Hypertension is a risk factor for progression of coronary artery disease
(CAD). Pepine and colleaguesArticle conducted a randomized
controlled trial among patients aged 50 years or older with hypertension and
CAD to compare outcomes of 2 multidrug blood pressure management strategies:
a verapamil-trandolapril–based strategy and an atenolol-hydrochlorothiazide–based
strategy. During a mean follow-up of 2.7 years, there were no significant
differences in the primary composite outcome of all-cause mortality, nonfatal
myocardial infarction, or nonfatal stroke between the treatment strategies.
In an editorial, AldermanArticle discusses ways to improve
cardiovascular disease prevention in both research studies and clinical practice.
The benefits of solitary pancreas transplant for diabetes mellitus remains
controversial. Venstrom and colleaguesArticle compared the
posttransplantation survival of patients with preserved renal function who
received either a pancreas alone or a pancreas-after-kidney transplant with
similar patients on the organ donor wait list during 1995-2000. After 4 years
of follow-up, patients who received a solitary pancreas transplant had worse
survival compared with patients who continued to receive conventional insulin
therapy. In a commentary, NathanArticle discusses the known
risks and benefits of isolated pancreas transplantation and urges diligent
attention to patient selection criteria.
The herbal remedy echinacea is widely used to treat symptoms of upper
respiratory tract infections (URIs), but its safety and efficacy have not
been established in children. Taylor and colleagues conducted a randomized,
placebo-controlled study of the effect of echinacea on reduction in URI symptom
severity and duration in children aged 2 to 11 years and found echinacea to
offer no advantage over placebo. Children receiving echinacea were signficantly
more likely to experience a rash during the course of their URIs compared
with those receiving placebo.
Mediastinal radiation has been associated with an increased risk of
myocardial infarction–related death and valvular heart disease in Hodgkin
lymphoma survivors. Hull and colleagues collected data from clinical record
review and patient interviews to assess the incidence, severity, and risk
factors associated with coronary and noncoronary vascular disease and valvular
abnormalities in Hodgkin disease survivors and compared their disease rates
with population-based data. They found higher than expected rates of valve
surgery and revascularization procedures 10 to 20 years after radiation to
fields including the heart and carotid and subclavian arteries. Traditional
coronary risk factors were associated with a higher likelihood of coronary
artery disease; no patient- or treatment-related risk factors were associated
with valvular dysfunction.
Morbidity and mortality conferences offer an opportunity to review adverse
events and errors, but it is not known whether morbidity and mortality conferences
accomplish this goal. Pierluissi and colleagues report the results of a cross-sectional
study of 151 internal medicine and surgery morbidity and mortality conferences
at 4 teaching hospitals. Internal medicine conferences were less likely to
include adverse events or errors and the discussion was more likely to avoid
acknowledgment of error compared with the surgical conferences.
As the global community marks the 15th World AIDS Day this week, US
physicians and public health specialists work to guide prevention and treatment
efforts in Africa and China.
A population-based case-control study suggests that the adenine-to-guanine
substitution polymorphism at nucleotide 870 of the cyclin D1 gene appears
to be associated with increased risk of advanced stage colorectal cancer.
The accuracy of estimates of the pretest probability for pulmonary embolism
based on clinical assessment by experienced clinicians is compared with that
of clinical prediction rules, which can be used by physicians of varying experience.
Quarantine: political and social aspects, quarantine for HIV in Cuba,
mathematical models of quarantine and isolation policies. Winners of the William
Carlos Williams Poetry Contest.
For your patients: Information about pulmonary embolism.
This Week in JAMA. JAMA. 2003;290(21):2769. doi:10.1001/jama.290.21.2769