In this issue of THE JOURNAL, 2 prospective cohort studies report on
recovery from concussion in collegiate football players during 3 competitive
seasons. Guskiewicz and colleagues,Articlein a study of football
players at 25 US colleges, found that the overall incidence of concussion
was 0.81 per 1000 athlete-exposures. History of previous concussion was significantly
associated with increased risk of incident concussion and with slower recovery
of neurological function after concussion. McCrea and colleaguesArticlestudied the acute effects of concussion and time to recovery after concussion
in football players at 15 US colleges. Athletes who sustained a concussion
exhibited the most severe symptoms, cognitive dysfunction, and balance problems
immediately after the concussion, followed by a gradual course of recovery
over 5 to 7 days. In an editorial,ArticleMcKeag discusses
some of the key aspects involved in current management of sports-related concussion.
Expanded newborn screening using tandem mass spectrometry allows testing
for more than 20 biochemical genetic disorders. Waisbren and colleaguesArticlecompared outcomes of children with biochemical genetic disorders
identified by expanded newborn screening in Maine and Massachusetts and by
a private laboratory in Pennsylvania with those identified clinically in any
New England state. Children identified by expanded newborn screening had fewer
hospitalizations, shorter hospital stays, fewer medical problems, and higher
scores on developmental tests than did children identified clinically. Mothers
in the screened group reported lower overall stress than did mothers in the
clinically identified group, but mothers of children who had false-positive
screening results reported greater stress and parent-child dysfunction than
did mothers of children with normal screening results. In an editorial,ArticleHoltzman examines whether expanded newborn screening using
tandem mass spectrometry meets criteria for use in population-wide screening
Gerdesmeyer and colleagues conducted a randomized trial to assess fluoroscopy-guided
extracorporeal shock wave therapy for treatment of calcific tendonitis of
the shoulder. Improvement in shoulder function was significantly greater at
the 6-month follow-up in patients with chronic, symptomatic calcific tendonitis
who received high-energy or low-energy extracorporeal shock wave therapy than
in those who received sham treatment.
Few methods are available to clinicians for estimating heart failure
mortality risk. Lee and colleagues used data from community-based patients
newly hospitalized with heart failure to develop and validate a predictive
model of heart failure mortality risk that uses clinical information routinely
available at the time patients present to the hospital. Significant predictors
of 30-day and 1-year mortality in patients with heart failure included older
age, lower systolic blood pressure, higher respiratory rate, higher urea nitrogen
level, hyponatremia, and the presence of comorbid conditions.
Most experts recommend 14 to 21 days of antimicrobial treatment for
ventilator-associated pneumonia (VAP). In this randomized trial among patients
in intensive care units with microbiologically proven VAP, Chastre and colleagues
found that among patients who received appropriate initial empirical therapy,
mortality from any cause and rate of recurrent pulmonary infection at 28 days
after onset of VAP were not significantly different in patients who received
antibiotics for 8 days compared with those who received antibiotics for 15
days. The number of antibiotic-free days from day 1 to day 28 was significantly
greater in those who received the 8-day regimen.
"For people employed in health care, having an ill family member creates
a tension that defies resolution." From "Conflict of Interest."
The movement of angiogenesis inhibitors from the laboratory into the
clinic has fallen short of expectations, but continuing research is leading
to better understanding of the process and development of new antiangiogenic
agents. (Photo credit: D. M. McDonald/Nature Publishing Group)
Pathogenesis, diagnosis, and management of chronic graft-vs-host disease.
For your patients: Information about concussion in sports.
This Week in JAMA. JAMA. 2003;290(19):2513. doi:10.1001/jama.290.19.2513