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This Week in JAMA
July 25, 2001

This Week in JAMA

JAMA. 2001;286(4):383. doi:10.1001/jama.286.4.383

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%.

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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 diabetes mellitus.

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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.

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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.

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Contempo Updates

New insights into the pathogenesis of asthma may explain the increase in asthma prevalence and lead to novel therapeutic strategies.

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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.

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Bolus Fibrinolytic Therapy for Acute MI

Review of bolus fibrinolytic therapy for dissolving the occlusive thrombosis associated with acute myocardial infarction (MI).

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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 importance.

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JAMA Patient Page

For your patients: Information about schizophrenia.

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Theme Issue on Violence and Human Rights