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Some data suggest that programming implantable cardioverter-defibrillators (ICDs) to use a greater number of intervals to detect ventricular tachyarrhythmias is associated with a reduction in unnecessary ICD therapies. In a multicenter trial that enrolled 1902 patients undergoing their first ICD implant for primary or secondary prevention, Gasparini and colleagues randomly assigned patients to receive an ICD programmed for either long-interval detection (using 30 of 40 intervals) or standard-interval detection (using 18 of 24 intervals) to detect ventricular arrhythmias. The authors report that use of a long-detection interval resulted in a lower rate of the combined trial end point of antitachycardia pacing, shocks, and inappropriate shocks. In an editorial, Raitt discusses optimization of ICD programming to reduce shocks and minimize adverse consequences.
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Worldwide, the prevalence of Helicobacter pylori infection ranges from 10% to 90%, with some individuals never infected even in the presence of high exposure rates. Genetic factors are hypothesized to confer susceptibility to H pylori. In a genome-wide association study conducted in 2 independent, population-based cohorts and involving 10 938 participants, Mayerle and colleagues identified an association between a single-nucleotide polymorphism in the toll-like receptor 1 (TLR1) gene and H pylori seroprevalence. In an editorial, El-Omar discusses the genetic basis of H pylori susceptibility and the potential utility of the reported findings for H pylori eradication.
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Substantial improvements have been made in the care of children and adolescents with end-stage kidney disease (ESKD) over the past several decades. However, whether mortality rates among children and adolescents with ESKD have declined since the 1990s is not clear. In a retrospective cohort study that included 23 401 children and adolescents who initiated dialysis for ESKD between 1990 and 2010, Mitsnefes and colleagues found that all-cause, cardiovascular, and infection-related mortality rates improved significantly between 1990 and 2010.
Elective Cesarean Delivery on Maternal Request
Ms A is a healthy 38-year-old woman who has had an uncomplicated first pregnancy. She works as a paralegal on birth injury medical liability cases. Based on her review of these cases and stories related by families and friends, she believes vaginal delivery is risky for the fetus. She does not want to jeopardize her child's health, so she has requested a scheduled cesarean delivery. Ecker discusses potential risks, benefits, and data supporting cesarean delivery on maternal request and considers factors when counseling women who request a cesarean delivery in the absence of any maternal or fetal indication.
For 20 years, the international Cochrane Collaboration has assessed the quality of evidence from clinical trials to help inform medical practice.
Connecting to health insurance coverage
Infrastructure for diverse research resources and public health
Developing quality measures to address health care overuse
Sever the link between coverage policy and USPSTF recommendations
“For physicians and patients, the increasingly widespread use of social media has created new opportunities along with new challenges.” From “Status Update: Whose Photo Is That?”
Join Justin B. Dimick, MD, MPH, Wednesday, May 15, from 2 to 3 PM eastern time to discuss bariatric surgery complications before and after establishing centers of excellence for the procedure. To register, go to http://www.ihi.org/AuthorintheRoom.
Dr Bauchner summarizes and comments on this week's issue. Go to www.jama.com.
For your patients: Information about screening for lung cancer.
This Week in JAMA. JAMA. 2013;309(18):1857. doi:10.1001/jama.2013.4905
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