Treatment given high priority in new White House drug control policy.

JAMA. 2010 Mar 3;303(9):821-2

Authors: Kuehn BM

PMID: 20197521 [PubMed - in process]

A piece of my mind. HIV clinic.

JAMA. 2010 Mar 3;303(9):819

Authors: Walker EP

PMID: 20197520 [PubMed - in process]

The cover. Homer and his guide.

JAMA. 2010 Mar 3;303(9):817

Authors: Cole TB

PMID: 20197519 [PubMed - in process]

Prone positioning in patients with acute respiratory distress syndrome.

JAMA. 2010 Mar 3;303(9):832; author reply 832-3

Authors: Russell JA

PMID: 20197525 [PubMed - in process]

Improving medication adherence promises great payback, but poses tough challenge.

JAMA. 2010 Mar 3;303(9):825

Authors: Mitka M

PMID: 20197524 [PubMed - in process]

Cardiac patients' herbal supplement use deserves more careful investigation.

JAMA. 2010 Mar 3;303(9):824

Authors: Voelker R

PMID: 20197523 [PubMed - in process]

Experts reconsider wisdom of limiting Chlamydia screening only to women.

JAMA. 2010 Mar 3;303(9):823-4

Authors: Voelker R

PMID: 20197522 [PubMed - in process]

Omega-3 fatty acids for CHD with depression.

JAMA. 2010 Mar 3;303(9):836; author reply 836

Authors: Anghelescu I

PMID: 20197529 [PubMed - in process]

Modeling cardiovascular disease prevention.

JAMA. 2010 Mar 3;303(9):835; author reply 835

Authors: Pletcher MJ, Tice JA, Pignone M

PMID: 20197528 [PubMed - in process]

Aldosterone antagonists in patients with heart failure.

JAMA. 2010 Mar 3;303(9):833; author reply 834-5

Authors: Fayssoil A

PMID: 20197527 [PubMed - in process]

Aldosterone antagonists in patients with heart failure.

JAMA. 2010 Mar 3;303(9):833-4; author reply 834-5

Authors: Ghali JK

PMID: 20197526 [PubMed - in process]

Aspirin for prevention of cardiovascular events in a general population screened for a low ankle brachial index: a randomized controlled trial.

JAMA. 2010 Mar 3;303(9):841-8

Authors: Fowkes FG, Price JF, Stewart MC, Butcher I, Leng GC, Pell AC, Sandercock PA, Fox KA, Lowe GD, Murray GD,

CONTEXT: A low ankle brachial index (ABI) indicates atherosclerosis and an increased risk of cardiovascular and cerebrovascular events. Screening for a low ABI can identify an asymptomatic higher risk group potentially amenable to preventive treatments. OBJECTIVE: To determine the effectiveness of aspirin in preventing events in people with a low ABI identified on screening the general population. DESIGN, SETTING, AND PARTICIPANTS: The Aspirin for Asymptomatic Atherosclerosis trial was an intention-to-treat double-blind randomized controlled trial conducted from April 1998 to October 2008, involving 28,980 men and women aged 50 to 75 years living in central Scotland, free of clinical cardiovascular disease, recruited from a community health registry, and had an ABI screening test. Of those, 3350 with a low ABI (< or = 0.95) were entered into the trial, which was powered to detect a 25% proportional risk reduction in events. INTERVENTIONS: Once daily 100 mg aspirin (enteric coated) or placebo. MAIN OUTCOME MEASURES: The primary end point was a composite of initial fatal or nonfatal coronary event or stroke or revascularization. Two secondary end points were (1) all initial vascular events defined as a composite of a primary end point event or angina, intermittent claudication, or transient ischemic attack; and (2) all-cause mortality. RESULTS: After a mean (SD) follow-up of 8.2 (1.6) years, 357 participants had a primary end point event (13.5 per 1000 person-years, 95% confidence interval [CI], 12.2-15.0). No statistically significant difference was found between groups (13.7 events per 1000 person-years in the aspirin group vs 13.3 in the placebo group; hazard ratio [HR], 1.03; 95% CI, 0.84-1.27). A vascular event comprising the secondary end point occurred in 578 participants (22.8 per 1000 person-years; 95% CI, 21.0-24.8) and no statistically significant difference between groups (22.8 events per 1000 person-years in the aspirin group vs 22.9 in the placebo group; HR, 1.00; 95% CI, 0.85-1.17). There was no significant difference in all-cause mortality between groups (176 vs 186 deaths, respectively; HR, 0.95; 95% CI, 0.77-1.16). An initial event of major hemorrhage requiring admission to hospital occurred in 34 participants (2.5 per 1000 person-years) in the aspirin group and 20 (1.5 per 1000 person-years) in the placebo group (HR, 1.71; 95% CI, 0.99-2.97). CONCLUSION: Among participants without clinical cardiovascular disease, identified with a low ABI based on screening a general population, the administration of aspirin compared with placebo did not result in a significant reduction in vascular events. TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN66587262.

PMID: 20197530 [PubMed - in process]

Three-year outcomes for Medicare beneficiaries who survive intensive care.

JAMA. 2010 Mar 3;303(9):849-56

Authors: Wunsch H, Guerra C, Barnato AE, Angus DC, Li G, Linde-Zwirble WT

CONTEXT: Although hospital mortality has decreased over time in the United States for patients who receive intensive care, little is known about subsequent outcomes for those discharged alive. OBJECTIVE: To assess 3-year outcomes for Medicare beneficiaries who survive intensive care. DESIGN, SETTING, AND PATIENTS: A matched, retrospective cohort study was conducted using a 5% sample of Medicare beneficiaries older than 65 years. A random half of all patients were selected who received intensive care and survived to hospital discharge in 2003 with 3-year follow-up through 2006. From the other half of the sample, 2 matched control groups were generated: hospitalized patients who survived to discharge (hospital controls) and the general population (general controls), individually matched on age, sex, race, and whether they had surgery (for hospital controls). MAIN OUTCOME MEASURE: Three-year mortality after hospital discharge. RESULTS: There were 35,308 intensive care unit (ICU) patients who survived to hospital discharge. The ICU survivors had a higher 3-year mortality (39.5%; n = 13,950) than hospital controls (34.5%; n = 12,173) (adjusted hazard ratio [AHR], 1.07 [95% confidence interval {CI}, 1.04-1.10]; P < .001) and general controls (14.9%; n = 5266) (AHR, 2.39 [95% CI, 2.31-2.48]; P < .001). The ICU survivors who did not receive mechanical ventilation had minimal increased risk compared with hospital controls (3-year mortality, 38.3% [n = 12,716] vs 34.6% [n=11,470], respectively; AHR, 1.04 [95% CI, 1.02-1.07]). Those receiving mechanical ventilation had substantially increased mortality (57.6% [1234 ICU survivors] vs 32.8% [703 hospital controls]; AHR, 1.56 [95% CI, 1.40-1.73]), with risk concentrated in the 6 months after the quarter of hospital discharge (6-month mortality, 30.1% (n = 645) for those receiving mechanical ventilation vs 9.6% (n = 206) for hospital controls; AHR, 2.26 [95% CI, 1.90-2.69]). Discharge to a skilled care facility for ICU survivors (33.0%; n = 11,634) and hospital controls (26.4%; n = 9328) also was associated with high 6-month mortality (24.1% for ICU survivors and hospital controls discharged to a skilled care facility vs 7.5% for ICU survivors and hospital controls discharged home; AHR, 2.62 [95% CI, 2.50-2.74]; P < .001 for ICU survivors and hospital controls combined). CONCLUSIONS: There is a large US population of elderly individuals who survived the ICU stay to hospital discharge but who have a high mortality over the subsequent years in excess of that seen in comparable controls. The risk is concentrated early after hospital discharge among those who require mechanical ventilation.

