JAMA : the journal of the American Medical Association
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Treatment results for acute lymphoblastic leukemia (ALL) clearly have improved over the past decade, but black children have not fared as well as white children in large national trials. ⋯ With equal access to effective antileukemic therapy, black and white children with ALL can expect the same high rate of cure.
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The role of race/ethnicity in survival of children with acute lymphoblastic leukemia (ALL) is unclear, with some studies reporting poorer survival among minority children and others reporting equivalent survival across race/ethnicity in the modern, risk-stratified treatment era. ⋯ Black, Hispanic, and American Indian/Alaskan Native children with ALL have worse survival than white and Asian/Pacific Islander children, even in the contemporary treatment era. Future work must delineate the social and biological factors, including any differences in pharmacokinetics associated with chemotherapeutic agents, that account for disparities in outcome.
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Hospital infection control policies that use patient isolation prevent nosocomial transmission of infectious diseases, but may inadvertently lead to patient neglect and errors. ⋯ Compared with controls, patients isolated for infection control precautions experience more preventable adverse events, express greater dissatisfaction with their treatment, and have less documented care.
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There are no definitive recommendations for the management of acute myocardial infarction (AMI) in patients with ST-segment elevation who have contraindications to thrombolytic therapy. It is not clear whether, and the extent to which, immediate mechanical reperfusion (IMR) reduces in-hospital mortality in this population. ⋯ In this population, IMR was associated with a reduced risk of in-hospital mortality after appropriate adjustments. Of those we studied who were eligible for IMR, 15 212 patients (76.4%) did not receive it. These results suggest that using IMR in patients with acute ST-segment elevation AMI and contraindications to thrombolytics should be strongly considered.