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.
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.
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.
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.
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.
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.
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.
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.
For your patients: Information about influenza.
This Week in JAMA . JAMA. 2004;292(17):2049. doi:10.1001/jama.292.17.2049