PMID: 20197531 [PubMed - in process]

Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: systematic review and meta-analysis.

JAMA. 2010 Mar 3;303(9):865-73

Authors: Briel M, Meade M, Mercat A, Brower RG, Talmor D, Walter SD, Slutsky AS, Pullenayegum E, Zhou Q, Cook D, Brochard L, Richard JC, Lamontagne F, Bhatnagar N, Stewart TE, Guyatt G

CONTEXT: Trials comparing higher vs lower levels of positive end-expiratory pressure (PEEP) in adults with acute lung injury or acute respiratory distress syndrome (ARDS) have been underpowered to detect small but potentially important effects on mortality or to explore subgroup differences. OBJECTIVES: To evaluate the association of higher vs lower PEEP with patient-important outcomes in adults with acute lung injury or ARDS who are receiving ventilation with low tidal volumes and to investigate whether these associations differ across prespecified subgroups. DATA SOURCES: Search of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (1996-January 2010) plus a hand search of conference proceedings (2004-January 2010). STUDY SELECTION: Two reviewers independently screened articles to identify studies randomly assigning adults with acute lung injury or ARDS to treatment with higher vs lower PEEP (with low tidal volume ventilation) and also reporting mortality. DATA EXTRACTION: Data from 2299 individual patients in 3 trials were analyzed using uniform outcome definitions. Prespecified effect modifiers were tested using multivariable hierarchical regression, adjusting for important prognostic factors and clustering effects. RESULTS: There were 374 hospital deaths in 1136 patients (32.9%) assigned to treatment with higher PEEP and 409 hospital deaths in 1163 patients (35.2%) assigned to lower PEEP (adjusted relative risk [RR], 0.94; 95% confidence interval [CI], 0.86-1.04; P = .25). Treatment effects varied with the presence or absence of ARDS, defined by a value of 200 mm Hg or less for the ratio of partial pressure of oxygen to fraction of inspired oxygen concentration (P = .02 for interaction). In patients with ARDS (n = 1892), there were 324 hospital deaths (34.1%) in the higher PEEP group and 368 (39.1%) in the lower PEEP group (adjusted RR, 0.90; 95% CI, 0.81-1.00; P = .049); in patients without ARDS (n = 404), there were 50 hospital deaths (27.2%) in the higher PEEP group and 44 (19.4%) in the lower PEEP group (adjusted RR, 1.37; 95% CI, 0.98-1.92; P = .07). Rates of pneumothorax and vasopressor use were similar. CONCLUSIONS: Treatment with higher vs lower levels of PEEP was not associated with improved hospital survival. However, higher levels were associated with improved survival among the subgroup of patients with ARDS.

PMID: 20197533 [PubMed - in process]

Comparative mortality risk of anemia management practices in incident hemodialysis patients.

JAMA. 2010 Mar 3;303(9):857-64

Authors: Brookhart MA, Schneeweiss S, Avorn J, Bradbury BD, Liu J, Winkelmayer WC

CONTEXT: Controversy exists about optimal management of anemia in end-stage renal disease. OBJECTIVE: To compare the mortality risk of different dialysis center-level patterns of anemia management. DESIGN, SETTING, AND PATIENTS: Using data from Medicare's end-stage renal disease program (1999-2007), we characterized each US dialysis center's annual anemia management practice by estimating its typical use of erythropoiesis-stimulating agents (ESAs) and intravenous iron in hemodialysis patients within 4 hematocrit categories. We used Cox proportional hazards regression to correlate center-level patterns of ESA and iron use with 1-year mortality risk in 269,717 incident hemodialysis patients. MAIN OUTCOME MEASURE: One-year all-cause mortality. RESULTS: Monthly mortality rates were highest in patients with hematocrit less than 30% (mortality, 2.1%) and lowest for those with hematocrit of 36% or higher (mortality, 0.7%). After adjustment for baseline case-mix differences, dialysis centers that used larger ESA doses in patients with hematocrit less than 30% had lower mortality rates than centers that used smaller doses (highest vs lowest dose group: hazard ratio [HR], 0.94; 95% confidence interval [CI], 0.90-0.97). Centers that administered iron more frequently to patients with hematocrit less than 33% also had lower mortality rates (highest vs lowest quintile, HR, 0.95; 95% CI, 0.91-0.98). However, centers that used larger ESA doses in patients with hematocrit between 33% and 35.9% had higher mortality rates (highest vs lowest quintile, HR, 1.07; 95% CI, 1.03-1.12). More intensive use of both ESAs and iron was associated with increased mortality risk in patients with hematocrit of 36% or higher. These findings persisted across a range of secondary analyses. CONCLUSIONS: Greater ESA and iron use were associated with decreased mortality risk at lower hematocrit levels, in which mortality rates are the highest. Although the overall mortality rate was lower at higher hematocrit levels, elevated mortality risk was associated with greater use of ESAs and iron in these patients.

PMID: 20197532 [PubMed - in process]

Reformulation of the sedation continuum.

JAMA. 2010 Mar 3;303(9):876-7

Authors: Green SM, Mason KP

PMID: 20197535 [PubMed - in process]

The Healthcare Innovation Zone: a platform for true reform.

JAMA. 2010 Mar 3;303(9):874-5

Authors: Kirch DG

PMID: 20197534 [PubMed - in process]

Aspirin as preventive therapy in patients with asymptomatic vascular disease.

JAMA. 2010 Mar 3;303(9):880-2

Authors: Berger JS

PMID: 20197537 [PubMed - in process]

Losing the opportunity to study influenza drugs.

JAMA. 2010 Mar 3;303(9):878-9

Authors: Meyerhoff A, Lietman P

PMID: 20197536 [PubMed - in process]

Abraham Flexner and his remarkable report on medical education: a century later.

JAMA. 2010 Mar 3;303(9):888-90

Authors: Markel H

PMID: 20197539 [PubMed - in process]

How much PEEP in acute lung injury.

JAMA. 2010 Mar 3;303(9):883-4

Authors: Rubenfeld GD

PMID: 20197538 [PubMed - in process]

JAMA patient page. Mechanical ventilation.

JAMA. 2010 Mar 3;303(9):902

Authors: Torpy JM, Campbell AD, Glass RM

PMID: 20197540 [PubMed - in process]

The complexity of animal model generation for complex diseases.

JAMA. 2010 Feb 17;303(7):657-8

Authors: Campochiaro PA

PMID: 20187264 [PubMed]

The cover. Mr and Mrs Ralph Izard (Alice Delancey).

JAMA. 2010 Feb 24;303(8):697

Authors: Torpy JM

PMID: 20179273 [PubMed - in process]

Risks from antipsychotic medications in children and adolescents.

JAMA. 2010 Feb 24;303(8):729-30; author reply 730-1

Authors: Lewin AB, Storch EA, Storch HD

PMID: 20179278 [PubMed - in process]

IOM: Improve clinician CME system.

