This Week in JAMA FREE

Stiell and colleaguesArticle, reporting phase II of the Ontario Prehospital Advanced Life Support study, found that the rate of survival to hospital discharge after out-of-hospital cardiac arrest increased 33% over baseline (phase I) following implementation of rapid defibrillation programs designed to have first-response teams with a defibrillator at the scene within 8 minutes of an emergency call. Cobb and colleaguesArticle found that the rate of survival to hospital discharge of individuals with out-of-hospital ventricular fibrillation improved significantly after the prehospital treatment protocol of immediate defibrillation was revised to include 90 seconds of cardiopulmonary resuscitation before defibrillation. In an editorial, Olson and FontanarosaArticle systematically appraise these before-after studies.

Elevated homocysteine levels have been associated with increased risk of cardiovascular disease in adults, but little is known about homocysteine levels in children. Using data from more than 3500 US children aged 13 and 14 years, Osganian and colleagues found that the distribution of serum homocysteine levels ranged from 0.1 to 25.7 µmol/L (median, 4.9 µmol/L). Mean homocysteine levels were higher in boys compared with girls and in black children compared with white or Hispanic children. A significant inverse correlation between homocysteine and serum folic acid and vitamin B₁₂ levels was observed.

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To explore the effects of estrogen on cognitive function, Shaywitz and coworkers performed functional magnetic resonance imaging during working memory tasks in a crossover trial of estrogen therapy in postmenopausal women. Brain activation patterns during memory tasks differed in the 2 treatment conditions (estrogen therapy vs placebo), including increased activation in the inferior parietal lobules (Figure 1, regions 1) and in the superior frontal gyri (regions 2) during the storage component of verbal memory among women treated with estrogen. Actual performance on the memory tasks was similar in both treatment conditions.

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Davidson and colleaguesArticle argue that because protein glycosylation is considered a major factor in microvascular diabetic complications, the lower diagnostic threshold for fasting plasma glucose concentration (FPG), 7.0 mmol/L (126 mg/dL), recommended by the American Diabetes Association (ADA), should not be considered diagnostic of diabetes unless elevated glycohemoglobin levels are also present. They report that in 2 large data sets approximately 60% of individuals with an FPG concentration between 7.0 mmol/L (126 mg/dL) and 7.7 mmol/L (139 mg/dL) had normal glycohemoglobin levels. In an editorial, VinicorArticle supports the current ADA recommendations until more is learned about the relationship between plasma glucose levels, glycosylation of proteins in addition to hemoglobin, and onset of microvascular and macrovascular complications.

Using prospective and cross-sectional data, Bleyer and colleagues found that the number of missed hemodialysis treatments per 100 patient-months was significantly higher among patients undergoing hemodialysis in the United States compared with patients in Japan and Sweden. The researchers speculate that variation in patient compliance among countries may explain, in part, international differences in treatment outcomes.

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Aware of the transmission of bovine spongiform encephalopathy ("mad cow disease") to a few people who ate British beef in the past decade, blood banking officials consider the possibility of—and cost of preventing—the spread of transmissible spongiform encephalopathies through transfusion.

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An approach to differential diagnosis in the clinical setting using studies of disease probability.

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Regulatory and legislative policies that are changing the US health care system are indirectly reshaping resident physician training.

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Are residency training programs keeping pace with shifts in patterns of disease and changes in the patient-physician relationship?

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For your patients: Importance of learning cardiopulmonary resuscitation.

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