JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENT
JAMA NEWS RELEASES
(Embargoed for Release: 3:00 p.m. CT, Tuesday, July 1, 2008)
JAMA NEWS RELEASES
SINCE INTRODUCTION OF HIGHLY ACTIVE ANTIRETROVIRAL THERAPY, DEATH RATE FOR HIV-INFECTED PERSONS HAS DECREASED
NEWBORNS IN ICUs OFTEN UNDERGO PAINFUL PROCEDURES, MOST WITHOUT PAIN MEDICATION
INVASIVE TREATMENT APPEARS BENEFICIAL FOR MEN AND HIGH-RISK WOMEN WITH CERTAIN TYPE OF ACUTE CORONARY SYNDROMES
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
ROUTINE CARDIAC CATHETERIZATION BENEFITS SOME WOMEN WITH HEART DISEASE MORE THAN OTHERS
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
TV Note: This week's JAMA Video News Report is on the benefit of invasive vs. conservative treatment for patients with a certain type of acute coronary syndromes. The report will be fed Tuesday, July 1, from 9:00 - 9:30 a.m. ET and 2:00 - 2:30 p.m. ET, on Galaxy 26 (formerly Intelsat America 6) C-Band, Transponder 14, downlink frequency: 3880 vertical, audio 6.2/6.8. For more information, call 312/464-JAMA.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, July 1, 2008
Media Advisory: To contact corresponding author Kholoud Porter, Ph.D., email: kp{at}ctu.mrc.ac.uk.
SINCE INTRODUCTION OF HIGHLY ACTIVE ANTIRETROVIRAL THERAPY, DEATH RATE FOR HIV-INFECTED PERSONS HAS DECREASED
CHICAGO—In industrialized countries, persons infected sexually with HIV now appear to experience mortality rates similar to those of the general population in the first 5 years following infection, though a higher risk of death remains as the duration of HIV infection lengthens, according to a study in the July 2 issue of JAMA.
A number of studies have reported the dramatic decreases in mortality among individuals infected with human immunodeficiency virus (HIV) since the widespread introduction of highly active antiretroviral therapy (HAART) in industrialized countries. “It is important to provide up-to-date and robust estimates of expected mortality as anti-HIV drugs and strategies continue to improve. Such estimates help policy makers and those planning health care to monitor the effectiveness of treatments at a population level and provide an indicator of the ongoing and likely future impact of HIV disease on health care needs,” the authors write.
Krishnan Bhaskaran, M.Sc., of the Medical Research Council Clinical Trials Unit, London, and colleagues evaluated changes in the excess mortality of HIV-infected individuals compared with expected mortality in the general uninfected population, adjusting for duration of HIV infection. Mortality following HIV seroconversion (development of antibodies in blood serum as a result of infection) in a large multinational collaboration of HIV seroconverter cohorts (CASCADE) was compared with expected mortality, calculated by applying general population death rates matched on demographic factors. A model was created, adjusted for duration of infection, to assess changes over calendar time in the excess mortality among HIV-infected individuals. Data pooled in September 2007 were analyzed in March 2008, covering years at risk 1981-2006.
Of 16,534 individuals with median (midpoint) duration of follow-up of 6.3 years, a total of 2,571 individuals had died as of December 2006, compared with an estimated 235 deaths that would have been expected in a matched general population cohort. The excess mortality rate per 1,000 person-years (the number of individuals in the study times the number of years of follow-up per person) was 40.8 pre-1996, decreasing in each subsequent calendar period to 6.1 in 2004-2006. By 2004-2006, there was no evidence of any excess mortality to 5 years from seroconversion among those infected sexually. However, in the longer term, some excess mortality was still evident, with the cumulative excess probability of death in the first 10 years from seroconversion estimated to be 4.8 percent in those 15 to 24 years old, and 4.3 percent in those 45 years or older at seroconversion.
“Considering the first years following the widespread introduction of HAART, we have estimated an 88 percent reduction in excess mortality in 2000-2001 compared with pre-1996, corresponding closely to the 87 percent reduction in the standardized mortality ratio in 1997-2001 compared with pre-1996, as reported by the Swiss HIV cohort. Our more recent data show that reductions have continued to 2004-2006, with excess mortality in this period 94 percent lower than pre-1996 levels. Corresponding to these reductions, the uptake of HAART increased, and though this leveled off after 2001, there followed an increasing use of nonnucleoside reverse transcriptase inhibitor-based HAART as the first-line treatment regimen and a substantial increase in the boosting of protease inhibitor-based regimens,” the authors write.
