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Estimating Hospital Deaths Due to Medical Error
Recently reported estimates of the number of deaths in US hospitals
due to medical error have been extremely high, but the validity of these estimates
has been questioned. In this study by Hayward and Hofer of 111 in-hospital
deaths at 7 Veterans Affairs medical centers, physician reviewers rated whether
deaths could have been prevented by better medical care, and estimated the
probability that the patient would have lived to discharge or for 3 months
or more in good cognitive health had care been optimal. Almost 23% of in-hospital
deaths were rated as at least possibly preventable by optimal care, similar
to that reported in prior studies. But the estimate of the percentage of patients
who died who would have left the hospital alive had optimal care been provided
was 6%, and the estimate of the percentage of patients who would have lived
3 months or more in good cognitive health, after adjusting for variability
and skewness of reviewer ratings, was only 0.5%.
Albuminuria and Cardiovascular Disease Risk
Microalbuminuria has been shown to be a strong independent risk factor
for cardiovascular (CV) events. Using data from the Heart Outcomes Prevention
Evaluation Study, a study of adults with a history of CV disease or with diabetes
mellitus and at least 1 CV risk factor, Gerstein and colleagues found that
any degree of albuminuria, including levels below the microalbuminuria threshold,
was a risk factor for cardiovascular events in individuals with or without
Neural Mechanisms of Anhedonia in Schizophrenia
Anhedonia, loss of the capacity to subjectively experience pleasure,
is a core clinical feature of schizophrenia. Crespo-Facorro and colleagues
compared the patterns of brain responses to olfactory stimuli of similar intensity
but opposite hedonic value (one odor extremely pleasant; the other, extremely
unpleasant) in patients with schizophrenia and in healthy volunteers. The
subjective experience of the unpleasant odor was similar in both study groups,
but patients with schizophrenia experienced the pleasant odor as significantly
less pleasant than did healthy volunteers. Positron emission tomographic data
of regional cerebral blood flow indicated that compared with healthy volunteers,
patients with schizophrenia failed to activate limbic and paralimbic regions
in response to the unpleasant odor, and instead, had increased activation
in frontal cortical regions.
Effects of Passive Smoking on Coronary Circulation
To study the acute effects of passive smoking on coronary circulation,
Otsuka and colleaguesArticle assessed coronary flow velocity reserve, a measure of
endothelial function, before and after a 30-minute exposure to environmental
tobacco smoke, using transthoracic Doppler echocardiography of the left anterior
descending coronary artery. Before exposure to environmental tobacco smoke,
coronary flow velocity reserve was significantly higher in nonsmokers than
in smokers. After exposure to environmental tobacco smoke, however, coronary
flow velocity reserve in nonsmokers decreased and was not significantly different
from that of smokers. In an editorial, Glantz and ParmleyArticle note that the effect
of passive smoking on cardiac mortality and morbidity may be as high as one
third of the effect of active smoking and emphasize the importance of protecting
everyone from even short-term exposure to secondhand smoke.
A 28-Year-Old Woman With Panic Disorder
Ms M has a history of anxiety beginning in childhood, and recently has
experienced several panic attacks characterized by tachycardia, pains in her
arms and legs, and fear that she was going to die. Gorman discusses the epidemiology
of panic disorder, and theories about its etiology, diagnosis, and treatment.
New insights into the pathogenesis of asthma may explain the increase
in asthma prevalence and lead to novel therapeutic strategies.
Medical News & Perspectives
Two decades after the emergence of HIV/AIDS, the United Nations General
Assembly has approved a blueprint to fight the global epidemic.
Bolus Fibrinolytic Therapy for Acute MI
Review of bolus fibrinolytic therapy for dissolving the occlusive thrombosis
associated with acute myocardial infarction (MI).
AIDS Research Model for Other Diseases
Folkers and Fauci describe the achievements of the biomedical research
and public health response to the AIDS pandemic and propose that this experience
serve as a model for controlling other infectious diseases of global health
JAMA Patient Page
For your patients: Information about schizophrenia.
Theme Issue on Violence and Human Rights
This Week in JAMA. JAMA. 2001;286(4):383. doi:10.1001/jama.286.4.383
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