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This Week in JAMA |

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JAMA. 2003;289(9):1077. doi:10.1001/jama.289.9.1077.
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ADVERSE DRUG EVENTS AMONG OLDER ADULTS

Medication use is common among adults aged 65 years and older; in a recent nationwide survey, more than one third of older noninstitutionalized adults used 5 or more different medications per week. Gurwitz and colleaguesArticle conducted a study of Medicare enrollees to evaluate the incidence and preventability of adverse drug events among older persons cared for in the ambulatory setting. In a cohort of Medicare enrollees (30 397 person-years of observation), 1523 adverse drug events were identified (50.1 per 1000 person-years), 27.6% of which were considered preventable (13.8 per 1000 person-years). In an editorial, ClassenArticle underscores the risk that medications pose to patients and emphasizes the need for strategies to reduce it.

INVASIVE VS MEDICAL MANAGEMENT OF CAD IN ELDERLY

In the Trial of Invasive versus Medical therapy in Elderly patients (TIME) study, functional outcomes of patients aged 75 years or older with coronary artery disease (CAD) who received invasive therapy were significantly better at 6 months than in the optimal medical management group, but early mortality was slightly higher. In this study of 1-year outcomes, Pfisterer and colleaguesArticle found that improvements in angina and quality of life compared with baseline persisted in both treatment groups, but there were no significant between-group differences in symptoms, quality of life, or rates of death or nonfatal myocardial infarction. Rates of hospitalization for uncontrolled symptoms and of late revascularization during the 1-year follow-up were significantly higher in the medical therapy group. In an editorial, PetersonArticle discusses how to approach treatment decisions for symptomatic elderly patients with CAD.

PREDICTORS OF OUTCOMES OF EXTREMELY LBW INFANTS

Bronchopulmonary dysplasia, brain injury, and severe retinopathy of prematurity are known risk factors for poor long-term outcomes of very preterm infants, but the individual and combined prognostic value of these common neonatal morbidities is uncertain. In this analysis of data from extremely low-birth-weight (LBW) infants enrolled in the international Trial of Indomethacin Prophylaxis in Preterms who survived to a postmenstrual age of 36 weeks, Schmidt and colleagues found that each of the 3 neonatal morbidities was independently associated with death or neurosensory impairment at 18 months. The rate of a poor outcome at 18 months increased from 18% in children with none of the neonatal morbidities to 88% with all 3 neonatal morbidities.

IMMUNOSUPPRESSION FOR APLASTIC ANEMIA

Stem cell transplantation and immunosuppression alone are both effective treatments for aplastic anemia, but late complications of immunosuppression have included high rates of relapse and evolution to other hematologic diseases. In a cohort of 122 patients with severe aplastic anemia treated with antithymocyte globulin and cyclosporine, Rosenfeld and colleagues found that overall actuarial survival at 7 years was 55%. Survival was associated with early satisfaction of response criteria and with the quality of the blood cell count response at 3 months. Relapse (defined as the requirement for further immunosuppressive therapy) was common, but severe pancytopenia usually did not recur. Thirteen patients had evolution to other hematologic diseases.

MEDICAL NEWS & PERSPECTIVES

New guidelines for colorectal cancer screening stress the importance of initial screenings for people aged 50 years or older.

INHALED NITRIC OXIDE FOR VASO-OCCLUSIVE CRISIS

Results of this preliminary randomized placebo-controlled trial suggest that inhaled nitric oxide may be beneficial for the treatment of acute vaso-occlusive crisis in patients with sickle cell disease.

AFFIRMATIVE ACTION IN MEDICAL SCHOOLS

Cohen discusses why affirmative action policies are critically important in medical school admissions.

CLINICIAN'S CORNER

Acute pericarditis: current concepts and clinical management.

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