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This Week in JAMA
December 3, 2003

This Week in JAMA

JAMA. 2003;290(21):2769. doi:10.1001/jama.290.21.2769
Antihypertensive Strategies for Patients With CAD

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.

Survival Following Pancreas Transplant for Diabetes

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.

Echinacea for Respiratory Infections in Children

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.

Cardiovascular Complications in Hodgkin Survivors

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.

Discussing Medical Errors in Conferences

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.

Medical News & Perspectives

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.

Cyclin D1 Polymorphism and Advanced Colorectal Cancer

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.

CLINICIAN'S CORNER

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.

JAMA

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.

JAMA Patient Page

For your patients: Information about pulmonary embolism.

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