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This Week in JAMA
March 9, 2011

This Week in JAMA

JAMA. 2011;305(10):969. doi:10.1001/jama.2011.272

Among patients hospitalized with a traumatic injury, in-hospital case fatality rates for the initial hospitalization may not be an adequate measure of trauma care success because postdischarge mortality is substantial. Davidson and colleagues analyzed 1995-2008 Washington State Trauma Registry and linked death certificate data to assess the long-term mortality of 124 421 patients who were treated in a Washington State designated trauma hospital. Among the authors' findings were that 7243 patients died before and 21 045 died after hospital discharge. During the 14-year study, in-hospital mortality of Washington State trauma patients decreased from 8% to 4.9%, whereas long-term cumulative mortality rates increased from 4.7% to 7.4%. The authors reported that 16% of patients died in the 3 years following injury compared with an expected population cumulative mortality of 5.9% and reported that patients who were discharged to a skilled nursing facility had a significantly increased risk of subsequent mortality compared with patients discharged home without assistance.

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Disclosure of conflicts of interest from pharmaceutical study funding and author-industry financial relationships is sometimes recommended for randomized controlled trials (RCTs) published in biomedical journals. There are no guidelines, however, for reporting conflicts of interest disclosed in original reports of RCTs when data from those trials are included in meta-analyses—potentially jeopardizing an assessment of bias in the evidence reported and conclusions reached. In a sample of 29 meta-analyses of patented pharmacological treatments published from January through October 2009 in high-impact general medicine and specialty medicine journals, Roseman and colleagues investigated the extent to which pharmaceutical industry funding and author-industry financial ties or author employment disclosed in published reports of RCTs were reported in meta-analyses of the trial data. The authors found that information concerning funding and author conflicts of interest disclosed in original reports of RCTs is rarely reported when RCT data are combined in meta-analyses.

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Mr P is a 70-year-old retired engineer with a history of Parkinson disease, hypertension, and atrial fibrillation; he also has a rapid eye movement sleep disorder, some daytime sleepiness, and occasional double vision. In 2007, Mr P voluntarily gave up race car driving—a long-standing passion—because he believed he had lost his “competitive edge” and because he was experiencing some difficulty with depth perception. Lately, Mr P reports that the cognitive aspects of driving are more difficult, and he wonders if he should refrain from all driving. Rizzo discusses medical disorders that can impair driving performance and the available sources of evidence for determining driving competence and their accuracy in identifying at-risk drivers. He summarizes professional and governmental guidelines regarding at-risk drivers and suggests potential interventions to improve driving performance.

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“The progression of dementia in my mother has been heartbreaking, and the perverse slide down the hill to total incapacity looms in front of us.” From “A Door Closes.”

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Postmarketing studies required to prove efficacy of a drug granted accelerated approval by the US Food and Drug Administration 15 years ago have yet to be carried out.

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Preserving the power of antimicrobials

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Ethics of physician shadowing

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Rethinking hospice eligibility criteria

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Performance gene testing and youth sports

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Authors are invited to submit manuscripts for an upcoming JAMA theme issue.

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Join Gabriela Schmajuk, MD, MS, on Wednesday, March 16, from 2 to 3 PM eastern time to discuss appropriate prescribing of disease-modifying antirheumatic drugs for patients with rheumatoid arthritis. To register, go to http://www.ihi.org/AuthorintheRoom.

For your patients: Information about general anesthesia.

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