Older age at seroconversion was associated with a higher risk of excess mortality (for age 45 years or older compared with age 15-24 years), as was a reported exposure category of injection drug use (compared with sex between males). Females appeared to be at lower risk than males.
“Our results show the progress in reducing mortality among HIV-infected individuals toward the levels experienced by the general uninfected population. However, there is continuing excess mortality, particularly evident in those infected for 10 years or more. Ongoing monitoring of excess mortality will be important as new treatment advances are implemented in an attempt to further reduce mortality rates among HIV-infected individuals,” the researchers conclude.
(JAMA. 2008;300[1]:51-59. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, July 1, 2008
Media Advisory: To contact Ricardo Carbajal, M.D., Ph.D., email: ricardo.carbajal{at}trs.aphp.fr.
NEWBORNS IN ICUs OFTEN UNDERGO PAINFUL PROCEDURES, MOST WITHOUT PAIN MEDICATION
CHICAGO—An examination of newborn intensive care finds that newborns undergo numerous procedures that are associated with pain and stress, and that many of these procedures are performed without medication or therapy to relieve pain, according to a study in the July 2 issue of JAMA.
“Repeated invasive procedures occur routinely in neonates [a baby, from birth to four weeks] who require intensive care, causing pain at a time when it is developmentally unexpected. Neonates are more sensitive to pain than older infants, children, and adults, and this hypersensitivity is exacerbated in preterm neonates. Multiple lines of evidence suggest that repeated and prolonged pain exposure alters their subsequent pain processing, long-term development, and behavior. It is essential, therefore, to prevent or treat pain in neonates,” the authors write. “Effective strategies to improve pain management in neonates require a better understanding of the epidemiology and management of procedural pain.”
Ricardo Carbajal, M.D., Ph.D., of the Hôpital d'enfants Armand Trousseau, Paris, and colleagues collected data on neonatal pain, based on direct bedside observations in intensive care units (ICUs) in the Paris region. The study, conducted between September 2005 and January 2006, included data on all painful and stressful procedures and corresponding analgesic (a medication used to relieve pain) therapy from the first 14 days of admission collected within a 6-week period from 430 neonates admitted to tertiary care centers. The average gestational age was 33 weeks, and the average intensive care unit stay was 8.4 days.
During the study period, neonates experienced 60,969 first-attempt procedures, with 42,413 (69.6 percent) painful and 18,556 (30.4 percent) stressful procedures; 11,546 supplemental attempts were performed during procedures including 10,366 (89.8 percent) for painful and 1,180 (10.2 percent) for stressful procedures. Examples of painful procedures that were performed include nasal and tracheal aspiration (removal of fluid), heel stick and adhesive removal. The average number of all procedures per neonate was 141 and the average number of procedures per day of hospitalization was 16. Each neonate experienced a median (midpoint) of 115 procedures during the study period and 16 procedures per day of hospitalization. Of these, each neonate experienced a median of 75 painful procedures during the study period and 10 painful procedures per day of hospitalization.
Infants received specific analgesia for a median of 20 percent of the painful procedures performed during the study period. Of the 42,413 painful procedures, 907 (2.1 percent) were performed with pharmacological-only therapy, 7,734 (18.2 percent) with nonpharmacological-only therapy, 164 (0.4 percent) with both, and 33,608 (79.2 percent) without specific preprocedural analgesia.
Further analysis indicated that prematurity, parental presence during procedures, neonates undergoing surgery, daytime performance (7 a.m. to 6 p.m.), and day of hospitalization (2-14 days) were associated with greater use of specific preprocedural analgesia, whereas mechanical ventilation, noninvasive ventilation, and the administration of nonspecific concurrent analgesia were associated with less frequent use of specific preprocedural analgesia.
“Advances in neonatal care in recent decades with increased survival of immature and sick neonates have led to an increased number of invasive procedures that may cause pain in these vulnerable neonates. The prevention of pain in critically ill neonates is not only an ethical obligation, but it also averts immediate and long-term adverse consequences,” the researchers write. “… strategies to reduce the number of procedures in neonates are needed urgently. The American Academy of Pediatrics recently emphasized the need to incorporate a principle of minimizing the number of painful disruptions in neonatal care protocols. Such strategies would aim at bundling interventions, eliminating unnecessary laboratory or radiographic procedures, using transcutaneous measurements when possible, and minimizing the number of procedures performed after failed attempts.”