JAMA. 2010 Feb 24;303(8):716

Authors: Kuehn BM

PMID: 20179277 [PubMed - in process]

Recession helped put brakes on growth in US health care spending for 2008.

JAMA. 2010 Feb 24;303(8):715

Authors: Mitka M

PMID: 20179276 [PubMed - in process]

Report: Too little surveillance, treatment for US patients with hepatitis B and C.

JAMA. 2010 Feb 24;303(8):713-4

Authors: Kuehn BM

PMID: 20179275 [PubMed - in process]

A piece of my mind. Doppelgänger.

JAMA. 2010 Feb 24;303(8):711-2

Authors: Kapur NA

PMID: 20179274 [PubMed - in process]

Event rates in trials of patients with type 2 diabetes.

JAMA. 2010 Feb 24;303(8):732-3; author reply 733

Authors: Preiss D, Sattar N, McMurray JJ

PMID: 20179281 [PubMed - in process]

Cardiovascular disease, hypertension, and risk of hip fracture.

JAMA. 2010 Feb 24;303(8):731; author reply 731-2

Authors: Strandberg TE

PMID: 20179280 [PubMed - in process]

Risks from antipsychotic medications in children and adolescents.

JAMA. 2010 Feb 24;303(8):729; author reply 730

Authors: Mangurian C, Fuentes-Afflick E, Newcomer JW

PMID: 20179279 [PubMed - in process]

Trends in the work hours of physicians in the United States.

JAMA. 2010 Feb 24;303(8):747-53

Authors: Staiger DO, Auerbach DI, Buerhaus PI

CONTEXT: Recent trends in hours worked by physicians may affect workforce needs but have not been thoroughly analyzed. OBJECTIVES: To estimate trends in hours worked by US physicians and assess for association with physician fees. DESIGN, SETTING, AND PARTICIPANTS: A retrospective analysis of trends in hours worked among US physicians using nationally representative workforce information from the US Census Bureau Current Population Survey between 1976 and 2008 (N = 116,733). Trends were estimated among all US physicians and by residency status, sex, age, and work setting. Trends in hours were compared with national trends in physician fees, and estimated separately for physicians located in metropolitan areas with high and low fees in 2001. MAIN OUTCOME MEASURE: Self-reported hours worked in the week before the survey. RESULTS: After remaining stable through the early 1990s, mean hours worked per week decreased by 7.2% between 1996 and 2008 among all physicians (from 54.9 hours per week in 1996-1998 to 51.0 hours per week in 2006-2008; 95% confidence interval [CI], 5.3%-9.0%; P < .001). Excluding resident physicians, whose hours decreased by 9.8% (95% CI, 5.8%-13.7%; P < .001) in the last decade due to duty hour limits imposed in 2003, nonresident physician hours decreased by 5.7% (95% CI, 3.8%-7.7%; P < .001). The decrease in hours was largest for nonresident physicians younger than 45 years (7.4%; 95% CI, 4.7%-10.2%; P < .001) and working outside of the hospital (6.4%; 95% CI, 4.1%-8.7%; P < .001), and the decrease was smallest for those aged 45 years or older (3.7%; 95% CI, 1.0%-6.5%; P = .008) and working in the hospital (4.0%; 95% CI, 0.4%-7.6%; P = .03). After adjusting for inflation, mean physician fees decreased nationwide by 25% between 1995 and 2006, coincident with the decrease in physician hours. In 2001, mean physician hours were less than 49 hours per week in metropolitan areas with the lowest physician fees, whereas physician hours remained more than 52 hours per week elsewhere (P < .001 for difference). CONCLUSION: A steady decrease in hours worked per week during the last decade was observed for all physicians, which was temporally and geographically associated with lower physician fees.

PMID: 20179284 [PubMed - in process]

Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial.

JAMA. 2010 Feb 24;303(8):739-46

Authors: Jones AE, Shapiro NI, Trzeciak S, Arnold RC, Claremont HA, Kline JA,

CONTEXT: Goal-directed resuscitation for severe sepsis and septic shock has been reported to reduce mortality when applied in the emergency department. OBJECTIVE: To test the hypothesis of noninferiority between lactate clearance and central venous oxygen saturation (ScvO2) as goals of early sepsis resuscitation. DESIGN, SETTING, AND PATIENTS: Multicenter randomized, noninferiority trial involving patients with severe sepsis and evidence of hypoperfusion or septic shock who were admitted to the emergency department from January 2007 to January 2009 at 1 of 3 participating US urban hospitals. INTERVENTIONS: We randomly assigned patients to 1 of 2 resuscitation protocols. The ScvO2 group was resuscitated to normalize central venous pressure, mean arterial pressure, and ScvO2 of at least 70%; and the lactate clearance group was resuscitated to normalize central venous pressure, mean arterial pressure, and lactate clearance of at least 10%. The study protocol was continued until all goals were achieved or for up to 6 hours. Clinicians who subsequently assumed the care of the patients were blinded to the treatment assignment. MAIN OUTCOME MEASURE: The primary outcome was absolute in-hospital mortality rate; the noninferiority threshold was set at Delta equal to -10%. RESULTS: Of the 300 patients enrolled, 150 were assigned to each group and patients were well matched by demographic, comorbidities, and physiological features. There were no differences in treatments administered during the initial 72 hours of hospitalization. Thirty-four patients (23%) in the ScvO2 group died while in the hospital (95% confidence interval [CI], 17%-30%) compared with 25 (17%; 95% CI, 11%-24%) in the lactate clearance group. This observed difference between mortality rates did not reach the predefined -10% threshold (intent-to-treat analysis: 95% CI for the 6% difference, -3% to 15%). There were no differences in treatment-related adverse events between the groups. CONCLUSION: Among patients with septic shock who were treated to normalize central venous and mean arterial pressure, additional management to normalize lactate clearance compared with management to normalize ScvO2 did not result in significantly different in-hospital mortality. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00372502.

PMID: 20179283 [PubMed - in process]

Event rates in trials of patients with type 2 diabetes.

JAMA. 2010 Feb 24;303(8):732; author reply 733

Authors: Patel A, Neal B, Chalmers J

PMID: 20179282 [PubMed - in process]

Front-of-package food labels: public health or propaganda?

JAMA. 2010 Feb 24;303(8):771-2

Authors: Nestle M, Ludwig DS

PMID: 20179287 [PubMed - in process]

Association between acute care and critical illness hospitalization and cognitive function in older adults.

