This Week in JAMA

In an analysis of cardiovascular device registry data from Massachusetts patients who underwent percutaneous coronary intervention and device implantation between April 2003 and October 2007, Resnic and colleagues Article found that computer-automated surveillance of the device registry was feasible and identified early, low-frequency potential safety risks that had not been observed in premarket approval studies of the devices. In an editorial, Rumsfeld and Peterson Article discuss the need for a proactive postapproval medical device surveillance system.

England's national health system provides universal access to health care; however, there remain geographic variations in coronary heart disease (CHD) mortality. In a cross-sectional study that involved all 152 geographically determined primary care trusts in England, Levene and colleagues examined population characteristics (eg, socioeconomic deprivation, levels of smoking, race/ethnicity, and registers of persons with diabetes—a measure of diabetes prevalence) and health service characteristics (eg, level of provision of primary care services and clinical performance data) and found that wide variations in CHD mortality were predominantly explained by population characteristics.

Central line–associated bloodstream infection rates are a patient care measure included in publicly released hospital report cards. However, if infection surveillance is not performed consistently across hospitals, hospital comparisons based on this measure would lack validity. To assess institutional variation in the performance of traditional bloodstream infection surveillance, Lin and colleagues compared central line–associated bloodstream infection rates derived from routine surveillance with infection rates determined through retrospective application of a computer algorithm reference standard. The retrospective cohort study involved 20 hospital intensive care units located at 4 medical centers and the authors found significant variation across medical centers in the application of standard central line–associated bloodstream infection surveillance definitions.

The and colleagues assessed the incidence and risk of severe obesity in adulthood in relation to adolescent weight status in an analysis of data from 8834 participants aged 12 to 21 years who enrolled in 1996 in the National Longitudinal Study of Adolescent Health and had follow-up into adulthood (through 2007-2009). The authors report that obesity in adolescence was significantly associated with increased risk of incident severe obesity in adulthood, with variations in risk by sex and race/ethnicity.

Clinical features of malaria infection are notoriously nonspecific and missed diagnoses are common. In a systematic literature review, Taylor and colleagues examined the predictive value of clinical findings associated with endemic and “imported” (travel-acquired) malaria in adults and children. The authors found that in endemic areas individual clinical features of malaria have limited predictive utility. Among returning travelers, information from the travel history and the presence of fever, splenomegaly, hyperbilirubinemia, or thrombocytopenia are associated with an increased likelihood of malaria; however, prompt laboratory testing is recommended.

“We share very little of our lives with patients—indeed even with colleagues—and our walls are one (if not the only) way of sharing.” From “Suitable for Framing.”

Efforts are under way to improve tools for assessing cardiovascular disease risk.

21st-century cardiovascular disease prevention

Putting ad hoc PCI on pause

Desktop medicine

Intentional infection of vulnerable populations

Join Michael A. Steinman, MD, Wednesday, November 17, from 2 to 3 PM eastern time to discuss managing medications for elders with clinically complex medical conditions. To register, go to www.ihi.org/AuthorintheRoom.

Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

For your patients: Information about malaria.