Automated external defibrillators (AEDs) are widely available in public places, but little is known about their reliability. Shah and MaiselArticle reviewed US Food and Drug Administration recalls, safety alert advisories, and adverse event reports from 1996 through 2005 to assess the number and rate of advisories for AEDs and accessories, the reasons that prompted the advisories, and the number of fatal malfunctions. The authors found 52 advisories for AEDs and accessories during this period. Overall, 21% of the AEDs distributed during this period were recalled, most commonly for electrical or software problems, and there were 370 fatal malfunctions. In an editorial, EstesArticle discusses the importance of postmarketing surveillance and reporting of device performance to accurately assess safety and reliability.
Some evidence suggests that the α-synuclein gene (SNCA) may be associated with risk of Parkinson disease, but studies from different populations have yielded conflicting results. Maraganore and colleagues, writing for the Genetic Epidemiology of Parkinson's Disease Consortium, report results of an international collaborative study to assess the relationship of SNCA promoter variability to Parkinson disease. In a comparison of SNCA alleles from patients with Parkinson disease and controls, the investigators found that variability in the length of a dinucleotide repeat sequence within the SNCA promoter is associated with Parkinson disease susceptibility but not age at onset.
Haemophilus influenzae type b (Hib) vaccine has nearly eradicated Hib disease in developed countries, but few data exist to evaluate the effectiveness of the vaccine in developing nations. Cowgill and colleagues assessed Hib disease incidence and vaccine effectiveness in a predominately rural district in Kenya, where the vaccine was added to the routine infant immunization program in 2001. Compared with Hib disease rates before vaccine introduction, the authors found a significant decline in Hib disease incidence among children younger than 5 years. This effect was evident 3 years after the Hib vaccine was added to the routine infant immunization program.
Among patients infected with HIV and receiving antiretroviral therapy, a high level of adherence to therapy is essential to suppress the virus and prevent drug resistance and disease progression. Concerns that patients living in poverty and with low educational achievement, such as HIV-infected persons in sub-Saharan Africa, would have suboptimal adherence that could lead to the development and spread of drug resistance have been raised. In a meta-analysis of data on adherence to antiretroviral therapy from studies conducted in sub-Saharan Africa and North America, Mills and colleagues found that significantly more patients in sub-Saharan Africa achieved adequate adherence compared with patients in North America.
“We acknowledge, but distance ourselves from, many of the emotional aspects of our patients' care and deny the vulnerability of our own human condition. However, when we were exposed to tragedy outside the medical arena, where our scrubs, masks, objectivity, and routine protect us like armor, our reactions were quite different.” From “In Only an Instant.”
New guidelines intended to standardize management of patients with valvular heart disease stress the importance of early diagnosis and advise valve repair rather than replacement for most patients with mitral valve regurgitation.
Mrs A, an elderly woman who was hospitalized and treated for urosepsis, desires to be discharged to her home despite being bedbound and lacking adequate social support and financial resources to manage safely. Carrese discusses physicians' ethical obligations to promote patient well-being while honoring a patient's right to refuse care.
Pronovost and colleagues discuss challenges in measuring patient safety and propose a method to track progress in making hospitals safer.
Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.
For your patients: Information about automated external defibrillators.
This Week in JAMA . JAMA. 2006;296(6):625. doi:10.1001/jama.296.6.625