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This Week in JAMA
May 10, 2006

This Week in JAMA

JAMA. 2006;295(18):2111. doi:10.1001/jama.295.18.2111
Certificate of Need Regulations and AMI Outcomes

Certificate of need (CON) regulations were enacted to limit unnecessary expansion of hospital services in the United States, but little is known about the relationship between CON regulations and outcomes of care. Popescu and colleaguesArticle compared the rates of coronary revascularization and mortality after acute myocardial infarction (AMI) for Medicare beneficiaries in states with and without CON regulations during 2000-2003. They found that patients in states with CON regulations were less likely to be admitted to hospitals with revascularization services or to undergo revascularization within the first 2 days compared with patients from states without regulations. Thirty-day mortality rates were comparable in states with and without CON regulations. In an editorial, HannanArticle discusses benefits that might accrue from optimally designed regionalized care for patients with AMI.

Collaborative Care for Alzheimer Disease

In a randomized trial of primary care patients with Alzheimer disease and their caregivers, Callahan and colleagues assessed the effectiveness of collaborative care, which included care management by an interdisciplinary team and defined protocols to identify, monitor, and treat behavioral and psychological symptoms of dementia vs usual care by the primary care physician augmented by a counseling session with a geriatric nurse practitioner and provision of written educational materials and community resource referral. The authors found that compared with patients receiving augmented usual care, patients in the collaborative care group had fewer behavioral and psychological symptoms of dementia at 12- and 18-month assessments, with no significant increase in the use of antipsychotics or sedative-hypnotics. Stress and depression were less in caregivers of patients receiving collaborative care vs caregivers of patients receiving usual care.

Visual Impairment in the United States

Vitale and colleagues examined data from the 1999-2002 National Health and Nutrition Examination Survey to assess the number of US residents aged 12 years and older who have impaired vision due to uncorrected refractive error. The authors estimate that nearly 14 million individuals (6.4% of persons aged 12 years and older) have visual impairment, defined as visual acuity of 20/50 or worse, and that 83% could achieve good visual acuity with corrective lenses.

Thyroid Cancer Incidence in the United States

Results of several recent studies suggest that the incidence of thyroid cancer in the United States is increasing. Whether this is due to a true increase in disease, changing pathologic criteria, or changes in diagnostic approach is not clear. Using nationally representative data from 1973-2002, Davies and WelchArticle analyzed trends in thyroid cancer incidence, histology, tumor size, and mortality. The authors found that thyroid cancer incidence increased 2.4-fold from 1973 to 2002, which was largely due to increased detection of small papillary cancers. There were no changes in the incidence of other common histological types, and mortality from thyroid cancer was stable during these years. In an editorial, MazzaferriArticle discusses the natural history and treatment of papillary thyroid cancer.

A Piece of My Mind

“The otoscope . . . was beautiful, its sleek silver base gleaming against the black velvet and its black specula perfectly symmetrical, stacking into each other like Russian nesting dolls.” From “The Otoscope.”

Medical News & Perspectives

Although a new study suggests that drug treatment of patients with high-normal blood pressure might reduce the risk they will develop hypertension, some experts question whether medicating the country’s 70 million “prehypertensive” individuals will actually prevent adverse cardiovascular events.


Ms F is a 55-year-old woman with chronic hepatitis B virus infection and end-stage liver disease, who is a candidate for liver transplant. Larson and Curtis discuss integrating palliative care in the pretransplant setting and the challenge of maintaining hope when the prognosis is potentially poor.

Access to Care

Authors are invited to submit manuscripts for a JAMA theme issue on access to care.

Author in the Room Teleconference

Join William Taylor, MD, on Wednesday, May 31, 2006, from 2 to 3 PM eastern time to discuss approaches to screening for colon cancer. To register, go to

JAMA Patient Page

For your patients: Information about liver transplantation.