Screening patients for abnormal preoperative hematocrit levels is common, but there is little evidence that preoperative anemia or polycythemia is associated with adverse outcomes. Using data from a retrospective cohort study of older veterans (predominantly men) undergoing major noncardiac surgery, Wu and colleaguesArticle investigated the prevalence of preoperative anemia and polycythemia and their relationship to 30-day postoperative mortality and cardiac event rates. The authors report that each percentage-point increase or decrease in hematocrit level outside the normal range was associated with a 1.6% (95% confidence interval, 1.1%-2.2%) increase in the study outcomes. In an editorial, Farjah and FlumArticle discuss the advantages of large and high-quality observational databases for assessing the relationship between patient factors and adverse outcomes.
Racial differences in the use of coronary revascularization after acute myocardial infarction (MI) have been documented. However, whether these disparities are a consequence of racial differences in admission to hospitals lacking revascularization services and rates of transfer to hospitals with revascularization services is not clear. Popescu and colleagues investigated the relationships of race, revascularization, and mortality in a retrospective cohort of black and white Medicare beneficiaries. The authors found that compared with white patients, black patients admitted to hospitals without revascularization services were less likely to be transferred to hospitals with the service, were less likely to undergo revascularization even in hospitals with revascularization, and had higher 1-year mortality rates.
In a review of National Institutes of Health (NIH) R01 grants for 1964-2004, Dickler and colleagues assessed the annual number of first-time applicants with an MD, a PhD, or both degrees; and by degree type, the relative likelihood of receiving a grant; the likelihood of applying for and receiving a subsequent award; and applicants' proposed involvement in clinical vs nonclinical research. The authors found that the annual number of first-time physician (MD-only) applicants was stable during the 4 decades studied. However, MD-only applicants had less success obtaining first and subsequent funding compared with applicants with a PhD alone or both degrees. First-time physician applicants were more likely to propose clinical research and were funded at lower rates than the other 2 applicant categories.
McAlister and colleagues reviewed the evidence relating to efficacy, effectiveness, and safety of atrial-synchronized biventricular pacemakers (cardiac resynchronization therapy [CRT]) for patients with symptomatic heart failure and left ventricular systolic dysfunction, despite optimal pharmacotherapy. The authors report that CRT use was associated with improvements in quality of life and functional status and with reductions in hospitalizations and all-cause mortality, with a 5% risk of device or lead failure and a 2% risk of infection in the first 6 months after implantation.
“I thought back to what often felt like the roller-coaster of the disease's hurtling progression toward death, with exacerbations and remissions, false hopes, and then sudden tragedy and disappointment.” From “Small Victories.”
Studies by military researchers using regional anesthesia to treat soldiers with acute injuries suggest this approach may be superior to general anesthesia and may help prevent the development of chronic pain.
The importance of value-based health insurance benefits to control health care costs and physician involvement in a medical commons to ensure proper allocation of medical resources.
A successful strategy to increase institutional research productivity includes investment of clinical income in biomedical research.
Announcing a new French-language online edition of JAMA.
For your patients: Information about heart failure.
This Week in JAMA . JAMA. 2007;297(22):2445. doi:10.1001/jama.297.22.2445