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This Week in JAMA |

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JAMA. 2005;294(7):773. doi:10.1001/jama.294.7.773.
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IMPACT OF VARICELLA VACCINE ON HEALTH CARE VISITS

Routine varicella vaccination was recommended for children in 1995, and substantial declines in varicella incidence have been documented. However, whether routine vaccination has resulted in fewer varicella-related medical visits is not known. Zhou and colleaguesArticle assessed 1994-2002 trends in varicella-related hospitalizations, ambulatory visits, and associated expenditures using a national insurance data set. Compared with the 1994-1995 prevaccination period, they found hospitalizations declined 88%; ambulatory visits, 59%; and associated expenditures, 74%. In an editorial, DavisArticle discusses important considerations when projecting and reviewing vaccine cost-effectiveness.

TIMING OF REPERFUSION AND HOSPITAL MORTALITY

Reperfusion therapy reduces mortality from ST-segment elevation myocardial infarction (STEMI), but factors that could influence time to reperfusion, such as time of day, day of week, or therapy type, may affect outcomes. Using data from a cohort of patients with STEMI treated with either fibrinolytic therapy or percutaneous coronary intervention (PCI), Magid and colleagues calculated door-to-drug or door-to-balloon times by time of day and day of week (regular hours, 7 AM-5 PM weekdays; off-hours, after 5 PM weekdays and all weekend) and the relationship of timing to in-hospital mortality. The authors found that most patients were treated during off-hours and patients having PCI during off-hours had significantly longer times to treatment. Patients presenting during off-hours had significantly higher mortality compared with patients presenting during regular hours.

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MULTINATIONAL EPIDEMIOLOGY OF ACUTE RENAL FAILURE

Data on the prevalence, etiology, management, and outcome of patients with acute renal failure (ARF) in different regions of the world are lacking. To address this, Uchino and colleagues conducted a prospective, epidemiological survey of patients with ARF in the intensive care unit of 54 centers in 23 nations. They found that the prevalence of ARF was between 5% and 6% and overall hospital mortality was about 60%. Factors contributing to ARF and mortality were identified.

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COMPARISON OF DRUG-ELUTING STENTS

Placement of coronary stents that elute either sirolimus or paclitaxel is common treatment for coronary artery disease. Whether there are safety and efficacy differences between the 2 drug-eluting stents is not clear. Kastrati and colleagues conducted a meta-analysis of outcome data from 6 randomized trials comparing the sirolimus-eluting stent with the paclitaxel-eluting stent. They found significantly fewer patients with the sirolimus-eluting stent required target lesion revasularization or had angiographic restenosis. Rates of death, death and myocardial infarction, and stent thrombosis were similar in patients receiving either stent.

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MINIMAL RISK STANDARD IN PEDIATRIC RESEARCH

Pediatric research that does not offer participants “a prospect of direct” benefit is constrained by federal regulations to that which carries at most a minimal or minor increase over minimal risk. Minimal risk is defined based on risks ordinarily encountered in daily life or during routine physical and psychological examinations or tests. Application of this standard by institutional review boards is inconsistent. Wendler and colleagues present empirical data on ordinary childhood risks, such as car travel and sports, and alternatives to the current definition of minimal risk.

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MEDICAL NEWS & PERSPECTIVES

Neuroimaging is helping scientists explore complex brain functions and advance the understanding of the brain in health and disease. But the use of such tools has ethical implications.

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CLINICIAN’S CORNER

Clinical Crossroads

Sachs discusses the case of Mrs W, whose first pregnancy ended with uterine rupture, a stillborn male infant, hysterectomy, and disseminated intravascular coagulation. He describes the lessons learned and departmental changes instituted.

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MEDICAL MARIJUANA

Federal public health powers and the patient-physician relationship following Gonzalez v Raich.

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JAMA PATIENT PAGE

For your patients: Information about chickenpox.

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