JAMA. 2010 Feb 24;303(8):763-70

Authors: Ehlenbach WJ, Hough CL, Crane PK, Haneuse SJ, Carson SS, Curtis JR, Larson EB

CONTEXT: Studies suggest that many survivors of critical illness experience long-term cognitive impairment but have not included premorbid measures of cognitive functioning and have not evaluated risk for dementia associated with critical illness. OBJECTIVES: To determine whether decline in cognitive function was greater among older individuals who experienced acute care or critical illness hospitalizations relative to those not hospitalized and to determine whether the risk for incident dementia differed by these exposures. DESIGN, SETTING, AND PARTICIPANTS: Analysis of data from a prospective cohort study from 1994 through 2007 comprising 2929 individuals 65 years old and older without dementia at baseline residing in the community in the Seattle area and belonging to the Group Health Cooperative. Participants with 2 or more study visits were included, and those who had a hospitalization for a diagnosis of primary brain injury were censored at the time of hospitalization. Individuals were screened with the Cognitive Abilities Screening Instrument (CASI) (score range, 0-100) every 2 years at follow-up visits, and those with a score less than 86 underwent a clinical examination for dementia. MAIN OUTCOME MEASURES: Score on the CASI at follow-up study visits and incident dementia diagnosed in study participants, adjusted for baseline cognitive scores, age, and other risk factors. RESULTS: During a mean (SD) follow-up of 6.1 (3.2) years, 1601 participants had no hospitalization, 1287 had 1 or more noncritical illness hospitalizations, and 41 had 1 or more critical illness hospitalizations. The CASI score was assessed more than 45 days after discharge for 94.3% of participants. Adjusted CASI scores averaged 1.01 points lower for visits following acute care illness hospitalization compared with follow-up visits not following any hospitalization (95% confidence interval [CI], -1.33 to -0.70; P < .001) and 2.14 points lower on average for visits following critical illness hospitalization (95% CI, -4.24 to -0.03; P = .047). There were 146 cases of dementia among those not hospitalized, 228 cases of dementia among those with 1 or more noncritical illness hospitalizations, and 5 cases of dementia among those with 1 or more critical illness hospitalizations. The adjusted hazard ratio for incident dementia was 1.4 following a noncritical illness hospitalization (95% CI, 1.1 to 1.7; P = .001) and 2.3 following a critical illness hospitalization (95% CI, 0.9 to 5.7; P = .09). CONCLUSIONS: Among a cohort of older adults without dementia at baseline, those who experienced acute care hospitalization and critical illness hospitalization had a greater likelihood of cognitive decline compared with those who had no hospitalization. Noncritical illness hospitalization was significantly associated with the development of dementia.

PMID: 20179286 [PubMed - in process]

Comparison of platelet function tests in predicting clinical outcome in patients undergoing coronary stent implantation.

JAMA. 2010 Feb 24;303(8):754-62

Authors: Breet NJ, van Werkum JW, Bouman HJ, Kelder JC, Ruven HJ, Bal ET, Deneer VH, Harmsze AM, van der Heyden JA, Rensing BJ, Suttorp MJ, Hackeng CM, ten Berg JM

CONTEXT: High on-treatment platelet reactivity is associated with atherothrombotic events following coronary stent implantation. OBJECTIVE: To evaluate the capability of multiple platelet function tests to predict clinical outcome. DESIGN, SETTING, AND PATIENTS: Prospective, observational, single-center cohort study of 1069 consecutive patients taking clopidogrel undergoing elective coronary stent implantation between December 2005 and December 2007. On-treatment platelet reactivity was measured in parallel by light transmittance aggregometry, VerifyNow P2Y12 and Plateletworks assays, and the IMPACT-R and the platelet function analysis system (PFA-100) (with the Dade PFA collagen/adenosine diphosphate [ADP] cartridge and Innovance PFA P2Y). Cut-off values for high on-treatment platelet reactivity were established by receiver operating characteristic curve analysis. MAIN OUTCOME MEASUREMENT: The primary end point was defined as a composite of all-cause death, nonfatal acute myocardial infarction, stent thrombosis, and ischemic stroke. The primary safety end point included TIMI (Thrombolysis In Myocardial Infarction) criteria major and minor bleeding. RESULTS: At 1-year follow-up, the primary end point occurred more frequently in patients with high on-treatment platelet reactivity when assessed by light transmittance aggregometry (11.7%; 95% confidence interval [CI], 8.9%-15.0% vs 6.0%; 95% CI, 4.2%-8.2%; P < .001), VerifyNow (13.3%; 95% CI, 10.2%-17.0% vs 5.7%; 95% CI, 4.1%-7.8%; P < .001) and Plateletworks (12.6%; 95% CI, 8.8%-17.2% vs 6.1%; 95% CI, 3.8%-9.2%; P = .005), which also had modest ability to discriminate between patients having and not having a primary event: light transmittance aggregometry (area under the curve [AUC], 0.63; 95% CI, 0.58-0.68), VerifyNow (AUC, 0.62; 95% CI, 0.57-0.67), and Plateletworks (AUC, 0.61; 95% CI, 0.53-0.69). The IMPACT-R, Dade PFA collagen/ADP, and Innovance PFA P2Y were unable to discriminate between patients with and without primary end point at 1-year follow-up (all AUCs included 0.50 in the CI). None of the tests identified patients at risk for bleeding. CONCLUSIONS: Of the platelet function tests assessed, only light transmittance aggregometry, VerifyNow, and Plateletworks were significantly associated with the primary end point. However, the predictive accuracy of these tests was only modest. None of the tests provided accurate prognostic information to identify low-risk patients at higher risk of bleeding following stent implantation. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00352014.

PMID: 20179285 [PubMed - in process]

Disassembling goal-directed therapy for sepsis: a first step.

JAMA. 2010 Feb 24;303(8):777-9

Authors: Lewis RJ

PMID: 20179290 [PubMed - in process]

Deep brain stimulation and the neuroethics of responsible publishing: when one is not enough.

JAMA. 2010 Feb 24;303(8):775-6

Authors: Schlaepfer TE, Fins JJ

PMID: 20179289 [PubMed - in process]

Registering clinical trial results: the next step.

JAMA. 2010 Feb 24;303(8):773-4

Authors: Miller JD

PMID: 20179288 [PubMed - in process]

JAMA patient page. Sepsis.

JAMA. 2010 Feb 24;303(8):804

Authors: Chang HJ, Lynm C, Glass RM

PMID: 20179292 [PubMed - in process]

Studies probe medication use in pregnancy.

JAMA. 2010 Feb 17;303(7):601

Authors: Kuehn BM

PMID: 20159864 [PubMed - in process]

Research Offers Only a Limited View of Imaging's Effect on Patient Outcomes.

JAMA. 2010 Feb 17;303(7):599-600

Authors: Mitka M

PMID: 20159863 [PubMed - in process]

Lonely.

JAMA. 2010 Feb 17;303(7):593

Authors: Adams KD

PMID: 20159862 [PubMed - in process]

{inverted exclamation}Otra Margarita! (Another Marguerite!).

JAMA. 2010 Feb 17;303(7):591

Authors: Torpy JM

PMID: 20159861 [PubMed - in process]

A 31-Year-Old Woman With a Low-grade Glioma.

JAMA. 2010 Feb 16;

Authors: Delbanco T

PMID: 20159860 [PubMed - as supplied by publisher]

Heritable disease and sperm donation.

JAMA. 2010 Feb 17;303(7):617-8

Authors: Bream KD, Lott JP

PMID: 20159866 [PubMed - in process]

Rising autism rates still pose a mystery.

JAMA. 2010 Feb 17;303(7):602

Authors: Mitka M

PMID: 20159865 [PubMed - in process]

Dynamics of obesity and chronic health conditions among children and youth.

