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This Week in JAMA
December 13, 2000

This Week in JAMA

JAMA. 2000;284(22):2835. doi:10.1001/jama.284.22.2835
Home-Based Primary Care After Hospital Discharge

The Veterans Affairs (VA) Team-Managed Home-Based Primary Care (TM/HBPC) program is a complex model of home-based health care that includes a primary care manager, 24-hour contact for patients, prior approval of hospital admissions, and HBPC team participation in hospital discharge planning. In this multisite randomized trial among 1966 patients with 2 or more activities of daily living impairments or a terminal illness, congestive heart failure, or chronic obstructive pulmonary disease, Hughes and colleagues found that functional status outcomes of patients assigned to receive TM/HBPC after hospital discharge did not differ significantly from those of patients who received customary VA and private sector care. Improvement in most health-related quality of life measures among patients with terminal illness was greater in the TM/HBPC group, satisfaction with care among patients who were not terminally ill was higher, caregiver outcomes were generally better, and hospital readmissions at 6 months were reduced, but not at 12 months. The total mean per person costs were 6.8% higher in the TM/HBPC group at 6 months and 12.1% higher at 12 months compared with standard care.

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Prepublication Dissemination of Clinical Trial Results

The National Institutes of Health issued clinical alerts reporting the results of 2 carotid endarterectomy clinical trials, the North American Symptomatic Carotid Endarterectomy Trial and the Asymptomatic Carotid Atherosclerosis Study, prior to their publication in peer-reviewed journals. Gross and colleaguesArticle found that the monthly carotid endarterectomy rates increased promptly and substantially after dissemination of the clinical alerts, but the changes in practice were applied to patients and in clinical settings not supported by the trial results. In editorials, Fontanarosa and FlanaginArticle discuss issues surrounding prepublication release of medical research, and with DeAngelisArticle, outline policies of THE JOURNAL regarding release of scientific information to the public.

TB Among Foreign-Born Persons in the United States

In the United States, the number of reported cases of tuberculosis (TB) has decreased since 1992, but this decline has occurred only among persons born in the United States. Talbot and colleagues report that between 1993 and 1998, the number of TB cases among foreign-born persons increased 2.6%, and the proportion of US cases that were foreign-born increased from 29.8% to 41.6%. The TB case rate was 32.9 per 100,000 population in foreign-born persons and 5.8 per 100,000 in US-born persons. Six states—California, New York, Texas, Florida, New Jersey, and Illinois—reported 73.4% of foreign-born cases.

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Short-term Prognosis After Transient Ischemic Attack

Transient ischemic attack (TIA) is difficult to diagnose with certainty, and the management of patients with suspected TIA varies widely. Johnston and colleagues studied 1707 patients, mean age 72 years, with an emergency department diagnosis of TIA. During the 90 days after the index TIA, stroke occurred in 180 persons, 91 within the first 2 days; and stroke or other adverse events occurred in 428 patients. Risk factors independently associated with stroke included age older than 60 years, diabetes mellitus, symptom duration greater than 10 minutes, weakness, and speech impairment.

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Terminal Illness and Desire for a Hastened Death

Understanding why some patients with terminal illness desire a hastened death is important to the practice of palliative care and to informed policy on physician-assisted suicide. Among 92 patients terminally ill with cancer, Breitbart and colleagues classified 16 patients (17%) as having a high desire for hastened death based on the self-report Schedule of Attitudes Toward Hastened Death. Depression and hopelessness were significant independent predictors of the desire for hastened death.

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A Piece of My Mind

"Perhaps more than anything, it is the difference in tone between the modern and ancient oaths that makes the greatest impression on me." From "Revisiting Hippocrates: Does an Oath Really Matter?"

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Contempo Updates

Advances in the prevention and treatment of influenza.

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Medical News & Perspectives

Researchers search for genes involved in human memory by studying the cognitive abilities of Drosophila.

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The Rational Clinical Examination

How to identify patients with sore throat who are likely to have group A β-hemolytic streptococcal pharyngitis.

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Living Organ Donors

Guidelines from the Live Organ Donor Consensus Group to ensure the welfare of living organ donors.

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New JAMA Column for Resident Physicians

Applications for the advisory board for the new resident physician column are requested from resident physicians, fellows, and fourth-year medical students.

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JAMA Patient Page

For your patients: Information about strep throat.

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