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This Week in JAMA
February 9, 2000

This Week in JAMA

JAMA. 2000;283(6):707. doi:10.1001/jama.283.6.707
Critical Pathway for Treatment of Pneumonia

Critical pathways define the essential steps of complex clinical management processes. Marrie and colleagues report that at 9 hospitals randomly assigned to use a critical pathway for treatment of patients with community-acquired pneumonia, admission of low-risk patients was reduced 18% and the number of bed days per patient managed was reduced 1.7 days compared with 10 hospitals assigned to conventional management. Health-related quality of life scores 6 weeks after treatment and the rate of complications, readmissions, and mortality were similar in both hospital groups.

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Development of Children of Women With PKU

The risk of developmental problems among offspring of women with phenylketonuria (PKU) may be reduced if metabolic control (plasma phenylalanine level ≤10 mg/dL [ ≤605 µmol/L]) is achieved prior to or early in pregnancy. In a group of 149 children of women with PKU, Waisbren and colleagues found that scores on McCarthy Scales of Children's Abilities at age 4 years were highest among children of women who attained metabolic control prior to pregnancy and decreased as the number of weeks to achieve metabolic control during pregnancy increased. In logistic regression analyses, factors that best predicted a score on the General Cognitive Index of the McCarthy Scales of 1 SD or more below the normative mean included low maternal IQ, a maternal plasma phenylalanine level greater than 20 mg/dL (1210 µmol/L) when on an unrestricted diet, delayed maternal metabolic control during pregnancy, and a low score on a measure of home environmental stimulation.

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Treatment of Weight Loss in Men Infected With HIV

Weight loss complicating human immunodeficiency virus (HIV) infection in men has been associated with low testosterone levels and increased morbidity and mortality. In this placebo-controlled trial, Bhasin and colleagues randomly assigned 61 men with HIV infection, moderate weight loss, and low serum testosterone levels to receive placebo, testosterone supplementation, resistance exercise and placebo, or testosterone combined with resistance exercise. After 16 weeks, testosterone supplementation and resistance exercise were each associated with significant increases in muscle strength, thigh muscle volume, and body weight compared with baseline, but testosterone combined with resistance exercise was not associated with greater increases than either intervention alone.

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Medical Textbooks Weak in End-of-Life Care

To assess how well medical textbooks cover end-of-life care, Rabow and colleagues estimated the quantity of information on care for patients at the end of life in 50 textbooks from multiple specialties and rated the usefulness of the information in 13 content domains. Overall, information was rated helpful in 24.1% of the expected end-of-life content domains, minimal in 19.1% of the domains, and absent in 56.9% of the domains. The content domains that were covered the least well were social, spiritual, ethical, and family issues, and physician responsibilities after a patient's death. Twenty-four of the 50 texts listed chapters on topics related to end-of-life care in the table of contents and the percentage of total textbook pages with end-of-life care key words listed in the index ranged from 0% to 12%.

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Out-of-Hospital Intubation of Critically Ill Children

In this controlled trial comparing endotracheal intubation with bag-valve-mask ventilation for out-of-hospital airway management by paramedics of critically ill patients aged 12 years or younger, Gausche and colleaguesArticle found no significant difference in the rate of survival to hospital discharge or the rate of achieving a good neurological outcome between the 2 treatment groups. In an editorial, GlaeserArticle considers factors that may have influenced these findings and discusses the implications of the results.

Contempo Updates

New therapies for acute and chronic wounds.

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Medical News & Perspectives

Institutional review boards are meeting the challenge to change with warnings from the federal government and guidance from their own membership associations.

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Oral Androstenedione and Sex Steroid Levels

Testosterone and estrogen levels in healthy young men after oral administration of androstenedione.

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Time to Address Genital Herpes

Recently approved type-specific serologic tests for herpes simplex virus offer a new opportunity to address the high proportion of unrecognized genital herpes simplex virus 2 infections.

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Ethical Use of Personal Health Information

An analysis of the use of personal health information in pharmacy benefits management programs highlights concerns about the pending federal regulations on standards for privacy of individually identifiable health information.

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JAMA Patient Page

For your patients: A primer on pneumonia.

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MSJAMA ONLINE

Part II of "Why Aren't There More Women Surgeons?" an interview with 3 women with careers in surgery, and a bibliography from the Women Physician's Health Study, the first large, national study of US women physicians.

www.msjama.org

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