What's new in the other general journals

Implantable cardiac devices have substantial failure rate

Pacemakers and implantable cardioverter defibrillators save lives—but only when they work. Although millions of people have these devices, it's hard to say accurately how often they fail and how often the patient's life is at risk when they do. All we know is that malfunction is not a rare event.

After appraising two new papers on the subject (pp 1901-6 and 1929-34), one commentator estimates that about seven in every 1000 pacemakers and about 21 in every 1000 cardioverter defibrillators malfunction badly enough to need replacing. Neither of these estimates included devices that broke down because of faulty leads. Nor did the estimates include people who died as a result of their device malfunctioning. Unreliable reporting means that both estimates are likely to be lower than the real rate, which, for pacemakers at least, seems to be going down. The trend for cardioverter defibrillators looks less predictable.

Information on the safety of these devices is a complex mosaic, the author writes, and many of the pieces are still missing. What, for example, should doctors do when regulators issue a safety warning about a particular model? In a third paper (pp 1907-11), doctors from Canada electively replaced the “faulty” cardioverter defibrillator in about a fifth of their patients, although some replaced none and others replaced 45% (24/53). In 6% (31/533) of patients, the elective replacement caused serious surgical complications, most commonly bleeding and infections. Two patients died.

Calls from a “prevention coach” help women remember cancer screening

Poor US women often miss out on recommended cancer screening services. In an attempt to reach them, researchers trained “prevention coaches” to telephone and motivate women to keep up to date with their cervical screening, mammography, and colorectal cancer screening. The coaches used a partially scripted interview technique to find out why women weren't attending and how any barriers to …