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This Week in JAMA
November 3, 2004

This Week in JAMA

JAMA. 2004;292(17):2049. doi:10.1001/jama.292.17.2049
Influenza Revaccination and Mortality in the Elderly

Annual influenza revaccination of institutionalized elderly individuals is associated with improved survival, but whether a mortality benefit exists for persons living in the community is not clear. Voordouw and colleagues investigated the effect of annual influenza revaccination vs no vaccination on mortality in community-dwelling elderly individuals aged 65 years and older. They found that annual influenza revaccination was associated with a significant mortality reduction among those aged 70 years and older and those with and without chronic comorbidities.

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Management of High-Risk Acute Coronary Syndromes

Professional guidelines recommend early invasive management (cardiac catheterization within 48 hours of presentation) for high-risk patients with non–ST-segment elevation acute coronary syndromes (NSTE ACS). However, it is not known whether this recommendation is reflected in clinical practice. Bhatt and colleagues conducted a multicenter observational study evaluating the care and outcomes for patients at high-risk of NSTE ACS and report use and predictors of early invasive management and in-hospital mortality. They found fewer than half the patients had early catheterization. Patients who did had few significant comorbidities, were likely to be cared for by cardiologists, and had lower in-hospital mortality.

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Genetics of Bone Density and Fracture

The estrogen receptor α (ESR1) gene is a candidate gene for osteoporosis, but prior studies of ESR1 polymorphisms and their relationship to bone mineral density (BMD) and fracture risk have been based on small studies with inconclusive results. Ioannidis and colleagues analyzed data from 18 917 individuals to assess whether 3 common ESR1 polymorphisms are associated with BMD and fractures. They found none of the polymorphisms influenced BMD; however, 1 genotype (XX) of the XbaI polymorphism was associated with a reduction in fracture risk that was independent of BMD.

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Factors Leading to Disability in the Elderly

Factors leading to disability in older adults are not well-defined. Gill and colleagues conducted a longitudinal study that enrolled nondisabled, community-dwelling persons aged 70 years or older to assess whether intervening events—a hospitalization or reduced activity—are related to the development of disability. Through 5 years of follow-up, more than half the participants developed disability. Illnesses or injuries leading to hospitalization and restricted activity were positively associated with disability without regard to physical frailty at baseline.

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Risks and Benefits of Phase 1 Cancer Trials

Enhanced targeting of cancer drugs and the increased oversight of research involving humans have the potential to reduce risks incurred by cancer clinical trial enrollees. However, whether these benefits accrue to patients in phase 1 trials is not known. Roberts and colleaguesArticlereviewed published reports of single-agent clinical trials from 1991 through 2002 to assess trends in treatment-related (toxic) death, objective tumor response, and serious toxicity. They found toxic deaths decreased more than 10-fold during the study period, and rates of serious toxicities declined as well. However, objective responses decreased by approximately half. In an editorial,ArticleChen and Tannock discuss the importance of maximizing patient benefit and innovative ways to measure tumor response at the molecular level.

Medical News & Perspectives

This year’s Lasker Awards honor 3 scientists whose discoveries revolutionized the fields of endocrinology and metabolism, and inventor of modern cataract surgery, and a researcher who made key contributions to molecular biology and public policy.

Article
Physicians in Congress

Physicians in Congress from 1960 to 2002, their sex, party affiliation, professional activity before election, and time served are compared with all members of Congress and contrasted with physician representation in the first 100 years of US history.

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CLINICIAN'S CORNER

The case of Frank, a 10-year-old boy experiencing his third relapse of acute lymphoblastic leukemia, is discussed by Hurwitz and colleagues and illustrates the complexities of pediatric palliative care.

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JAMA Patient Page

For your patients: Information about influenza.

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