Routine varicella vaccination was recommended for children in 1995,
and substantial declines in varicella incidence have been documented. However,
whether routine vaccination has resulted in fewer varicella-related medical
visits is not known. Zhou and colleaguesArticle assessed 1994-2002
trends in varicella-related hospitalizations, ambulatory visits, and associated
expenditures using a national insurance data set. Compared with the 1994-1995
prevaccination period, they found hospitalizations declined 88%; ambulatory
visits, 59%; and associated expenditures, 74%. In an editorial, DavisArticle discusses important considerations when projecting and reviewing vaccine cost-effectiveness.
Reperfusion therapy reduces mortality from ST-segment elevation myocardial
infarction (STEMI), but factors that could influence time to reperfusion,
such as time of day, day of week, or therapy type, may affect outcomes. Using
data from a cohort of patients with STEMI treated with either fibrinolytic
therapy or percutaneous coronary intervention (PCI), Magid and colleagues
calculated door-to-drug or door-to-balloon times by time of day and day of
week (regular hours, 7 AM-5 PM weekdays; off-hours,
after 5 PM weekdays and all weekend) and the relationship of
timing to in-hospital mortality. The authors found that most patients were
treated during off-hours and patients having PCI during off-hours had significantly
longer times to treatment. Patients presenting during off-hours had significantly
higher mortality compared with patients presenting during regular hours.
Data on the prevalence, etiology, management, and outcome of patients
with acute renal failure (ARF) in different regions of the world are lacking.
To address this, Uchino and colleagues conducted a prospective, epidemiological
survey of patients with ARF in the intensive care unit of 54 centers in 23
nations. They found that the prevalence of ARF was between 5% and 6% and overall
hospital mortality was about 60%. Factors contributing to ARF and mortality
Placement of coronary stents that elute either sirolimus or paclitaxel
is common treatment for coronary artery disease. Whether there are safety
and efficacy differences between the 2 drug-eluting stents is not clear. Kastrati
and colleagues conducted a meta-analysis of outcome data from 6 randomized
trials comparing the sirolimus-eluting stent with the paclitaxel-eluting stent.
They found significantly fewer patients with the sirolimus-eluting stent required
target lesion revasularization or had angiographic restenosis. Rates of death,
death and myocardial infarction, and stent thrombosis were similar in patients
receiving either stent.
Pediatric research that does not offer participants “a prospect
of direct” benefit is constrained by federal regulations to that which
carries at most a minimal or minor increase over minimal risk. Minimal risk
is defined based on risks ordinarily encountered in daily life or during routine
physical and psychological examinations or tests. Application of this standard
by institutional review boards is inconsistent. Wendler and colleagues present
empirical data on ordinary childhood risks, such as car travel and sports,
and alternatives to the current definition of minimal risk.
Neuroimaging is helping scientists explore complex brain functions and
advance the understanding of the brain in health and disease. But the use
of such tools has ethical implications.
Sachs discusses the case of Mrs W, whose first pregnancy ended with
uterine rupture, a stillborn male infant, hysterectomy, and disseminated intravascular
coagulation. He describes the lessons learned and departmental changes instituted.
Federal public health powers and the patient-physician relationship
following Gonzalez v Raich.
For your patients: Information about chickenpox.
This Week in JAMA . JAMA. 2005;294(7):773. doi:10.1001/jama.294.7.773