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This Week in JAMA
October 5, 2005

This Week in JAMA

JAMA. 2005;294(13):1589. doi:10.1001/jama.294.13.1589
Pulmonary Artery Catheters and Patient Outcomes

The pulmonary artery catheter (PAC) is widely used in critically ill patients, but whether it improves outcomes is not clear. Results from 2 studies reported in this issue of JAMA address this question. In the first article from the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trialArticle, the investigators found that patients who were randomly assigned to treatment guided by PAC monitoring and clinical assessment vs clinical assessment alone had similar hospital days and mortality but experienced more in-hospital adverse events. In the second article, Shah and colleaguesArticle report results of a meta-analysis of data from 13 clinical trials in which patients were randomly assigned to receive PAC or not to receive PAC. They found that in the patient groups studied—surgical patients, intensive care unit admissions for sepsis, patients with acute respiratory distress or advanced heart failure—the PAC had a neutral effect on mortality and hospital days. In an editorial, HallArticle discusses the evidence for and against widespread use of PACs in critically ill patients.

6A in Cancer

Evidence suggests that TGFBRI*6A, a common polymorphism of the type I transforming growth factor β receptor (TGFBRI), is involved in cancer development, but precisely how is not known. Pasche and colleagues investigated the acquisition of *6A in tumor tissue from patients with several common cancers and explored molecular properties of *6A that may influence cancer development. They report that *6A is likely to be acquired during cancer development. They also determined that a characteristic molecular change in the signal sequence of *6A may be responsible for growth stimulation in affected cancer cells.

Article
Risk of Multiple Primary Melanomas

Patients with a history of a primary melanoma are at increased risk of a second primary melanoma, but the risk factors are not well defined. Ferrone and colleagues used information from a prospectively maintained database of patients with melanoma to assess the incidence of and risk factors associated with multiple primary melanoma (MPM). In their patient population, the incidence of MPM was 8.6%. A personal or family history of dysplastic nevi was associated with an increased risk of MPM.

Article
Kidney Transplants and Donor/Recipient Pairs

Live kidney paired donation (KPD) is an emerging transplantation option for patients with end-stage renal disease and incompatible donors. Montgomery and colleaguesArticle assessed the feasibility and effectiveness of KPD in a small series of patients. At a median follow-up of 13 months, patient survival and graft survival were comparable with those achieved with directed compatible live donor transplants, and rejection episodes were similar to those reported for living unrelated transplant recipients. In an editorialArticle, Matas and Sutherland discuss efforts to increase live kidney donations.

Medical News & Perspectives

Experts warn that the mental health repercussions for thousands of survivors of Hurricane Katrina mean that ongoing support, intervention, and treatment will be needed for months and years to come.

Article
CLINICIAN’S CORNER

An evidence-based review of new therapies for juvenile idiopathic arthritis.

Article
The Supreme Court’s Influence on Medicine

The Rehnquist Court’s profound effect on medicine and health, 1986 to 2005.

Article
Reducing Risk in Obstetrics

Public education and other strategies to reduce obstetricians’ risk of malpractice litigation.

Article
JAMA Patient Page

For your patients: Information about juvenile idiopathic arthritis.

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