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This Week in JAMA
September 24, 2008

This Week in JAMA

JAMA. 2008;300(12):1383. doi:10.1001/jama.300.12.1383

Blacks have a higher incidence of colorectal cancer and higher colorectal cancer–related mortality rates, and they may develop cancer at a younger age than whites. To assess whether there are racial differences in the age-adjusted prevalence and location of colorectal cancer precursor lesions (advanced adenomas, polyps sized > 9 mm), Lieberman and colleagues Article analyzed colonoscopy data from 85 525 asymptomatic white and black patients who received a screening colonoscopy at 67 gastrointestinal practice sites in 25 states. The authors found that compared with white patients, black patients undergoing screening colonoscopy had a higher prevalence of cancer precursor lesions. Among patients older than 60 years, black patients were more likely than white patients to have proximal polyps sized more than 9 mm. In an editorial, Roy and Bianchi Article discuss the utility of individualized risk assessment to inform colorectal cancer screening recommendations.

Outcomes following out-of-hospital cardiac arrest are addressed in 2 articles in this issue. First, in an analysis of data from a prospective observational study of 20 520 out-of-hospital cardiac arrests assessed, treated, or both by emergency medical services (EMS) personnel in 10 North American sites (8 US and 2 Canadian), Nichol and colleagues Article found wide variation across sites in the incidence and outcome of EMS-assessed and EMS-treated cardiac arrest. The adjusted incidence of EMS-treated cardiac arrest per 100 000 population ranged from 40.3 to 86.7 and survival to discharge ranged from 3.0% to 16.2%. In the second article, Sasson and colleagues Article report results of an analysis of data from a cardiac arrest registry that included 5505 cases of adult out-of-hospital cardiac arrest in 8 US cities. The authors confirmed the validity of 2 termination of resuscitation rules—one intended for use by basic life support responders and the other by those who provide advanced life support—to identify patients in the out-of-hospital setting who are unlikely to survive to hospital discharge. In an editorial, Sanders and Kern Article discuss community-level factors that can influence the outcomes of out-of-hospital cardiac arrest.

Inhaled anticholinergics (ipratropium bromide or tiotropium bromide) are widely prescribed for patients with chronic obstructive pulmonary disease (COPD). Whether these agents are associated with an increased risk of cardiovascular events is not clear. To address this question, Singh and colleagues reviewed the literature and identified 17 randomized trials of inhaled anticholinergics vs placebo or an active comparator (control) for the treatment of COPD. In a meta-analysis of the trial data, the authors found that patients who received inhaled anticholinergics for more than 30 days were at increased risk of cardiovascular death, myocardial infarction, or stroke compared with patients who received the control intervention.


“Patients are no longer passive and adoring, and our relationship is no longer hierarchical and paternalistic.” From “Who's Afraid of the Empowered Patient?”


A new report highlights the substantial barriers that many primary care physicians face in being paid for the mental health services they provide to patients, despite the demonstrated benefits of such front-line care.


Banning tobacco sales in pharmacies


Risks and benefits of imported pharmaceuticals


Ethical issues in short-term global health training programs


Join Ingrid Nygaard, MD, MS, October 15 from 2 to 3 PM eastern time to discuss symptomatic pelvic floor disorders in women.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.

How would you manage a 60-year-old woman with mild memory impairment and white matter lesions on MRI? Go to www.jama.com, read the case, and submit your response, which may be selected for online publication. Submission deadline is September 24.

For your patients: Information about colon polyps.