“The knowledge that some vulnerable neonates underwent 153 tracheal aspirations or 95 heel sticks in a two-week period should elicit a thoughtful and relevant analysis on the necessity and the risk-benefit ratio of our clinical practices.”
(JAMA. 2008;300[1]:60-70. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, July 1, 2008
Media Advisory: To contact Michelle O’Donoghue, M.D., call Kevin Myron at 617-534-1605.
INVASIVE TREATMENT APPEARS BENEFICIAL FOR MEN AND HIGH-RISK WOMEN WITH CERTAIN TYPE OF ACUTE CORONARY SYNDROMES
CHICAGO—An analysis of previous studies indicates that among men and high-risk women with a certain type of heart attack or angina an invasive treatment strategy is associated with reduced risk of rehospitalization, heart attack or death, whereas low-risk women may have an increased risk of heart attack or death with this treatment, according to an article in the July 2 issue of JAMA.
Although an invasive strategy is frequently used in patients with unstable angina and non–ST-segment elevation myocardial infarction (NSTEMI; a type of heart attack with certain findings on an electrocardiogram), data from some trials suggest that this strategy may not benefit women, with a possible higher risk of death or heart attack, according to background information in the article. “Thus, the benefit of an invasive strategy in women remains unclear. However, individual trials have not been large enough to explore outcomes reliably within subgroups,” the authors write.
For this study, an invasive strategy was defined as the referral of all patients with non–ST-segment elevation acute coronary syndromes (NSTE ACS) for coronary angiography followed by revascularization (repeat procedure to unblock a coronary artery) if deemed appropriate. A conservative treatment strategy was defined as a primary strategy of pharmacological management and subsequent coronary angiography reserved only for those patients with recurrent symptoms of unprovoked ischemia or objective evidence of inducible ischemia on noninvasive testing.
Michelle O’Donoghue, M.D., of Brigham and Women’s Hospital and Massachusetts General Hospital, Boston, and colleagues conducted a meta-analysis of randomized trials to examine the benefits and risks of an invasive strategy in women vs. in men with NSTE ACS. Through a review of medical literature, the researchers identified eight randomized trials. Data were combined for these trials, and the incidence of death, myocardial infarction (MI; heart attack), or rehospitalization with ACS (unstable angina or heart attack) were available for 10,150 patients, including 3,075 women and 7,075 men.
Women who received an invasive strategy had a 19 percent lower risk for the composite of death, MI, or ACS, compared to women who received a conservative strategy (21.1 percent vs. 25.0 percent); men had a 27 percent lower risk for the composite of death, MI, or ACS, compared to men who received a conservative strategy (21.2 percent vs. 26.3 percent).
Among high-risk biomarker-positive women, an invasive strategy was associated with a 33 percent lower odds of death, MI, or ACS and a nonsignificant 23 percent lower odds of death or MI. In contrast, an invasive strategy was not associated with a significant reduction in the triple composite end point in biomarker-negative women and was associated with a nonsignificant 35 percent higher odds of death or MI. Among men, the risk for death, MI, or ACS was 44 percent lower if biomarker-positive and 28 percent lower if biomarker-negative.
“Our data provide evidence to support the updated American College of Cardiology/American Heart Association guidelines that now recommend that a conservative strategy be used in low-risk women with NSTE ACS,” the authors write.
“Combination of these data enabled us to explore the association of sex with outcomes both overall and within high-risk subgroups, whereas individual studies may be insufficiently powered in this regard. Future investigations should include novel methods for identifying women at high-risk of adverse outcomes after NSTE ACS and whose risk could be modifiable with an invasive approach.”
(JAMA. 2008;300[1]:71-80. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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JAMA REPORTS
VIDEO: Windows Media | Quicktime
ROUTINE CARDIAC CATHETERIZATION BENEFITS SOME WOMEN WITH HEART DISEASE MORE THAN OTHERS
INTRO:
Heart disease is the number one killer of women each year in the United States. Cardiac catheterization is a routine procedure that allows doctors to find potential blockages in coronary arteries in order to help prevent new heart attacks and even death. A recent study finds that high risk women, who do have a heart attack, benefit from this procedure just as much as men. But for some women the procedure may not always be the best option. Jennifer Mitchell explains in this week’s JAMA Report.
