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Allowing transplantation of hearts from donors with hepatitis C virus (HCV) would expand the number of available donor hearts. But, whether survival of recipients of HCV-positive donor hearts is compromised is unknown. In a retrospective study of transplant recipients, Gasink and colleaguesArticle found that receipt of an HCV-positive donor heart was associated with decreased survival vs receipt of an HCV-negative donor heart. Survival was independent of the recipient's HCV status and age. In an editorial, Qamar and RubinArticle discuss the links between viral infection, allograft injury, and graft rejection.
In a trial of patients scheduled for elective coronary artery bypass graft (CABG) surgery and at high risk of postoperative pulmonary complications, Hulzebos and colleagues assessed the efficacy of preoperative pulmonary therapy, which included intensive inspiratory muscle training, to reduce pulmonary complications. The authors found that compared with patients who were randomly assigned to usual care, patients who received preoperative inspiratory muscle training were significantly less likely to have pulmonary complications after surgery.
Few studies have assessed the risk of adverse drug events (ADEs) occurring outside health care facilities. Budnitz and colleagues analyzed data from an ADE surveillance project involving 63 nationally representative hospitals to assess the burden of ADEs that resulted in emergency department visits in 2004 through 2005. The authors report there were 21 298 patients with ADEs treated in the participating emergency departments in 2004-2005 and, based on this, estimate that more than 700 000 patients were treated for ADEs in US emergency departments each year. Patient factors associated with ADEs resulting in an emergency department visit included age 65 years or older and taking a drug that typically requires ongoing monitoring.
Dilated cardiomyopathy (DCM) is the most common form of cardiomyopathy in children, but its epidemiology and clinical course are not well established. Towbin and colleagues reviewed data from 2 cohorts of children with primary DCM to advance understanding of this disease. They found a higher risk in boys than in girls, in black than in white children, and in infants than in children. Two thirds of cases were idiopathic, but important identifiable causes were myocarditis and neuromuscular disease. Outcomes were influenced by age, heart failure status at diagnosis, and cause.
Whether publication of data suggesting an approved medication is associated with adverse events influences clinical practice is unknown. To investigate this question, Hauptman and colleagues assessed the use of nesiritide and other intravenous vasoactive therapies among patients with decompensated heart failure at 491 hospitals before and after data were published, suggesting that increased risks of renal failure and mortality are associated with nesiritide. They found that nesiritide use decreased sharply after publication of data that questioned its safety.
“Hope is an enduring source of fortitude, courage, and, on some level, ingenuity in the face of adversity.” From “Hope Is the Thing With Feathers.”
The first genome-wide scans of breast and colorectal cancer cells have revealed new insights into the genetic causes of these diseases.
Despite the presence of methylmercury and other contaminants in some fish, the potential health benefits of modest fish intake (1-2 servings per week) exceed the potential risks among adults.
Join David Spiros, MD, MPH, October 18, 2006, from 2 to 3 PM eastern time to discuss wait-and-see prescription for otitis media. 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.
For your patients: Information about eating fish: health benefits and risks.
This Week in JAMA . JAMA. 2006;296(15):1809. doi:10.1001/jama.296.15.1809