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This Week in JAMA
January 3, 2007

This Week in JAMA

JAMA. 2007;297(1):9. doi:10.1001/jama.297.1.9
Pexelizumab and Mortality in AMI

Among patients with acute ST-elevation myocardial infarction (STEMI) who are treated with percutaneous coronary intervention (PCI), a postreperfusion inflammatory response has been associated with subsequent mortality. In an experimental model, pexelizumab, a humanized monoclonal antibody that binds the C5 component of complement, reduced inflammation and infarct size and possible reductions in mortality were observed in early clinical studies of patients undergoing PCI with pexelizumab. The randomized, placebo-controlled Assessment of Pexelizumab in Acute Myocardial Infarction Trial (APEX AMI) was designed to assess whether pexelizumab as an adjunct to PCI could improve outcomes after STEMI. The trial investigatorsArticle report that there were no differences between the pexelizumab and placebo treatment groups in 30-day or 90-day all-cause mortality or in a composite outcome of death, cardiogenic shock, or congestive heart failure. In an editorial, Eikelboom and O’DonnellArticle discuss the APEX AMI trial, possible explanations for the lack of demonstrated benefit from adjunctive pexelizumab therapy, and implications for future research.

Validation of a Prediction Rule for Bacterial Meningitis

Previously, Nigrovic and colleagues described the development and single-center validation of the Bacterial Meningitis Score, which estimates the likelihood a child has bacterial meningitis on the basis of cerebrospinal fluid (CSF) findings, peripheral blood neutrophil count, and history of seizure. Nigrovic and colleagues report the results of a multicenter, retrospective cohort study of 3295 children with CSF pleocytosis in which the authors assessed the sensitivity and negative predictive value of the Bacterial Meningitis Score. The authors found that the Bacterial Meningitis Score had a sensitivity of 98.4% (95% CI, 94.2%-99.8%) and a negative predictive value of 99.9% (95% CI, 99.6%-100%).

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Performance Measures and Heart Failure Outcomes

In an analysis of data from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure registry, Fonarow and colleagues examined the relationship between current American College of Cardiology/American Heart Association (ACC/AHA) performance measures for hospitalized patients with heart failure and relevant clinical outcomes. Of the 5 ACC/AHA performance measures, the investigators found that only 1, the prescription of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker at discharge, was related to mortality or combined mortality or rehospitalization in the first 60 to 90 days after discharge.

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Claims Data and Risk-Adjusted Mortality

Risk-adjusted hospital mortality rates, often used as a quality indicator, are typically derived from analyses of administrative claims data, which may not accurately reflect hospital quality. In an analysis of administrative claims data and clinical data abstracted from medical records, Pine and colleagues assessed whether the addition of a limited set of clinical data to administrative claims data could improve risk adjustment of inpatient mortality. The authors found that the addition of present on-admission codes and a limited set of laboratory data substantially improved the power of risk-adjustment equations to predict hospital quality. Inclusion of more difficult-to-obtain clinical data in risk-adjustment models added little additional predictive power to their models.

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A Piece of My Mind

“There are great doctors everywhere . . . in the gloomy cold, hidden from sight behind the snow fort of forms on their desks . . . I was one of them and did not even know it.” From “A Place in the Sun.”

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Medical News & Perspectives

2007 marks the 200th anniversary of the founding of the nation's first public medical school, the University of Maryland School of Medicine.

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CLINICIAN'S CORNER

Community-dwelling patients who have fallen in the past year or who have abnormalities in gait or balance are at risk of future falls.

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Use Law to Foster Health

How law can be used to facilitate healthier lifestyles and prevent obesity.

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Author in the Room Teleconference

Join Dennis Black, PhD, January 17, 2007, from 2 to 3 PM eastern time to discuss the effects of continuing or stopping alendronate after 5 years. To register, go to http://www.ihi.org/AuthorintheRoom.

Audio Commentary

Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

JAMA Patient Page

For your patients: Information about meningitis.

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