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In This Issue of JAMA
January 19, 2016


JAMA. 2016;315(3):223-225. doi:10.1001/jama.2015.14058
Death, Dying, and End of Life

Edited by Howard Bauchner, MD, and Phil B. Fontanarosa, MD, MBA


In an analysis of administrative and registry data from 7 developed countries (United States, Belgium, Canada, England, Germany, the Netherlands, and Norway), Bekelman and colleagues examined patterns of care, health care utilization, and expenditures over the 180-day and 30-day periods before death for patients aged 65 years or older who died of cancer in 2010. Among the authors’ findings was that end-of-life care was less hospital-centric in the Netherlands and the United States than in the other countries. Hospital expenditures near the end of life were higher in the United States, Norway, and Canada, intermediate in Germany and Belgium, and lower in the Netherlands and England. Intensive care unit admission was more than twice as common in the United States compared with the other countries.

Author Video Interview and Continuing Medical Education

Patients with advanced-stage cancer often receive aggressive medical care at the end of life despite evidence that aggressive treatment does not improve quality of life, patient outcomes, or caregiver bereavement. Wright and colleagues surveyed 1146 family members of Medicare patients who died with advanced-stage lung or colorectal cancer to assess the association of aggressive end-of-life care with family members’ perceptions of the quality of care and whether the care was consistent with patients’ preferences for end-of-life care. The authors found that family perceptions of better end-of-life care were associated with earlier hospice enrollment, avoidance of intensive care unit admission in the 30 days before death, and death occurring outside the hospital.

Continuing Medical Education

Clinical Review & Education

Prehospital helicopter transport of US military personnel within 60 minutes of a critical combat injury was mandated by the Department of Defense in 2009. An article in JAMA Surgery reported morbidity and mortality outcomes for 21 089 military casualties that occurred during the Afghanistan conflict (September 11, 2001, to March 31, 2014). The authors found a decline in case fatality rate after the mandate, which was associated with an increasing percentage of casualties transported in 60 minutes or less and improvements in treatment capability. In this From the JAMA Network article, Martin and colleagues discuss changes in trauma care implemented concurrently with the 1-hour evacuation policy and highlight efforts to optimize outcomes of critically injured military personnel.

A 5-year-old boy who was receiving oral prednisone and cyclosporine for nephrotic syndrome presented with recent-onset localized scalp alopecia. The lesion was mildly pruritic but not painful. No new hair products had been used. A cat lived in the home. On examination, the area was swollen and erythematous, with some pustules and crusting. Hairs could be easily plucked from the lesion. Cervical adenopathy was present. Laboratory test results were unremarkable. What would you do next?

This JAMA Diagnostic Test Interpretation article by Callaghan and colleagues presents a 66-year-old man with a 2-year history of type 2 diabetes who has worsening tingling and weakness in his legs, problems with balance, and increasing low back pain relieved with sitting. On examination, mild weakness was noted in dorsiflexion and plantar flexion of the feet; pinprick sensation was decreased to the ankles and the Achilles reflex was absent bilaterally. He was unable to walk on his toes or heels. Nerve conduction studies and electromyography were performed. How would you interpret the test results?