseline who were
followed up for a mean of 20.3 years in the Lipid Research Clinics Prevalence
Study. Baseline exercise capacity and heart rate responses during exercise
and recovery were strong, independent predictors of cardiovascular and all-cause
mortality, whereas exercise-induced ST-segment depression was not.
Influenza vaccine has been shown to reduce the occurrence of acute otitis
media (AOM) in studies of children mainly older than 2 years. Hoberman and
colleagues conducted a randomized placebo-controlled trial to evaluate whether
inactivated trivalent influenza vaccine would prevent AOM among younger children
aged 6 to 24 months. In 2 cohorts of children enrolled before the 1999-2000
and 2000-2001 respiratory seasons, the proportion of children in the influenza
vaccine and placebo groups who had at least 1 episode of AOM during the respiratory
season was not significantly different. The monthly rate of AOM, the estimated
proportion of time with middle ear effusion, and the utilization of selected
health care and related resources were also not significantly different.
Registered nurses (RNs) in the United States receive their basic education
through 3 types of programs: 3-year hospital diploma programs, associate degree
nursing programs in community colleges, and baccalaureate nursing programs
in colleges and universities. To evaluate whether the educational backgrounds
of hospital staff RNs are associated with patient outcomes, Aiken and colleagues
analyzed outcomes data from general, orthopedic, and vascular surgery patients
discharged from 168 Pennsylvania hospitals combined with information on characteristics
of the treating hospitals and data obtained from surveys of hospital nurses.
Each 10% increase in the proportion of hospital RNs educated at the baccalaureate
level or higher was associated with a 5% decrease in risk of both patient
mortality and failure to rescue (deaths in patients with serious complications)
within 30 days of hospital admission.
Attention-deficit/hyperactivity disorder persists into adulthood but
is often undiagnosed in adults. Advances in diagnosis and treatment can help
adults who have struggled for years with effects of this condition.
Tunis and coauthors discuss the need for high-quality scientific evidence
to support clinical and health policy decisions, describe requisite features
of clinical trials specifically designed to answer practical questions faced
by health care decision makers, and propose strategies to promote such trials.
The Rational Clinical Examination Precision
and accuracy of history and physical examination for diagnosing acute otitis
media in children.
For your patients: Information about acute otitis media.
This Week in JAMA. JAMA. 2003;290(12):1549. doi:10.1001/jama.290.12.1549