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This Week in JAMA
September 24, 2003

This Week in JAMA

JAMA. 2003;290(12):1549. doi:10.1001/jama.290.12.1549
Health of Long-term Survivors of Childhood Cancer

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.

Antithrombotic Treatment Before Catheter Intervention

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 catheterization.

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Prognostic Value of Exercise Testing in Women

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.

Article
Influenza Vaccine and Prevention of Acute Otitis Media

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.

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Education of Hospital Nurses and Patient Mortality

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.

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Medical News & Perspectives

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.

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Research Base for Clinical, Policy Decisions

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.

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CLINICIAN'S CORNER

The Rational Clinical Examination
Precision and accuracy of history and physical examination for diagnosing acute otitis media in children.

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JAMA Patient Page

For your patients: Information about acute otitis media.

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