An estimated 12% to 16% of patients undergoing elective abdominal surgery develop postoperative peritonitis and require emergency laparotomy. If peritonitis persists, on-demand or planned relaparotomy are common treatment strategies, but whether one strategy is associated with better outcomes than the other is not clear. van Ruler and colleagues Article report results of a randomized multicenter trial comparing on-demand vs planned relaparotomy for patients with severe secondary peritonitis. During a 12-month follow-up, the authors found no significant difference in the combined end point of mortality and peritonitis-related morbidity among patients having on-demand vs planned relaparotomy. In an editorial, Dellinger Article discusses the importance of patients' clinical status when determining the need for reoperation. In a second editorial, Farjah and Flum Article discuss the design and analysis of clinical trials assessing the superiority, equivalence, or noninferiority of surgical treatment strategies.
Some evidence suggests the increasing prevalence of hypertension in children and adolescents parallels the increase in childhood obesity. However, because the diagnosis of hypertension in children is complicated by variations in the definitions of normal and abnormal blood pressure depending on age, sex, and height, underdiagnosis of hypertension is possible. In an analysis of medical record data from 14 187 children and adolescents seen for well-child care visits over a 7-year period, Hansen and colleagues assessed the frequency of undiagnosed hypertension and prehypertension. The authors report that 26% of the children with hypertension and 11% of the children with prehypertension had the diagnosis documented in their electronic medical record. Patient age, height, and obesity-related diagnoses and the magnitude and frequency of abnormal blood pressure readings were associated with diagnosis and documentation.
Subgroup analyses by sex are common in clinical research, but whether claims of differential effects by sex are justified and valid is not clear. Patsopoulos and colleagues assessed the internal and external validity of claims of sex differences in prominent studies of gene-disease associations and found insufficient documentation of gene-sex interactions in the majority of studies. In a reanalysis of data from a subsample of the gene-sex interactions, the authors found that more than half did not reach nominal statistical significance.
Mr L, a prison inmate in his early 40s, has stage IV adenocarcinoma of the lung that is unresponsive to radiation and chemotherapy, and he has been referred for hospice care within the prison facility. Linder and Meyers discuss health care in correctional facilities and issues specific to palliative care in this setting.
In a literature review on diabetic retinopathy, Mohamed and colleagues found evidence that tight glycemic and blood pressure control reduces retinopathy incidence and progression. The authors also discuss what is known about the efficacy and safety of other interventions.
New molecular insights and an international “roadmap” are bolstering efforts to develop a malaria vaccine.
Mortality and functional outcomes following heatstroke and prognostic factors for heat-related mortality are reported in 2 articles in the August 15 online issue of the Archives of Internal Medicine. O’Malley discusses what is known about heat-related illness and the importance of preparation and prompt intervention in the event of heat and other weather-related catastrophes.
Physicians' role in patient-based and community-wide interventions to reduce childhood obesity and overweight.
Join Douglas R. Lowy, MD, on September 19 from 2 to 3 PM eastern time to discuss human papillomavirus vaccine among young women with preexisting infection. To register, go to http://www.ihi.org/AuthorintheRoom.
Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.
Theme Issue on Medical Education
For your patients: Information about retinopathy.
This Week in JAMA . JAMA. 2007;298(8):837. doi:10.1001/jama.298.8.837