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This Week in JAMA
October 25, 2006

This Week in JAMA

JAMA. 2006;296(16):1935. doi:10.1001/jama.296.16.1935
Use of High-Volume Hospitals for Complex Surgery

Patients undergoing complex surgical procedures often have better outcomes at high-volume than at low-volume hospitals, but whether patient characteristics influence where care is received is not clear. In a retrospective analysis of California hospital discharge data, Liu and colleaguesArticle investigated the association of patient race/ethnicity and insurance status with receipt of 10 complex surgical procedures at high-volume vs low-volume hospitals. The authors found that patients who were nonwhite, had Medicaid coverage, or were uninsured were less likely to receive care at high-volume hospitals and were more likely to receive care at low-volume hospitals. In an editorial, FinlaysonArticle discusses patient preference in hospital choice and challenges the assumption that volume-based referral policies improve surgical quality.

Intellectual Disability and Psychopathology in Youth

Among children and adolescents with intellectual disability, coexisting psychopathology can interfere with education, recreational opportunities, and achievement of other goals. Few studies have examined the nature and course of psychopathology in this population. To address this deficiency, Einfeld and colleagues assessed longitudinal changes in psychopathology in a cohort of children and adolescents with intellectual disability. The authors documented behavioral and emotional disturbances in approximately 40% of the cohort, and the severity of psychopathology diminished minimally during the 14-year study.

Influenza Vaccine Safety in Infants and Toddlers

Influenza vaccination was recommended for all children ages 6 to 23 months in winter 2004-2005. To assess the vaccine's safety in this population, Hambidge and colleagues examined the risk of medically attended events (MAEs)—visits to clinics, emergency departments, or hospitalizations—in the 14 days after receipt of the trivalent inactivated influenza vaccine. Among the 45 356 children in the cohort, the authors found no increased risk of MAEs for any serious condition after influenza vaccination.

Quality of Care and Racial Disparities in Medicare

To examine the relationship between quality of care and racial disparities in quality, Trivedi and colleagues analyzed data from the Health Plan Employer and Data Information Set (HEDIS) for 4 quality outcome measures among Medicare managed care enrollees with diabetes, hypertension, or history of a coronary event. The authors found that clinical performance on the HEDIS outcome measures was significantly lower for black enrollees than white enrollees. This disparity was often seen within the same health plan, and there was no consistent relationship between overall performance and racial disparity in these outcomes.

HCV From a Contaminated Radiopharmaceutical

Hepatitis C virus (HCV) infection is the most common blood-borne infection in the United States. Patel and colleagues investigated an outbreak of HCV infection among patients who had myocardial perfusion studies and received an injected radiopharmaceutical prepared at one pharmacy. The authors identified 16 patients with acute HCV infection, all of whom received radiopharmaceutical injections from a single vial. The authors describe the molecular epidemiological investigation that identified the source of the HCV and probable breaks in aseptic technique that led to contamination of the radiopharmaceutical.

A Piece of My Mind

“I was one of those wayward English majors who somehow ends up in medical school; the sort who’ll sooner believe ‘ribosomes’ or ‘mitochondria’ are the names of ancient Greek goddesses than an actual part of the human body.” From “The Thought of a Book.”

Medical News & Perspectives

Concerned over a lack of progress in bringing targeted cancer therapies into the clinic, experts say that changes are needed in how oncology drugs are discovered, developed, and tested.

Clinician's corner

Lumbar puncture (LP) technique and test accuracy in adult patients with suspected bacterial meningitis.

Universal HIV Screening

Gostin discusses new guidelines for routine HIV screening in health care settings, barriers to implementation, and conflicts between civil liberties and public health.

JAMA Patient Page

For your patients: Information about lumbar puncture.