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This Week in JAMA
April 13, 2005

This Week in JAMA

JAMA. 2005;293(14):1701. doi:10.1001/jama.293.14.1701
Racial Differences in

Racial disparities in health care are well documented, but little is known about racial differences in genetic susceptibility testing. Armstrong and colleaguesArticle investigated the relationship between race and use of BRCA1/2 counseling among women with a family history of breast or ovarian cancer and assessed the contributions of socioeconomic factors, probability of carrying a BRCA1/2 mutation, cancer risk perceptions and worry, attitudes about genetic testing, and physician recommendations to the counseling decision. They found that African American women were significantly less likely than white women to undergo genetic counseling, with much of the disparity unexplained by the potential confounders considered. In an editorial, Hall and OlopadeArticle discuss factors contributing to race- and ethnicity-related disparities in cancer prevention and general preventive care.

Predicting Cardiovascular Mortality in Kidney Disease

Elderly patients with chronic kidney disease are at increased risk of cardiovascular mortality, but the relative importance of traditional vs novel risk factors in predicting risk has not been evaluated. Shlipak and colleagues assessed the predictive value of traditional and novel risk factors in a longitudinal study of patients with and without chronic kidney disease. Among patients with chronic kidney disease, traditional risk factors including left ventricular hypertrophy, current smoking, physical inactivity, systolic hypertension, diabetes, and nonuse of alcohol were better predictors of cardiovascular mortality than novel risk factors.

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Fibrinolytic Therapy Dosing Errors

Incorrect dosing of fibrinolytic therapy has been associated with adverse clinical outcomes, but whether the adverse events are related to the dosing errors or patient factors is not clear. Mehta and colleagues analyzed data from a randomized trial in which patients with an ST-segment elevation myocardial infarction were assigned to either a bolus of tenecteplase (with alteplase placebo) or a bolus of alteplase (with tenecteplase placebo) to examine the relationships between fibrinolytic therapy dose, patient factors, and adverse outcomes. In their analyses, adverse outcomes were as likely in patients with alteplase placebo dosing errors as in patients with alteplase dosing errors, suggesting that patient-related factors, not fibrinolytic dosing errors, are responsible for the adverse outcomes.

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Combination Pneumococcal-Meningococcal Vaccine

Buttery and colleagues report results of a randomized trial assessing the safety and immunogenicity of a combination 9-valent pneumococcal–group C meningococcal conjugate candidate vaccine (Pnc9-MnC) compared with a monovalent group C meningococcal conjugate (MenC) in infants. Reports of increased irritability and decreased activity were higher in the Pnc9-MnC group, and infants receiving the Pnc9-MnC vaccine had reduced group C meningococcal immunogenicity compared with those receiving the MenC vaccine.

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Abciximab Therapy in STEMI

To better establish the role of abciximab as adjunctive therapy to reperfusion in ST-segment elevation myocardial infarction (STEMI), De Luca and colleagues conducted a meta-analysis of data from 11 randomized trials of abciximab in STEMI. They found that compared with patients in the control group, patients undergoing primary angioplasty and receiving abciximab had significant reductions in 30-day and 6- to 12-month mortality, and the 30-day reinfarction rate was reduced in patients receiving abciximab and treated with either fibrinolysis or primary angioplasty. Major bleeding complications were more common in patients receiving fibrinolytics and abciximab compared with those among control patients.

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Medical News & Perspectives

Researchers are exploring the use of transcranial magnetic stimulation, a technique that uses a magnetic field to induce small electrical currents in the brain, as a potential treatment for depression and other brain conditions.

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HIPAA and Patient Care

Guidance for understanding when incidental disclosures of patient information are ethically permissible under US federal health privacy regulations.

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Clinician’s corner

Ms Q is a 64-year-old woman with a history of hypercalcemia. Strewler discusses the evaluation of patients with hyperparathyroidism, end-organ effects, and treatment options.

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Child Health

Accurate assessment of child health requires data on biological, behavioral, environmental, and social factors.

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JAMA Patient Page

For your patients: Information about hyperparathyroidism.

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