JAMA. 2010 Feb 17;303(7):623-30

Authors: Van Cleave J, Gortmaker SL, Perrin JM

CONTEXT: Rates of obesity and other childhood chronic conditions have increased over recent decades. Patterns of how conditions change over time have not been widely examined. OBJECTIVE: To evaluate change in prevalence of obesity and other chronic conditions in US children, including incidence, remission, and prevalence. DESIGN, SETTING, AND PARTICIPANTS: Prospective study using the National Longitudinal Survey of Youth-Child Cohort (1988-2006) of 3 nationally representative cohorts of children. Children were aged 2 through 8 years at the beginning of each study period, and cohorts were followed up for 6 years, from 1988 to 1994 (cohort 1, n = 2337), 1994 to 2000 (cohort 2, n = 1759), and 2000 to 2006 (n = 905). MAIN OUTCOME MEASURES: Parent report of a child having a health condition that limited activities or schooling or required medicine, special equipment, or specialized health services and that lasted at least 12 months. Obesity was defined as a body mass index at or above the 95th percentile for age. Chronic conditions were grouped into 4 categories: obesity, asthma, other physical conditions, and behavior/learning problems. RESULTS: The end-study prevalence of any chronic health condition was 12.8% (95% confidence interval [CI], 11.2%-14.5%) for cohort 1 in 1994, 25.1% (95% CI, 22.7%-27.6%) for cohort 2 in 2000, and 26.6% (95% CI, 23.5%-29.9%) for cohort 3 in 2006. There was substantial turnover in chronic conditions: 7.4% (95% CI, 6.5%-8.3%) of participants in all cohorts had a chronic condition at the beginning of the study that persisted to the end, 9.3% (95% CI, 8.3%-10.3%) reported conditions at the beginning that resolved within 6 years, and 13.4% (95% CI, 12.3%-14.6%) had new conditions that arose during the 6-year study period. The prevalence of having a chronic condition during any part of the 6-year study period was highest for cohort 3 (51.5%; 95% CI, 47.3%-55.0%), and there were higher rates among male (adjusted odds ratio [AOR], 1.24; 95% CI, 1.07-1.42), Hispanic (AOR, 1.36; 95% CI, 1.11-1.67), and black (AOR, 1.60; 95% CI, 1.35-1.90) youth. CONCLUSIONS: Prevalence of chronic conditions among children and youth increased from 1988 to 2006. However, presence of these conditions was dynamic over each 6-year cohort.

PMID: 20159870 [PubMed - in process]

Disruptive innovations and health care reform.

JAMA. 2010 Feb 17;303(7):620-1

Authors: Kirch DG

PMID: 20159869 [PubMed - in process]

Minimally Invasive vs Open Radical Prostatectomy.

JAMA. 2010 Feb 17;303(7):619-20

Authors: Lowrance WT, Elkin EB, Eastham JA

PMID: 20159868 [PubMed - in process]

Heritable disease and sperm donation.

JAMA. 2010 Feb 17;303(7):617

Authors: Siffroi JP, Charron P, Bujan L

PMID: 20159867 [PubMed - in process]

Association Between 9p21 Genomic Markers and Heart Disease: A Meta-analysis.

JAMA. 2010 Feb 17;303(7):648-56

Authors: Palomaki GE, Melillo S, Bradley LA

CONTEXT: Associations between chromosome 9p21 single-nucleotide polymorphisms (SNPs) and heart disease have been reported and replicated. If testing improves risk assessments using traditional factors, it may provide opportunities to improve public health. OBJECTIVES: To perform a targeted systematic review of published literature for effect size, heterogeneity, publication bias, and strength of evidence and to consider whether testing might provide clinical utility. DATA SOURCES: Electronic search via HuGE Navigator through January 2009 and review of reference lists from included articles. STUDY SELECTION: English-language articles that tested for 9p21 SNPs with coronary heart/artery disease or myocardial infarction as primary outcomes. Included articles also provided race, numbers of participants, and data to compute an odds ratio (OR). Articles were excluded if reporting only intermediate outcomes (eg, atherosclerosis) or if all participants had existing disease. Twenty-five articles were initially identified and 16 were included. A follow-up search identified 6 additional articles. DATA EXTRACTION: Independent extraction was performed by 2 reviewers and consensus was reached. Credibility of evidence was assessed using published Venice criteria. DATA SYNTHESIS: Forty-seven distinct data sets from the 22 articles were analyzed, including 35 872 cases and 95 837 controls. The summary OR for heart disease among individuals with 2 vs 1 at-risk alleles was 1.25 (95% confidence interval [CI], 1.21-1.29), with low to moderate heterogeneity. Age at disease diagnosis was a significant covariate, with ORs of 1.35 (95% CI, 1.30-1.40) for age 55 years or younger and 1.21 (95% CI, 1.16-1.25) for age 75 years or younger. For a 65-year-old man, the 10-year heart disease risk for 2 vs 1 at-risk alleles would be 13.2% vs 11%. For a 40-year-old woman, the 10-year heart disease risk for 2 vs 1 at-risk alleles would be 2.4% vs 2.0%. Nearly identical but inverse results were found when comparing 1 vs 0 at-risk alleles. Three studies showed net reclassification indexes ranging from -0.1% to 4.8%. CONCLUSION: We found a statistically significant association between 9p21 SNPs and heart disease that varied by age at disease onset, but the magnitude of the association was small.

PMID: 20159873 [PubMed - in process]

Ancestry and Pathology in King Tutankhamun's Family.

JAMA. 2010 Feb 17;303(7):638-47

Authors: Hawass Z, Gad YZ, Ismail S, Khairat R, Fathalla D, Hasan N, Ahmed A, Elleithy H, Ball M, Gaballah F, Wasef S, Fateen M, Amer H, Gostner P, Selim A, Zink A, Pusch CM

CONTEXT: The New Kingdom in ancient Egypt, comprising the 18th, 19th, and 20th dynasties, spanned the mid-16th to the early 11th centuries bc. The late 18th dynasty, which included the reigns of pharaohs Akhenaten and Tutankhamun, was an extraordinary time. The identification of a number of royal mummies from this era, the exact relationships between some members of the royal family, and possible illnesses and causes of death have been matters of debate. OBJECTIVES: To introduce a new approach to molecular and medical Egyptology, to determine familial relationships among 11 royal mummies of the New Kingdom, and to search for pathological features attributable to possible murder, consanguinity, inherited disorders, and infectious diseases. DESIGN: From September 2007 to October 2009, royal mummies underwent detailed anthropological, radiological, and genetic studies as part of the King Tutankhamun Family Project. Mummies distinct from Tutankhamun's immediate lineage served as the genetic and morphological reference. To authenticate DNA results, analytical steps were repeated and independently replicated in a second ancient DNA laboratory staffed by a separate group of personnel. Eleven royal mummies dating from circa 1410-1324 bc and suspected of being kindred of Tutankhamun and 5 royal mummies dating to an earlier period, circa 1550-1479 bc, were examined. MAIN OUTCOME MEASURES: Microsatellite-based haplotypes in the mummies, generational segregation of alleles within possible pedigree variants, and correlation of identified diseases with individual age, archeological evidence, and the written historical record. RESULTS: Genetic fingerprinting allowed the construction of a 5-generation pedigree of Tutankhamun's immediate lineage. The KV55 mummy and KV35YL were identified as the parents of Tutankhamun. No signs of gynecomastia and craniosynostoses (eg, Antley-Bixler syndrome) or Marfan syndrome were found, but an accumulation of malformations in Tutankhamun's family was evident. Several pathologies including Köhler disease II were diagnosed in Tutankhamun; none alone would have caused death. Genetic testing for STEVOR, AMA1, or MSP1 genes specific for Plasmodium falciparum revealed indications of malaria tropica in 4 mummies, including Tutankhamun's. These results suggest avascular bone necrosis in conjunction with the malarial infection as the most likely cause of death in Tutankhamun. Walking impairment and malarial disease sustained by Tutankhamun is supported by the discovery of canes and an afterlife pharmacy in his tomb. CONCLUSION: Using a multidisciplinary scientific approach, we showed the feasibility of gathering data on Pharaonic kinship and diseases and speculated about individual causes of death.

