Optimal pharmacologic strategiesArticle for preventing coronary heart disease
continue to evolve rapidly, as illustrated by AFCAPS/TexCAPS. This randomized
controlled trial demonstrates that lipid-lowering therapy reduces acute major
coronary events in low-risk patients with average to mildly elevated total
and low-density lipoprotein cholesterol levels.
See related commentary Article
Despite changes in the organization and delivery of medical care, 2
traditional indices find that prenatal care utilization has remained relatively
stable. However, 2 new indices, based on American College of Obstetricians
and Gynecologists' recommendations, include a more-than-recommended-care category.
Applying these measures to US births between 1981 and 1995, Dr Kogan and colleagues
foundArticle an increase in prenatal care utilization, especially intensive use.
See related editorial Article
Dr Klassen and colleagues studied which of 3 glucocorticoid regimens
was most effective in children aged 3 months to 5 years with mild-to-moderate
croup. In this randomized controlled trial, they found no difference in change
in croup score among oral dexamethasone, nebulized budesonide, or oral dexamethasone
with nebulized budesonide. They suggest that oral dexamethasone alone is the
preferred regimen because it is less expensive and easier to administer.
People are less likely to die in fires if their residences have working
smoke detectors. However, these devices have been presumed to be less effective
for people who are too young, too incapacitated, or too intoxicated to respond
appropriately to the alarm. Dr Marshall and colleagues found the risk of death
in a residential fire is reduced even among these groups and show that smoke
detectors are most effective when a rescuer is available to assist vulnerable
Clinical performance and outcome reports cards are popular among health
care managers and public policy experts, but patients seem to pay scant attention.
Drs Schneider and Epstein found that in 1996 in Pennsylvania, a state that
issues comparative reports on mortality for coronary artery bypass grafts,
just 12% of patients undergoing the procedure even knew of the existence of
such information before surgery. And fewer than 1% knew how their surgeon
and hospital ranked and said it affected their selection process.
Unwanted pregnancy is a common concern among women aged 40 to 45 years.
The patient in this Clinical Crossroads, Mrs B, has had 3 healthy children
and is faced with deciding the best way to prevent future pregnancies. Dr
Peterson discusses preventing unwanted pregnancy and patients' options for
"Undulating hills of an almost tropical green and great, puffy clouds
sailing across a blue sky . . ." Hayley Lever, Midday in
the Harbor, c 1917, American.
Will "cosmeceuticals" keep baby boomers blooming? The safety and efficacy
of cosmetics said to have druglike effects—but unregulated by the FDA—concern
Critically ill patients at risk—a systematic review of 10 years
of studies on risk factors for ICU-acquired pneumonia.
"I think the decline in gift giving by patients results from a feeling
of distance from their physicians, which paradoxically has been bred by familiarity."
From "The Ungifted Physician."
This week's topic: prenatal care.
This Week in JAMA. JAMA. 1998;279(20):1593. doi:10.1001/jama.279.20.1593