A 1-year hospital-wide program severely restricting all cephalosporin
use was associated with a significant decrease in the incidence of cephalosporin-resistant Klebsiella infection and colonization compared with the
prior year. But, report Rahal and colleaguesArticle, the increased use of imipenem-cilastin
during the study period was associated with an increase in incidence of imipenem-resistant Pseudomonas aeruginosa. In an editorial, BurkeArticle comments
that optimal antibiotic use based on individual patient information might
achieve heterogeneity of antibiotic use, reduce unnecessary use, and help
stabilize antibiotic resistance.
Olds and colleaguesArticle found that adolescents from high-risk families who
participated in a prenatal and early childhood nurse home visitation program
had a significantly lower incidence of serious antisocial behavior and substance
use in a 15-year follow-up study compared with adolescents from families who
received routine care. In an editorial, EarlsArticle discusses the effects of early
intervention on developmental pathways and policy considerations for intervention
In a 10-year retrospective study of more than 1000 autopsies, Burton
and colleaguesArticle found that malignancies were either undiagnosed or misdiagnosed
in 100 patients and were directly related to the immediate cause of death
in 57 of these patients. The 44% discordance rate between clinical and autopsy
diagnoses of malignancies is comparable to that in similar studies published
in 1923 and 1972. In an editorial emphasizing the importance of autopsies
for quality of care, LundbergArticle proposes, in response to a sharp decline in
autopsy rates, that Medicare participation and hospital accreditation be tied
to mandatory rates of autopsy examinations.
A computerized drug utilization review program at 13 mail-service pharmacy
sites designed to improve prescribing for elderly patients generated more
than 40,000 alerts for potentially inappropriate medications in 1 year. Monane
and colleagues report that pharmacists were able to contact about half of
the prescribing physicians by telephone following an alert. The rate of medication
change after telephone discussion was 24% compared with an expected 2% rate
In a mail survey of 4 US academic training programs, Christie and coworkers
found that over half of internal medicine residents who used prescription
medications during their residency reported prescribing medications for their
own use. Residents often obtained prescription medications from the drug sample
closet and occasionally from pharmaceutical company representatives.
In this Rational Clinical Examination article, Panju and colleagues
summarize the clinical and ECG findings most likely to be predictive of myocardial
infarction in patients with acute chest pain and highlight the importance
of identifying patients with ischemic cardiac conditions associated with a
high risk of complications.
". . . which nearly out-baroques the Baroque." Michiel van Musscher, Portrait of an Artist in Her Studio, c 1680-1685, Dutch.
US-funded AIDS research is intensifying vaccine efforts and prevention
studies. The new director of the Office of AIDS Research describes his priorities.
"Living with a disease on a daily basis cannot be learned from a textbook
or in a busy clinic." From "Call of the Loon."
An analysis of data from public opinion polls on tobacco regulation
explains in part the recent failure to pass comprehensive tobacco legislation
and identifies factors likely to improve the success of future legislation.
For your patients: Understanding antibiotic resistance.
This Week in JAMA. JAMA. 1998;280(14):1209. doi:10.1001/jama.280.14.1209