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This Week in JAMA
April 16, 2003

This Week in JAMA

JAMA. 2003;289(15):1889. doi:10.1001/jama.289.15.1889
Risk Stratification for Complicated Endocarditis

Observational studies have suggested that valve surgery is effective for patients with complicated left-sided native valve endocarditis, but there are no randomized trials of surgery for endocarditis or validated prognostic classification systems to guide management decisions. Using data collected retrospectively from a cohort of adults with complicated left-sided native valve endocarditis, Hasbun and colleaguesArticle derived and validated a risk classification system based on 5 baseline clinical features that were independently associated with 6-month mortality. In an editorial, Granowitz and LongworthArticle note that this validated quantitative model will be useful for designing randomized clinical trials of valve surgery for patients with active endocarditis and explain why the model should not be used to decide whether individual patients with endocarditis should undergo surgery.

Clinical Outcomes After Universal Leukoreduction

Leukocytes in blood products have been associated with increased risk of infection and mortality, but evidence of the clinical benefit of leukoreduction of blood products is inconsistent. In this issue of THE JOURNAL, 2 retrospective studies evaluated outcomes after red blood cell transfusions in high-risk populations before and after implementation of a universal leukoreduction program for red blood cell products in Canada. In a cohort of adults who received red blood cell transfusions after cardiac surgery or repair of hip fracture or who required intensive care following surgery, Hébert and colleaguesArticle found that all-cause in-hospital mortality risk and risk of posttransfusion fevers decreased significantly after introduction of the leukoreduction program, but risk of serious nosocomial infection was not significantly different. Among premature infants weighing less than 1250 g admitted to a neonatal intensive care unit, Fergusson and colleaguesArticle found that neonatal intensive care unit mortality and rate of nosocomial bacteremia in the leukoreduction period did not differ significantly from that in the nonleukoreduction period. In an editorial, Corwin and AuBuchonArticle consider whether a universal leukoreduction policy should be adopted in the United States.

External Hip Protectors and Prevention of Hip Fractures

External hip protectors are designed to decrease the force of a fall on the trochanter below the fracture threshold. van Schoor and colleagues conducted a randomized trial to assess the effectiveness of hip protectors for reducing the incidence of hip fractures in a population of elderly persons with low bone density and/or high risk of falling. During a mean follow-up of 69.6 weeks, time to first hip fracture among individuals assigned to receive hip protectors and written information on bone health and external risk factors for falls was not significantly different from that among individuals who received written information only.

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Informed Consent Process Among Critically Ill Patients

When invasive procedures are required emergently, critically ill patients may not be capable of providing informed consent, and their proxies may not be available. In this prospective study of the informed consent process among patients admitted to an intensive care unit, Davis and colleagues found that during a 2-month baseline period, 53% of procedures were performed with written informed consent. After introduction of a universal consent form with which patients or their proxies were able to provide advanced written consent for 8 procedures commonly performed in the intensive care unit, 90% of procedures were performed with consent. In both the baseline and intervention periods, the majority of consents were provided by proxies.

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A Piece of My Mind

"I have never been sorry for an instant that I provided my patients with dreadful news sooner rather than later." From "The ‘Magic' Word."

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Medical News & Perspectives

Risa Lavizzo-Mourey, MD, MBA, who recently became the first woman to direct the Robert Wood Johnson Foundation, reflects on her new position and the foundation's goals for the future.

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Dissemination of Innovation

Berwick examines the theory of dissemination of innovation within an organization, identifying factors that influence the rate of spread of innovation, and suggests ways to disseminate innovation in health care.

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Clinician's corner

Scientific Review/Clinical Applications

Evidence on screening and treatment of hearing loss in older adults is reviewed in part 1Article of this 2-part article. In part 2Article, clinical cases common to the primary care setting illustrate diagnostic and therapeutic strategies to improve detection, evaluation, and treatment of adult hearing loss.

JAMA Patient Page

For your patients: Information about adult hearing loss.

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