VIDEO:
B-ROLL
Virginia in kitchen
Picture of family
AUDIO:
VIRGINIA DEVLIN SAYS SHE FELT TIGHTNESS IN HER CHEST AND TINGLING IN HER ARM. GIVEN HER STRONG FAMILY HISTORY OF HEART ATTACKS SHE WORRIED SHE MAY BE HAVING ONE TOO.
VIDEO:
SOT/FULL
Super @: 11
Virginia Devlin
Had Cardiac Catheterization
Runs: 08
AUDIO:
“According to the lab studies I didn’t have any real damage to my heart but I had the types of symptoms that would indicate that I was borderline.”
VIDEO:
B-ROLL
Heart images
Pan of artery
File: @ :28 to :33
Shot of stent and OR
Women on street
AUDIO:
THESE ARE IMAGES OF VIRGINIA’S CORONARY ARTERIES. DURING A CARDIAC CATHETERIZATION DOCTORS DETERMINED SHE HAD A PARTIAL BLOCKAGE IN ONE ARTERY. THEY INSERTED A STENT TO CORRECT THE PROBLEM. BUT RESEARCHERS HAVE FOUND THIS INVASIVE PROCEDURE MAY NOT BENEFIT CERTAIN WOMEN.
VIDEO:
SOT/FULL
Super @: 35
Michelle O’Donoghue, M.D.
Brigham and Women’s Hospital
Runs:14
AUDIO:
“High risk women appear to have as much benefit as men. However in contrast and importantly low risk women do not appear to have a substantial benefit from a routine invasive strategy and this strategy may even potentially be harmful.”
VIDEO:
B-ROLL
Doctor walking shot
Doctor at desk
Graphic:
Cardiac Catheterization Study (title)
Women with heart attacks
Benefit comparable to men
Some women: Increased risk
AUDIO:
CARDIOLOGIST MICHELLE O’DONOGHUE LED A TEAM OF RESEARCHERS WHO COMPARED TREATMENT STRATEGIES IN ABOUT TEN THOUSAND MEN AND WOMEN WITH UNSTABLE HEART DISEASE. THEY FOUND WOMEN WHO HAD SUFFERED A HEART ATTACK APPEARED TO BENEFIT JUST AS MUCH AS MEN FOLLOWING ROUTINE CARDIAC CATHETERIZATION. BUT WOMEN WHO EXPERIENCED A NEAR HEART ATTACK, ALSO CALLED UNSTABLE ANGINA, HAD AN INCREASED RISK OF EXPERIENCING A HEART ATTACK OR DEATH AFTER THE PROCEDURE.
VIDEO:
SOT/FULL
Michelle O’Donoghue, M.D.
Brigham and Women’s Hospital
Runs: 11
AUDIO:
“A more conservative strategy would be primarily managing these patients with medicines and then reserving cardiac catheterization only for those patients who either have ongoing symptoms or have a positive stress test before leaving the hospital.”
VIDEO:
B-ROLL
GXF/JAMA COVER
Doctor at desk with heart model
AUDIO:
THE STUDY APPEARS THIS WEEK IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION. RESEARCHERS SAY SEVERAL FACTORS MAY CONTRIBUTE TO THESE FINDINGS, INCLUDING PRE-EXISTING MEDICAL CONDITIONS.
VIDEO:
SOT/FULL
Michelle O’Donoghue, M.D.
Brigham and Women’s Hospital
Runs: 11
AUDIO:
“Women appear to have a higher incidence of diabetes, high blood pressure and high cholesterol when they come into the emergency room that may put them at higher risk of complications after cardiac catheterization.”
VIDEO:
B-ROLL
Virginia at sink
AUDIO:
VIRGINIA IS TRYING HER BEST TO AVOID SUCH CONDITIONS.
VIDEO:
SOT/FULL
Virginia Devlin
Had Cardiac Catheterization
Runs: 07
AUDIO:
AUDIO
“I’m exercising more and I’m eating better than I was so all of those are on the plus side.”
VIDEO:
B-ROLL
Images of heart/arteries
AUDIO:
SHE HOPES IT’S ENOUGH TO KEEP HER HEART HEALTHY. JENNIFER MITCHELL THE JAMA REPORT.
TAG:
Researchers say the findings are consistent with updated guidelines from the American Heart Association and the American College of Cardiology. The guidelines recommend that high risk women should undergo cardiac catheterization but women considered low risk may need further testing such as a stress test to help determine if they would benefit from the procedure. For more information about this study you can log on to www.jama.com.
