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This Week in JAMA
July 27, 2005

This Week in JAMA

JAMA. 2005;294(4):399. doi:10.1001/jama.294.4.399
Predicting Prostate Cancer–Specific Mortality

Identification of risk factors for prostate cancer–specific mortality is the subject of 2 articles in this issue of JAMA. Freedland and colleaguesArticle assessed prostate-specific antigen doubling time (PSADT), pathological Gleason score, and time from surgery to biochemical recurrence in a cohort of men who had received radical prostatectomy. They found that these 3 clinical factors were useful for risk stratification. D’Amico and colleaguesArticle examined the velocity of PSA level increase in the year prior to diagnosis in men who received radiation therapy. They found that a PSA velocity greater than 2.0 ng/mL was associated with a shorter time to prostate cancer–specific mortality, even in men with tumor characteristics suggestive of low-risk disease. In an editorial, AnscherArticle discusses the clinical and research utility of these findings.

Acute MI Complicated by Cardiogenic Shock

Early mechanical revascularization is recommended for patients with acute myocardial infarction (MI) and cardiogenic shock for those who are younger than 75 years, but whether this strategy has been adopted in routine practice is not known. To assess trends in early revascularization and mortality for patients with cardiogenic shock complicating acute MI, Babaev and colleagues analyzed data from the National Registry of Myocardial Infarction from January 1995 to May 2004. They found that among hospitals with revascularization capability, primary percutaneous coronary intervention rates increased from 27.4% to 54.4%, and this was associated with improved survival.

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Acute Illness and Pesticide Exposure

Pesticides used on school grounds or on contiguous properties may pose health risks for children and school employees. In an analysis of data from 3 national pesticide surveillance systems from 1998 to 2002, Alarcon and colleagues estimated that pesticide exposure was a factor in 6.8 illnesses per million children and 27.3 illnesses per million school employee full-time equivalents. Illness severity was classified as low in the majority of cases, and insecticides and disinfectants were implicated in two thirds of the reported events.

Hypertension in the Elderly

Hypertension is common in elderly individuals, but few studies have examined treatment, control, and risk factors among persons aged 80 years and older. Using data from the Framingham Heart Study, Lloyd-Jones and colleagues compared prevalence, treatment, and control of hypertension across age groups. They found that hypertension prevalence increases with advancing age, exceeding 70% in those older than 80 years. Rates of control are low, particularly among elderly women, and absolute risks for cardiovascular disease are markedly increased among elderly persons with hypertension.

Preventive Services for Older Adults

In an analysis of survey data from 3660 physicians and linked Medicare claims data, Pham and colleagues found that the proportion of Medicare beneficiaries receiving 6 preventive services was less than national goals. They identified certain physician and practice-setting characteristics including medical school location, practice size, access to information technology, and Medicaid revenues that were associated with preventive care patterns.

Medical News & Perspectives

New studies reveal that tiny lengths of RNA molecules called microRNAs play a role in the development of cancer—findings that may point the way to new diagnostics and therapies.

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Advice for physicians to help their patients quit smoking.

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Viral Encephalitis in Organ Recipients

An article in the Archives of Neurology reports clinical and autopsy findings from 4 recipients of organs and tissue from a common donor who on postmortem examination was found to be infected with the rabies virus. Roos discusses predonation testing of potential organ donors with encephalitic illnesses.

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Efficiency in Health Care

Grove, former chairman of the board of Intel Corporation, compares and contrasts research and translational and operational efficiencies of the computer and health care industries.

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JAMA Patient Page

For your patients: Information about viral encephalitis.