PMID: 20159872 [PubMed - in process]

Association between a literature-based genetic risk score and cardiovascular events in women.

JAMA. 2010 Feb 17;303(7):631-7

Authors: Paynter NP, Chasman DI, Paré G, Buring JE, Cook NR, Miletich JP, Ridker PM

CONTEXT: While multiple genetic markers associated with cardiovascular disease have been identified by genome-wide association studies, their aggregate effect on risk beyond traditional factors is uncertain, particularly among women. OBJECTIVE: To test the predictive ability of a literature-based genetic risk score for cardiovascular disease. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort of 19 313 initially healthy white women in the Women's Genome Health Study followed up over a median of 12.3 years (interquartile range, 11.6-12.8 years). Genetic risk scores were constructed from the National Human Genome Research Institute's catalog of genome-wide association study results published between 2005 and June 2009. MAIN OUTCOME MEASURE: Incident myocardial infarction, stroke, arterial revascularization, and cardiovascular death. RESULTS: A total of 101 single nucleotide polymorphisms reported to be associated with cardiovascular disease or at least 1 intermediate cardiovascular disease phenotype at a published P value of less than 10(-7) were identified and risk alleles were added to create a genetic risk score. During follow-up, 777 cardiovascular disease events occurred (199 myocardial infarctions, 203 strokes, 63 cardiovascular deaths, 312 revascularizations). After adjustment for age, the genetic risk score had a hazard ratio (HR) for cardiovascular disease of 1.02 per risk allele (95% confidence interval [CI], 1.00-1.03/risk allele; P = .006). This corresponds to an absolute cardiovascular disease risk of 3% over 10 years in the lowest tertile of genetic risk (73-99 risk alleles) and 3.7% in the highest tertile (106-125 risk alleles). However, after adjustment for traditional factors, the genetic risk score did not improve discrimination or reclassification (change in c index from Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults [ATP III] risk score, 0; net reclassification improvement, 0.5%; [P = .24]). The genetic risk score was not associated with cardiovascular disease risk (ATP III-adjusted HR/allele, 1.00; 95% CI, 0.99-1.01). In contrast, self-reported family history remained significantly associated with cardiovascular disease in multivariable models. CONCLUSION: After adjustment for traditional cardiovascular risk factors, a genetic risk score comprising 101 single nucleotide polymorphisms was not significantly associated with the incidence of total cardiovascular disease.

PMID: 20159871 [PubMed - in process]

Skiers, snowboarders, and safety helmets.

JAMA. 2010 Feb 17;303(7):661-2

Authors: Cusimano MD, Kwok J

PMID: 20159875 [PubMed - in process]

Potential for Revealing Individual-Level Information in Genome-wide Association Studies.

JAMA. 2010 Feb 17;303(7):659-60

Authors: Lumley T, Rice K

PMID: 20159874 [PubMed - in process]

King tutankhamun, modern medical science, and the expanding boundaries of historical inquiry.

JAMA. 2010 Feb 17;303(7):667-8

Authors: Markel H

PMID: 20159878 [PubMed - in process]

Evolving notions of childhood chronic illness.

JAMA. 2010 Feb 17;303(7):665-6

Authors: Halfon N, Newacheck PW

PMID: 20159877 [PubMed - in process]

Aligning rewards with large-scale improvement.

JAMA. 2010 Feb 17;303(7):663-4

Authors: Mandel KE

PMID: 20159876 [PubMed - in process]

Chronic diseases of children.

JAMA. 2010 Feb 17;303(7):682

Authors: Torpy JM, Campbell A, Glass RM

PMID: 20159879 [PubMed - in process]

The changing of the seasons.

JAMA. 2010 Feb 10;303(6):493-4

Authors: Ratner TJ

PMID: 20145216 [PubMed - in process]

Vocalization.

JAMA. 2010 Feb 10;303(6):486

Authors: Butt CA

PMID: 20145215 [PubMed - in process]

Comparing endovascular and open repair of abdominal aortic aneurysm.

JAMA. 2010 Feb 10;303(6):513

Authors: Dalainas I

PMID: 20145222 [PubMed - in process]

Comparing endovascular and open repair of abdominal aortic aneurysm.

JAMA. 2010 Feb 10;303(6):513-4

Authors: van Kuijk JP, Flu WJ, Poldermans D

PMID: 20145221 [PubMed - in process]

Hormone may play role in triggering panic attacks.

JAMA. 2010 Feb 10;303(6):498

Authors: Kuehn BM

PMID: 20145220 [PubMed - in process]

New item on pediatric menu: food allergy.

JAMA. 2010 Feb 10;303(6):497-8

Authors: Voelker R

PMID: 20145219 [PubMed - in process]

Safety plan for opioids meets resistance: opioid-linked deaths continue to soar.

JAMA. 2010 Feb 10;303(6):495-7

Authors: Kuehn BM

PMID: 20145218 [PubMed - in process]

Coda: don't touch me.

JAMA. 2010 Feb 10;303(6):494

Authors: Brown RE

PMID: 20145217 [PubMed - in process]

Association Between CYP2D6 Polymorphisms and Breast Cancer Outcomes.

JAMA. 2010 Feb 10;303(6):516

Authors: Lash TL

PMID: 20145226 [PubMed - in process]

Association Between CYP2D6 Polymorphisms and Breast Cancer Outcomes.

JAMA. 2010 Feb 10;303(6):516-7

Authors: Dieudonné AS, Van Belle V, Neven P

PMID: 20145225 [PubMed - in process]

High perioperative oxygen fraction for abdominal surgery and risk of surgical site infection.

JAMA. 2010 Feb 10;303(6):515

Authors: Yu H, Yang XY

PMID: 20145224 [PubMed - in process]

Comparing endovascular and open repair of abdominal aortic aneurysm.

JAMA. 2010 Feb 10;303(6):514

Authors: Findeiss LK

PMID: 20145223 [PubMed - in process]

Age- and sex-specific genomic profiles in non-small cell lung cancer.

JAMA. 2010 Feb 10;303(6):535-43

Authors: Mostertz W, Stevenson M, Acharya C, Chan I, Walters K, Lamlertthon W, Barry W, Crawford J, Nevins J, Potti A

