Chronic Helicobacter pylori infection is a
risk factor for the development of gastric cancer. Wong and colleaguesArticle
conducted a randomized trial among healthy carriers of H pylori infection from Fujian Province, China, to determine
whether a 2-week course of H pylori eradication treatment
would reduce the incidence of gastric cancer. After 7.5 years of follow-up,
the incidence of gastric cancer in the group that received H pylori eradication treatment was not significantly different from
that in the placebo group. In a subgroup analysis of outcomes among H pylori carriers who did not have precancerous lesions
at study entry, the incidence of gastric cancer was significantly reduced
in the H pylori eradication treatment group compared
with the placebo group. In an editorial, Parsonnet and FormanArticle discuss the implications of these findings for H pylori screening and treatment initiatives.
Hospital procedural and patient volumes have been proposed as quality
indicators for the purpose of selective referral strategies. Two articles
in this issue of THE JOURNAL examine the relationship between hospital volume
and patient outcomes. In an analysis of data from coronary artery bypass graft
(CABG) procedures from the Society of Thoracic Surgeons National Cardiac Database,
Peterson and colleaguesArticle found that after adjusting for
patient risk and clustering issues, hospital CABG volume was only modestly
associated with all-cause operative mortality. This association was not observed
in patients younger than 65 years or in those at low operative risk and was
confounded by surgeon procedural volume. Rogowski and colleaguesArticle, in an analysis of data on very low-birth-weight (VLBW) infants from a network
of hospitals with neonatal intensive care units, found that although annual
volume of VLBW infant admissions was significantly associated with mortality
prior to discharge home, it explained only 9% of the variation in mortality
rates across hospitals. In an editorial, ShahianArticle evaluates
the potential usefulness of hospital procedural volume as a quality metric
for CABG surgery.
Guidelines recommend coronary heart disease (CHD) risk assessment for
all adults to guide primary prevention. Greenland and colleagues conducted
a prospective study of asymptomatic adults with at least 1 coronary risk factor
but without diabetes or history of CHD to determine whether coronary artery
calcium score (CACS) assessment combined with the Framingham Risk Score (FRS)
provides prognostic information superior to either method alone. The CACS
significantly modified risk prediction among patients with an FRS of at least
10%, but not among patients with an FRS less than 10%.
Anecdotal reports of sudden cardiac death and cerebrovascular accidents
have raised questions about the safety of dietary weight-loss supplements
that contain ephedra and caffeine (DSEC). In this randomized crossover study
among healthy volunteers, McBride and colleagues found that the mean maximal
corrected QT interval (QTc) and systolic blood pressure were significantly
increased after a single dose of Metabolife 356, a widely used multicomponent
DSEC, compared with placebo.
Outbreaks of enterovirus 71 have been associated with serious morbidity
and mortality. Lin and colleagues conducted a prospective family cohort study
in Taiwan to investigate enterovirus 71 transmission and determine clinical
outcomes within households of patients infected with enterovirus 71. Household
transmission rates of enterovirus 71 were significantly higher among children
than among adults. Infection of household children, especially those younger
than 3 years, was associated with serious complications, sequelae, and death,
whereas infection of adults was usually asymptomatic or mild.
Sleep experts are concerned that a drug approved to treat sleepiness
in patients with narcolepsy and a few other disorders will be used "off-label"
by healthy individuals as a means to shortchange themselves on sleep.
Prenatal ultrasound scans can show potential markers of abnormalities
such as Down syndrome, but because many such markers are also found in normal
fetuses, clinicians are divided on whether they provide useful information
or cause needless worry for pregnant women.
Part 1Article of this 2-part article presents recommendations
for the diagnosis and management of subclinical thyroid disease and assesses
the evidence supporting each recommendation. In part 2Article, case scenarios illustrate evidence-based approaches to managing patients
with subclinical hypothyroidism and hyperthyroidism.
For your patients: Information about gastric cancer.
This Week in JAMA. JAMA. 2004;291(2):155. doi:10.1001/jama.291.2.155