This Week in JAMA FREE

Stillbirth affects 1 in 160 pregnancies in the United States each year. Two articles in this issue from the Stillbirth Collaborative Research Network, a prospective, population-based study that involved 59 hospitals in 5 states, report findings relating to causes of stillbirth and associated risk factors. Investigators report that standardized postmortem examination of 512 stillbirths led to a probable or possible cause in a majority of cases. Obstetric conditions or placental abnormalities were the most common causes of stillbirth, although the distribution differed by race/ethnicity. In the second article—an analysis of maternal sociodemographic, medical and physiological, psychosocial, and reproductive history variables from 614 stillbirth and 1816 live born deliveries—investigators found that multiple risk factors associated with stillbirth could be ascertained at the time of pregnancy confirmation; however, these factors accounted for only a small proportion of the overall risk. In an editorial, Iams and Lynch discuss implications of stillbirth research for improved care of pregnant women.

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Case reports have suggested that patients with myotonic muscular dystrophy—an autosomal dominant multisystem disorder characterized by unstable nucleotide repeat expansions—may be at increased risk of malignancy. To more fully assess cancer risk in this patient population, Gadalla and colleagues analyzed hospital and outpatient visit discharge and cancer registry data from 1658 Swedish and Danish patients with myotonic muscular dystrophy. The authors report that 104 patients developed cancer during postdischarge follow-up, which reflected an increased risk of cancer—primarily of the endometrium, brain, ovary, and colon—compared with the general population.

Guidelines have discouraged the performance of elective percutaneous coronary intervention (PCI) at institutions without on-site cardiac surgery capability, and results of studies that compare patient outcomes at centers with and without on-site surgery are discrepant. To assess the safety and outcomes of primary and nonprimary PCI performed at centers without on-site cardiac surgery capability, Singh and colleagues performed a meta-analysis of data from 15 studies published between 1990 and 2010 that reported rates of in-hospital mortality and emergency coronary artery bypass graft (CABG) surgery following PCI at centers with and without on-site surgery. The authors report that rates of in-hospital mortality and emergency CABG surgery for primary and nonprimary PCI were similar at centers with and without on-site surgery. In an editorial, Kinlay discusses the safety of PCI without on-site CABG capability and the need for ongoing and systematic assessment of patient characteristics and outcomes.

Guidelines for cancer screening written by different organizations often diverge, even when based on the same evidence, creating confusion for physicians, the public, and policy makers. Brawley and colleagues describe the American Cancer Society's revised method for developing and communicating cancer screening guidelines. Key features of the revised process include a single generalist group for writing guidelines, independent systematic evidence review, and clear articulation of benefits, limitations, and harms associated with a screening test.

“In the absence of a real relationship with [our cadaver], we created one through our stories.” From “The Artist of Medicine.”

A medication once believed to improve mortality rates of patients with severe sepsis has been withdrawn from the market after a recent study found it performed no better than placebo.

What patients really want

Improving ambulatory patient safety

Should patients get direct access to laboratory test results?

Onward Howard Kelly, marching as to war

Dr Zylke summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

Join Daniel Leffler, MD, MS, on Wednesday, December 21, at 2 PM eastern time to discuss celiac disease. To register, go to http://www.ihi.org/AuthorintheRoom.

How would you manage a house officer with a needle-stick injury? Go to www.jama.com to read the case. Submit your response by January 1 for possible online posting.

For your patients: Information about muscular dystrophy.