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This Week in JAMA
February 17, 1999

This Week in JAMA

JAMA. 1999;281(7):589. doi:10.1001/jama.281.7.589
Comprehensive Posthospital Care Improves Outcomes

Extending their earlier work, Naylor and colleaguesArticle examined the effectiveness of comprehensive discharge planning and home care by advanced practice nurses for elderly patients at high risk of poor outcomes after hospital discharge. Patients in the intervention group were much less likely to be rehospitalized during the 6-month study follow-up and had a longer time to first readmission than patients who received routine discharge planning and home care. In an editorial, BolingArticle highlights essential features of postacute care management.

Missed Cases of Abusive Head Trauma in Children

In this retrospective medical record review, Jenny and colleaguesArticle found that physicians initially failed to recognize 54 (31.2%) of 173 cases of abusive head trauma in children younger than 3 years. Compared with children in whom abusive head trauma was recognized, children in whom the diagnosis was missed were younger and more were white, from intact families, and presented with milder, nonspecific symptoms. Reinjury and medical complications were attributed to the delay in diagnosis in 27.8% and 40.7% of missed cases of abusive head trauma, respectively. In an editorial, LeventhalArticle identifies factors that interfere with diagnostic reasoning and impair recognition of child abuse.

Marked Geographic Variation in Therapy for Acute MI

O'Connor and coworkers studied the use of 7 therapies, identified by expert consensus as quality indicators for the treatment of acute myocardial infarction (MI), in Medicare beneficiaries hospitalized with first MI. Marked geographic variation in use of most of the therapies was observed. For example, the rate of reperfusion using thrombolytic therapy or coronary angioplasty ranged from 33.0% to 93.3% of patients determined to be ideal candidates for this treatment (Figure 1).

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Pulse Pressure Predicts CHF in Elderly

Pulse pressure, the difference between systolic blood pressure and diastolic blood pressure, increases with age as a result of arterial stiffening. Chae and colleagues report that pulse pressure was an independent predictor of congestive heart failure (CHF) in a cohort of 1621 community-based elderly individuals followed up prospectively for almost 4 years. The risk of congestive heart failure among patients in the highest tertile of pulse pressure was 55% higher than the risk in the lowest tertile.

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Physicians Detect Thinner Melanomas

In primary cutaneous melanoma, thinner lesions are associated with better patient survival. Epstein and colleagues interviewed patients with newly detected melanoma to determine who first detected the lesion and to investigate the relationship between patterns of detection and tumor thickness. Lesions detected by physicians were thinner than those detected by patients or other nonphysicians, and physician-detected lesions were more likely to undergo biopsy within a month of detection.

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Web resources for surgical information.

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Medical News & Perspectives

The first doctoral program of its kind, at the University of Illinois at Chicago, teaches physicians how to treat disabled people and about the emerging culture of disability.

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Special Communication

Analysis of variable and fixed costs of a large urban teaching hospital and implications for cost-saving strategies.

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Clinical Cardiology

Hypertrophic cardiomyopathy mortality rates reported by tertiary referral centers may overestimate the true mortality risk associated with this disease.

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Policy Perspectives

How to provide high-quality service in health care: lessons from other service industries.

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JAMA Patient Page

For your patients: A primer on skin cancer.

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