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This Week in JAMA | April 17, 2013|

This Week in JAMA FREE

JAMA. 2013;309(15):1555. doi:10.1001/jama.2012.145372.
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SURGICAL COMPLICATIONS AND HOSPITAL FINANCES

In a retrospective analysis of 2010 administrative data from 34 256 inpatient surgical discharges from a nonprofit 12-hospital system, Eappen and colleagues examined the relationship between major surgical complications and hospital costs, revenues, and contribution margin (revenue minus variable expenses) by payer type. The authors report that the occurrence of postsurgical complications was associated with a higher per-encounter hospital contribution margin for patients covered by Medicare and private insurance and a lower contribution margin for patients covered by Medicaid and self-payment. In an editorial, Reinhardt discusses ramifications of surgical complications for hospital finances.

INFANTILE COLIC AND CHILDHOOD MIGRAINE

In a case-control study involving 328 children (aged 6 to 18 years) with migraine or tension-type headache and 471 children of similar age without a history of recurrent headaches, Romanello and colleagues assessed whether there is an association between a history of infantile colic and migraine headache in childhood. The authors found that children with migraine—but not tension-type headache—were more likely to have experienced infantile colic than children without migraine. In an editorial, Epstein and Zee discuss the pathophysiology of and the association between infantile colic and migraine.

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CVD, LIFESTYLE FACTORS, AND NATIONAL INCOME

To assess the adoption of healthy lifestyle behaviors—avoidance or cessation of smoking, eating a healthful diet, and undertaking regular physical activity—among individuals with cardiovascular disease (CVD) in nations representing various levels of economic development, Teo and colleagues analyzed data from a prospective survey of 153 996 adults residing in 628 urban and rural communities in 17 low-, middle- and high-income countries. Among 7519 individuals with self-reported CVD, the authors found that the overall prevalence of these healthy behaviors was low, with even lower levels in poorer countries.

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INTRACORONARY CELL THERAPY IN CHRONIC HEART FAILURE

Assmus and colleagues previously reported that extracorporeal application of low-energy shockwaves enhances homing of bone marrow–derived cells (BMCs) to the targeted area. In a randomized, placebo-controlled trial that enrolled 103 patients with chronic congestive heart failure, the authors found that compared with cardiac shockwave application alone, the use of shockwave-facilitated intracoronary BMC therapy resulted in modest improvement in left ventricular ejection fraction at 4 months' follow-up.

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CLINICIAN'S CORNER JAMA CLINICAL CHALLENGE

A woman who had a renal transplant 10 years earlier is admitted for evaluation of lower-extremity edematous erythema, subcutaneous plaques, and severe pain present for the past month. She has a fever, which has not responded to 3 separate courses of intravenous antibiotics. Blood cultures are negative. What would you do next?

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MEDICAL NEWS & PERSPECTIVES

Infections with hard-to-treat carbapenem-resistent Enterobacteriaceae are becoming more prevalent at US health care institutions, particularly long-term care facilities, warns the US Centers for Disease Control and Prevention.

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VIEWPOINTS

Future of biomedical research

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Video recording for quality improvement

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Drug development for heart failure

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Combination therapy to prevent cardiovascular disease

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A PIECE OF MY MIND

“The age gap between me and my patients has narrowed somewhat, but it is still wide enough for me to able to look after them.” From “Mind the Gap.”

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AUTHOR IN THE ROOM TELECONFERENCE

Join Justin B. Dimick, MD, MPH, Wednesday, May 15, from 2 to 3 PM eastern time to discuss bariatric surgery complications before and after establishing centers of excellence for the procedure. To register, go to http://www.ihi.org/AuthorintheRoom.

EDITOR'S AUDIO SUMMARY

Dr Bauchner summarizes and comments on this week's issue. Go to http://jama.jamanetwork.com/multimedia.aspx#Weekly

JAMA PATIENT PAGE

For your patients: Information about aspirin therapy.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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