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JAMA. 2002;288(21):2643. doi:10.1001/jama.288.21.2643.
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Among patients presenting to the emergency department (ED) with chest pain or other symptoms suggestive of acute cardiac ischemia, some without acute ischemia may be unnecessarily admitted to the hospital or special observation unit, while others with acute ischemia may be inappropriately discharged from the ED. Udelson and colleaguesArticle conducted a randomized trial among adult ED patients with suspected acute cardiac ischemia but without initial electrocardiogram changes diagnostic of acute ischemia to assess whether incorporating sestamibi myocardial perfusion imaging into an ED evaluation protocol would improve initial ED triage. Among patients with a final diagnosis of acute cardiac ischemia based on subsequent testing, ED triage decisions using a standard evaluation were not significantly different from those in which the standard evaluation was supplemented with sestamibi imaging. However, among patients without acute cardiac ischemia, the rate of hospitalization was significantly lower in the sestamibi imaging group. In an editorial, GibbonsArticle discusses issues to be considered before using myocardial perfusion imaging in the routine evaluation and triage of patients with acute chest pain.


Decision aids are intended to increase patient participation in treatment decision making. In this randomized trial among women with menorrhagia, Kennedy and colleagues compared health status outcomes, treatment choices, and costs in 3 study groups: an information-only group, in which women received a specially designed booklet and complementary videotape; an interview group, in which women received the same materials as the information group and also a structured interview to clarify and elicit treatment preferences prior to specialist consultation; and a control group. In general, health status outcomes measured at 2-year follow-up were not significantly different in the 3 study groups. Hysterectomy rates and costs were significantly lower in the interview group compared with the information and control groups.

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Metabolic syndrome is characterized by disturbed glucose and insulin metabolism, overweight and abdominal fat distribution, mild dyslipidemia, and hypertension. To assess the association between metabolic syndrome and cardiovascular and overall mortality, Lakka and colleagues analyzed 11-year follow-up data from men enrolled in the prospective Kuopio Ischaemic Heart Disease Risk Factor Study who were aged 42 to 60 years at baseline and did not have cardiovascular disease, cancer, or diabetes. Cardiovascular disease mortality and all-cause mortality were significantly increased in men with metabolic syndrome according to National Cholesterol Education Program and World Health Organization definitions, independent of other important and potentially confounding cardiovascular disease risk factors.

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Sudden infant death syndrome (SIDS) is the leading cause of infant mortality among American Indians. In this population-based case-control study in American Indian communities in South Dakota, North Dakota, Nebraska, and Iowa, Iyasu and colleagues found that 2 or more layers of clothing on the infant, periconceptual maternal alcohol use, and maternal first-trimester binge drinking were associated with a significantly increased risk of SIDS. Any public health nurse visit before or after birth was associated with a significantly lower risk of SIDS.

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Driven by an ever-widening HIV/AIDS pandemic, researchers are exploring some novel stategies in their quest to develop an HIV vaccine.

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Evidence on the association between Chlamydia pneumoniae infection and pathogenesis of atherosclerosis.

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Perspectives on Care at the Close of Life
Excerpts of interviews with the son of a 77-year-old woman with pulmonary fibrosis and respiratory failure and with her physicians illustrate processes involved in decisions to withdraw life-sustaining therapies from critically ill patients.

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Berliner and Ginzberg identify factors contributing to the current nursing shortage and discuss why this shortage is unlikely to respond solely to economic remedies used in the past.

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For your patients: Information about sudden infant death syndrome.

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