CONTEXT: Gene expression profiling may be useful in examining differences underlying age- and sex-specific outcomes in non-small cell lung cancer (NSCLC). OBJECTIVE: To describe clinically relevant differences in the underlying biology of NSCLC based on patient age and sex. Design, Setting, and PATIENTS: Retrospective analysis of 787 patients with predominantly early stage NSCLC performed at Duke University, Durham, North Carolina, from July 2008 to June 2009. Lung tumor samples with corresponding microarray and clinical data were used. All patients were divided into subgroups based on age (<70 vs >/=70 years old) or sex. Gene expression signatures representing oncogenic pathway activation and tumor biology/microenvironment status were applied to these samples to obtain patterns of activation/deregulation. MAIN OUTCOME MEASURES: Patterns of oncogenic and molecular signaling pathway activation that are reproducible and correlate with 5-year recurrence-free patient survival. RESULTS: Low- and high-risk patient clusters/cohorts were identified with the longest and shortest 5-year recurrence-free survival, respectively, within the age and sex NSCLC subgroups. These cohorts of NSCLC demonstrate similar patterns of pathway activation. In patients younger than 70 years, high-risk patients, with the shortest recurrence-free survival, demonstrated increased activation of the Src (25% vs 6%; P<.001) and tumor necrosis factor (76% vs 42%; P<.001) pathways compared with low-risk patients. High-risk patients aged 70 years or older demonstrated increased activation of the wound healing (40% vs 24%; P = .02) and invasiveness (64% vs 20%; P<.001) pathways compared with low-risk patients. In women, high-risk patients demonstrated increased activation of the invasiveness (99% vs 2%; P<.001) and STAT3 (72% vs 35%; P<.001) pathways while high-risk men demonstrated increased activation of the STAT3 (87% vs 18%; P<.001), tumor necrosis factor (90% vs 46%; P<.001), EGFR (13% vs 2%; P = .003), and wound healing (50% vs 22%; P<.001) pathways. Multivariate analyses confirmed the independent clinical relevance of the pathway-based subphenotypes in women (hazard ratio [HR], 2.02; 95% confidence interval [CI], 1.34-3.03; P<.001) and patients younger than 70 years (HR, 1.83; 95% CI, 1.24-2.71; P = .003). All observations were reproducible in split sample analyses. CONCLUSIONS: Among a cohort of patients with NSCLC, subgroups defined by oncogenic pathway activation profiles were associated with recurrence-free survival. These findings require validation in independent patient data sets.

PMID: 20145230 [PubMed - in process]

Risk factors and outcomes associated with first-trimester fetal growth restriction.

JAMA. 2010 Feb 10;303(6):527-34

Authors: Mook-Kanamori DO, Steegers EA, Eilers PH, Raat H, Hofman A, Jaddoe VW

CONTEXT: Adverse environmental exposures lead to developmental adaptations in fetal life. The influences of maternal physical characteristics and lifestyle habits on first-trimester fetal adaptations and the postnatal consequences are not known. OBJECTIVE: To determine the risk factors and outcomes associated with first-trimester growth restriction. DESIGN, SETTING, AND PARTICIPANTS: Prospective evaluation of the associations of maternal physical characteristics and lifestyle habits with first-trimester fetal crown to rump length in 1631 mothers with a known and reliable first day of their last menstrual period and a regular menstrual cycle. Subsequently, we assessed the associations of first-trimester fetal growth restriction with the risks of adverse birth outcomes and postnatal growth acceleration until the age of 2 years. The study was based in Rotterdam, the Netherlands. Mothers were enrolled between 2001 and 2005. MAIN OUTCOME MEASURES: First-trimester fetal growth was measured as fetal crown to rump length by ultrasound between the gestational age of 10 weeks 0 days and 13 weeks 6 days. Main birth outcomes were preterm birth (gestational age <37 weeks), low birth weight (<2500 g), and small size for gestational age (lowest fifth birth centile). Postnatal growth was measured until the age of 2 years. RESULTS: In the multivariate analysis, maternal age was positively associated with first-trimester fetal crown to rump length (difference per maternal year of age, 0.79 mm; 95% confidence interval [CI], 0.41 to 1.18 per standard deviation score increase). Higher diastolic blood pressure and higher hematocrit levels were associated with a shorter crown to rump length (differences, -0.40 mm; 95% CI, -0.74 to -0.06 and -0.52 mm; 95% CI, -0.90 to -0.14 per standard deviation increase, respectively). Compared with mothers who were nonsmokers and optimal users of folic acid supplements, those who both smoked and did not use folic acid supplements had shorter fetal crown to rump lengths (difference, -3.84 mm; 95% CI, -5.71 to -1.98). Compared with normal first-trimester fetal growth, first-trimester growth restriction was associated with increased risks of preterm birth (4.0% vs 7.2%; adjusted odds ratio [OR], 2.12; 95% CI, 1.24 to 3.61), low birth weight (3.5% vs 7.5%; adjusted OR, 2.42; 95% CI, 1.41 to 4.16), and small size for gestational age at birth (4.0% vs 10.6%; adjusted OR, 2.64; 95% CI, 1.64 to 4.25). Each standard deviation decrease in first-trimester fetal crown to rump length was associated with a postnatal growth acceleration until the age of 2 years (standard deviation score increase, 0.139 per 2 years; 95% CI, 0.097 to 0.181). CONCLUSIONS: Maternal physical characteristics and lifestyle habits were independently associated with early fetal growth. First-trimester fetal growth restriction was associated with an increased risk of adverse birth outcomes and growth acceleration in early childhood.

PMID: 20145229 [PubMed - in process]

Laparoscopic adjustable gastric banding in severely obese adolescents: a randomized trial.

JAMA. 2010 Feb 10;303(6):519-26

Authors: O'Brien PE, Sawyer SM, Laurie C, Brown WA, Skinner S, Veit F, Paul E, Burton PR, McGrice M, Anderson M, Dixon JB

CONTEXT: Adolescent obesity is a common and serious health problem affecting more than 5 million young people in the United States alone. Bariatric surgery is being evaluated as a possible treatment option. Laparoscopic adjustable gastric banding (gastric banding) has the potential to provide a safe and effective treatment. OBJECTIVE: To compare the outcomes of gastric banding with an optimal lifestyle program on adolescent obesity. Design, Setting, and PATIENTS: A prospective, randomized controlled trial of 50 adolescents between 14 and 18 years with a body mass index (BMI) higher than 35, recruited from the Melbourne, Australia, community, assigned either to a supervised lifestyle intervention or to undergo gastric banding, and followed up for 2 years. The study was performed between May 2005 and September 2008. MAIN OUTCOME MEASURES: Weight loss. Secondary outcomes included change in metabolic syndrome, insulin resistance, quality of life, and adverse outcomes. RESULTS: Twenty-four of 25 patients in the gastric banding group and 18 of 25 in lifestyle group completed the study. Twenty-one (84%) in the gastric banding and 3 (12%) in the lifestyle groups lost more than 50% of excess weight, corrected for age. Overall, the mean changes in the gastric banding group were a weight loss of 34.6 kg (95% CI, 30.2-39.0), representing an excess weight loss of 78.8% (95% CI, 66.6%-91.0%), 12.7 BMI units (95% CI, 11.3-14.2), and a BMI z score change from 2.39 (95% CI, 2.05-2.73) to 1.32 (95% CI, 0.98-1.66). The mean losses in the lifestyle group were 3.0 kg (95% CI, 2.1-8.1), representing excess weight loss of 13.2% (95% CI, 2.6%-21.0%), 1.3 BMI units (95% CI, 0.4-2.9), and a BMI z score change from 2.41 (95% CI, 2.21-2.66) to 2.26 (95% CI, 1.91-2.43). At entry, 9 participants (36%) in the gastric banding group and 10 (40%) in the lifestyle group had the metabolic syndrome. At 24 months, none of the gastric banding group had the metabolic syndrome (P = .008; McNemar chi(2)) compared with 4 of the 18 completers (22%) in the lifestyle group (P = .13). The gastric banding group experienced improved quality of life with no perioperative adverse events. However, 8 operations (33%) were required in 7 patients for revisional procedures either for proximal pouch dilatation or tubing injury during follow-up. CONCLUSIONS: Among obese adolescent participants, use of gastric banding compared with lifestyle intervention resulted in a greater percentage achieving a loss of 50% of excess weight, corrected for age. There were associated benefits to health and quality of life. Trial Registration ANZCTR Identifier: 12605000160639.

