This Week in JAMA FREE

Moderate levels of alcohol intake have been associated with reduction in the risk of coronary heart disease (CHD) and CHD mortality, but this relationship has not been studied specifically among patients with diabetes mellitus. Valmadrid and colleagues report that among 983 subjects with diabetes diagnosed after age 30 years enrolled in the Wisconsin Epidemiologic Study of Diabetic Retinopathy and followed up for up to 12.3 years, the risk of CHD mortality declined progressively with increasing alcohol intake in the light to moderate range. In an editorial, Criqui and Golomb consider mechanisms to explain how alcohol consumption might influence CHD risk in patients with diabetes.

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Hereditary nonpolyposis colorectal cancer (HNPCC) has been associated with germline mutations in several DNA mismatch repair genes. To determine the clinical usefulness of cancer susceptibility testing for HNPCC, Syngal and coworkers assessed the prevalence of mutations in hMSH2 and hMLH1 mismatch repair genes in individuals meeting different sets of clinical criteria for HNPCC. Definite pathogenic mutations were found in 18 of 70 families enrolled in the study; prevalence was highest among families meeting Amsterdam diagnostic criteria. In an editorial, O'Leary discusses the clinical application of hMSH2 and hMLH1 gene testing to guide cancer surveillance in HNPCC families.

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Apolipoprotein E ∊4 (APOE ∊4) has been associated with an increased risk of dementia with stroke, but whether this effect is mediated through dyslipidemia or whether dyslipidemia has an independent effect on vascular dementia is not known. In this study by Moroney and colleagues of 1111 nondemented individuals aged 65 years or older followed up for an average of 2.1 years, 61 developed dementia with stroke and 225, probable Alzheimer disease. Elevated levels of low-density lipoprotein cholesterol were associated with a significantly increased risk of dementia with stroke independent of APOE genotype, but not with the development of Alzheimer disease.

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In some managed care plans, primary care physicians have been given a gatekeeper role to limit patient access to specialty care, a function that has received substantial criticism. In this survey of 7718 adults enrolled in managed care plans in California, Grumbach and colleagues found that most respondents valued the role of the primary care physician as a source of first-contact care and coordinator of referrals. Patient ratings of levels of trust and confidence in their primary care physician and overall satisfaction were generally high. However, levels of trust, confidence, and satisfaction were significantly lower among patients who reported needing specialty referrals and had difficulty obtaining them compared with patients who said they did not need referrals or with those who needed referrals and were able to obtain them easily.

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Adverse drug events (ADEs) may best be reduced by interventions at the time of prescribing. Leape and coworkers report that in a medical intensive care unit (ICU), the rate of preventable ADEs due to ordering errors decreased from 10.4 per 1000 patient-days to 3.5 when a pharmacist participated in daily rounds with the ICU team in addition to being present in the unit each morning and available on call. In contrast, the baseline rate of preventable ordering ADEs in a control unit where a pharmacist was available during part of the day but did not make rounds with the staff was essentially unchanged during the same period (from 10.9 to 12.4 ADEs per 1000 patient-days).

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"One of my biggest struggles in becoming a physician is developing aequanimitas while figuratively working on both sides of the blue drape." From "The Blue Drape."

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Thymic output of T cells persists into adulthood and may contribute to the immune reconstitution observed in adults with HIV infection treated with highly active antiretroviral therapy.

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Progress against chronic hepatitis C infection, a serious and growing public health threat, is being made via various biomedical disciplines.

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At the Clinical Center of the National Institutes of Health. A 27-year-old man with seronegative hepatitis develops marked pancytopenia 8 weeks after diagnosis and profound bone marrow hypocellularity.

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For your patients: Proper medication use.

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