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This Week in JAMA |

This Week in JAMA FREE

JAMA. 2004;291(2):155. doi:10.1001/jama.291.2.155.
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ERADICATION OF

Chronic Helicobacter pylori infection is a risk factor for the development of gastric cancer. Wong and colleaguesArticle conducted a randomized trial among healthy carriers of H pylori infection from Fujian Province, China, to determine whether a 2-week course of H pylori eradication treatment would reduce the incidence of gastric cancer. After 7.5 years of follow-up, the incidence of gastric cancer in the group that received H pylori eradication treatment was not significantly different from that in the placebo group. In a subgroup analysis of outcomes among H pylori carriers who did not have precancerous lesions at study entry, the incidence of gastric cancer was significantly reduced in the H pylori eradication treatment group compared with the placebo group. In an editorial, Parsonnet and FormanArticle discuss the implications of these findings for H pylori screening and treatment initiatives.

HOSPITAL VOLUME AS A QUALITY INDICATOR

Hospital procedural and patient volumes have been proposed as quality indicators for the purpose of selective referral strategies. Two articles in this issue of THE JOURNAL examine the relationship between hospital volume and patient outcomes. In an analysis of data from coronary artery bypass graft (CABG) procedures from the Society of Thoracic Surgeons National Cardiac Database, Peterson and colleaguesArticle found that after adjusting for patient risk and clustering issues, hospital CABG volume was only modestly associated with all-cause operative mortality. This association was not observed in patients younger than 65 years or in those at low operative risk and was confounded by surgeon procedural volume. Rogowski and colleaguesArticle, in an analysis of data on very low-birth-weight (VLBW) infants from a network of hospitals with neonatal intensive care units, found that although annual volume of VLBW infant admissions was significantly associated with mortality prior to discharge home, it explained only 9% of the variation in mortality rates across hospitals. In an editorial, ShahianArticle evaluates the potential usefulness of hospital procedural volume as a quality metric for CABG surgery.

PREDICTION OF CHD RISK IN ASYMPTOMATIC ADULTS

Guidelines recommend coronary heart disease (CHD) risk assessment for all adults to guide primary prevention. Greenland and colleagues conducted a prospective study of asymptomatic adults with at least 1 coronary risk factor but without diabetes or history of CHD to determine whether coronary artery calcium score (CACS) assessment combined with the Framingham Risk Score (FRS) provides prognostic information superior to either method alone. The CACS significantly modified risk prediction among patients with an FRS of at least 10%, but not among patients with an FRS less than 10%.

ADVERSE EFFECTS OF A SUPPLEMENT WITH EPHEDRA, CAFFEINE

Anecdotal reports of sudden cardiac death and cerebrovascular accidents have raised questions about the safety of dietary weight-loss supplements that contain ephedra and caffeine (DSEC). In this randomized crossover study among healthy volunteers, McBride and colleagues found that the mean maximal corrected QT interval (QTc) and systolic blood pressure were significantly increased after a single dose of Metabolife 356, a widely used multicomponent DSEC, compared with placebo.

HOUSEHOLD TRANSMISSION OF ENTEROVIRUS 71

Outbreaks of enterovirus 71 have been associated with serious morbidity and mortality. Lin and colleagues conducted a prospective family cohort study in Taiwan to investigate enterovirus 71 transmission and determine clinical outcomes within households of patients infected with enterovirus 71. Household transmission rates of enterovirus 71 were significantly higher among children than among adults. Infection of household children, especially those younger than 3 years, was associated with serious complications, sequelae, and death, whereas infection of adults was usually asymptomatic or mild.

MEDICAL NEWS & PERSPECTIVES

Sleep experts are concerned that a drug approved to treat sleepiness in patients with narcolepsy and a few other disorders will be used "off-label" by healthy individuals as a means to shortchange themselves on sleep.

Prenatal ultrasound scans can show potential markers of abnormalities such as Down syndrome, but because many such markers are also found in normal fetuses, clinicians are divided on whether they provide useful information or cause needless worry for pregnant women.

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(Photo credit: Rebecca Smith-Bindman, MD/UCSF)

CLINICIAN'S CORNER

Part 1Article of this 2-part article presents recommendations for the diagnosis and management of subclinical thyroid disease and assesses the evidence supporting each recommendation. In part 2Article, case scenarios illustrate evidence-based approaches to managing patients with subclinical hypothyroidism and hyperthyroidism.

JAMA PATIENT PAGE

For your patients: Information about gastric cancer.

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(Photo credit: Rebecca Smith-Bindman, MD/UCSF)

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