PMID: 20145228 [PubMed - in process]

Clinical trial registration and publication of randomized controlled trials.

JAMA. 2010 Feb 10;303(6):517-8

Authors: Lockshin MD, Katz PP, Yelin EH

PMID: 20145227 [PubMed - in process]

Enhancing the effectiveness of food labeling in restaurants.

JAMA. 2010 Feb 10;303(6):553-4

Authors: Blumenthal K, Volpp KG

PMID: 20145233 [PubMed - in process]

Perioperative {beta}-Blockers for Cardiac Risk Reduction: Time for Clarity.

JAMA. 2010 Feb 10;303(6):551-2

Authors: Chopra V, Eagle KA

PMID: 20145232 [PubMed - in process]

Hospital characteristics associated with feeding tube placement in nursing home residents with advanced cognitive impairment.

JAMA. 2010 Feb 10;303(6):544-50

Authors: Teno JM, Mitchell SL, Gozalo PL, Dosa D, Hsu A, Intrator O, Mor V

CONTEXT: Tube-feeding is of questionable benefit for nursing home residents with advanced dementia. Approximately two-thirds of US nursing home residents who are tube fed had their feeding tube inserted during an acute care hospitalization. OBJECTIVE: To identify US hospital characteristics associated with higher rates of feeding tube insertion in nursing home residents with advanced cognitive impairment. Design, Setting, and PATIENTS: The sample included nursing home residents aged 66 years or older with advanced cognitive impairment admitted to acute care hospitals between 2000 and 2007. Rate of feeding tube placement was based on a 20% sample of all Medicare Claims files and was assessed in hospitals with at least 30 such admissions during the 8-year period. A multivariable model with the unit of the analysis being the hospital admission identified hospital-level factors independently associated with feeding tube insertion rates, including bed size, ownership, urban location, and medical school affiliation. Measures of each hospital's care practices for all patients with serious chronic illnesses were evaluated, including intensive care unit (ICU) use in the last 6 months of life, the use of hospice services, and the ratio of specialist to primary care physicians. Patient-level characteristics were also considered. MAIN OUTCOME MEASURE: Endoscopic or surgical insertion of a gastrostomy tube during a hospitalization. RESULTS: In 2797 acute care hospitals with 280 869 admissions among 163 022 nursing home residents with advanced cognitive impairment, the rate of feeding tube insertion varied from 0 to 38.9 per 100 hospitalizations (mean [SD], 6.5 [5.3]; median [interquartile range], 5.3 [2.6-9.3]). The mean rate of feeding tube insertions per 100 admissions was 7.9 in 2000, decreasing to 6.2 in 2007. Higher insertion rates were associated with the following hospital features: for-profit ownership vs government owned (8.5 vs 5.5 insertions per 100 hospitalizations; adjusted odds ratio [AOR], 1.33; 95% confidence interval [CI], 1.21-1.46), larger size (>310 beds vs <101 beds: 8.0 vs 4.3 insertions per 100 hospitalizations; AOR, 1.48; 95% CI, 1.35-1.63), and greater ICU use in the last 6 months of life (highest vs lowest decile: 10.1 vs 2.9 insertions per 100 hospitalizations; AOR, 2.60; 95% CI, 2.20-3.06). These differences persisted after controlling for patient characteristics. Specialist to primary care ratio and hospice use were weakly or not associated with feeding tube placement. CONCLUSION: Among nursing home residents with advanced cognitive impairment admitted to acute care hospitals, for-profit ownership, larger hospital size, and greater ICU use was associated with increased rates of feeding tube insertion, even after adjusting for patient-level characteristics.

PMID: 20145231 [PubMed - in process]

Bariatric surgery.

JAMA. 2010 Feb 10;303(6):576

Authors: Torpy JM, Lynm C, Glass RM

PMID: 20145238 [PubMed - in process]

First-trimester determination of complications of late pregnancy.

JAMA. 2010 Feb 10;303(6):561-2

Authors: Smith GC

PMID: 20145237 [PubMed - in process]

Surgical treatment of obesity in adolescence.

JAMA. 2010 Feb 10;303(6):559-60

Authors: Livingston EH

PMID: 20145236 [PubMed - in process]

Darwin's Compassionate View of Human Nature.

JAMA. 2010 Feb 10;303(6):557-8

Authors: Ekman P

PMID: 20145235 [PubMed - in process]

Replicating high-quality medical care organizations.

JAMA. 2010 Feb 10;303(6):555-6

Authors: Mechanic D

PMID: 20145234 [PubMed - in process]

An oath to my grandfather.

JAMA. 2010 Feb 3;303(5):397

Authors: Grant R

PMID: 20124528 [PubMed - in process]

An oath to my grandfather.

JAMA. 2010 Feb 3;303(5):397

Authors: Grant R

PMID: 20124528 [PubMed - in process]

Star shaped islamic tiles with cross shaped infill.

JAMA. 2010 Feb 3;303(5):395

Authors: Cole TB

PMID: 20124527 [PubMed - in process]

Star shaped islamic tiles with cross shaped infill.

JAMA. 2010 Feb 3;303(5):395

Authors: Cole TB

PMID: 20124527 [PubMed - in process]

Procalcitonin-based guidelines and lower respiratory tract infections.

JAMA. 2010 Feb 3;303(5):418

Authors: Cals JW, Metlay JP

PMID: 20124534 [PubMed - in process]

Procalcitonin-based guidelines and lower respiratory tract infections.

JAMA. 2010 Feb 3;303(5):418

Authors: Cals JW, Metlay JP

PMID: 20124534 [PubMed - in process]

Procalcitonin-based guidelines and lower respiratory tract infections.

JAMA. 2010 Feb 3;303(5):418-9

Authors: Stijnis C, van Nieuwkoop C, van Dissel JT

PMID: 20124533 [PubMed - in process]

Procalcitonin-based guidelines and lower respiratory tract infections.

JAMA. 2010 Feb 3;303(5):418-9

Authors: Stijnis C, van Nieuwkoop C, van Dissel JT

PMID: 20124533 [PubMed - in process]

Office of Inspector General: CDC Lax in Policing Advisors' Conflicts of Interest.

JAMA. 2010 Feb 3;303(5):412

Authors: Kuehn BM

PMID: 20124532 [PubMed - in process]

Office of Inspector General: CDC Lax in Policing Advisors' Conflicts of Interest.

JAMA. 2010 Feb 3;303(5):412

Authors: Kuehn BM

PMID: 20124532 [PubMed - in process]

Epilepsy experts focus on treatment gaps.

JAMA. 2010 Feb 3;303(5):406-12

Authors: Hampton T

PMID: 20124531 [PubMed - in process]

Epilepsy experts focus on treatment gaps.

JAMA. 2010 Feb 3;303(5):406-12

Authors: Hampton T

PMID: 20124531 [PubMed - in process]

New findings challenge thinking about anemia, iron deficiency, and heart risk.

JAMA. 2010 Feb 3;303(5):405-6

Authors: Mitka M

PMID: 20124530 [PubMed - in process]

New findings challenge thinking about anemia, iron deficiency, and heart risk.

JAMA. 2010 Feb 3;303(5):405-6

Authors: Mitka M

PMID: 20124530 [PubMed - in process]