Evidence to guide the use of long-acting β2-agonists
in the long-term maintenance management of persistent asthma is limited. In
2 companion trials reported in this issue of THE JOURNAL, patients with persistent
asthma entered a common 6-week run-in period during which they received low-dose
inhaled triamcinolone. Among patients whose asthma was well controlled with
this therapy, Lazarus and colleaguesArticle found that rates of treatment failure
and asthma exacerbation were significantly lower among patients who continued
to receive triamcinolone compared with patients who were changed to salmeterol
monotherapy or to placebo. Patients whose asthma was not well controlled after
the run-in period entered the other trial and received add-on therapy with
salmeterol. Lemanske and colleaguesArticle found that the rate of treatment failure
was not significantly different among patients who underwent a 50% reduction
of triamcinolone dose while continuing salmeterol compared with patients who
did not undergo triamcinolone reduction. But the risk of treatment failure
when patients then discontinued triamcinolone and received salmeterol alone
was 4.3-fold higher than among patients who continued to receive the original
triamcinolone dose. In an editorial, HolgateArticle explains how the combined actions
of inhaled corticosteroids and long-acting β2-agonists may
improve asthma control, but emphasizes the importance of anti-inflammatory
therapy for patients with persistent asthma.
Many hospitals have initiated performance improvement efforts to increase
the use of β-blockers after acute myocardial infarction (MI). In this
qualitative study to identify factors that may influence the success of hospital-based
improvement efforts, Bradley and colleagues conducted in-depth, open-ended
interviews at 8 US hospitals with physician, nursing, quality management,
and administrative staff involved in improving the care of patients with acute
MI. Characteristics that appeared to distinguish hospitals with greater improvements
in β-blocker use over time included the presence of shared goals for
improvement, substantial administrative support, strong physician leadership,
and use of credible data feedback.
Individuals frequently use the Internet as a source for health information.
Berland and colleagues evaluated health information available on the Internet
for 4 conditions—breast cancer, depression, obesity, and childhood asthma—through
English- and Spanish-language search engines. Search engines were only moderately
efficient in locating information on a specific condition. Coverage of key
information was poor and inconsistent, but accuracy was generally good. All
of the English-language sites and most of the Spanish-language sites required
high school level or greater reading ability.
In this Special Communication, Robinson describes the decline of managed
care and the emergence of the health care consumer as the central decision
maker in the US health care system. He discusses possible roles for physicians,
employers, insurers, and government in the future and considers the likely
characteristics of a consumer-driven health care system.
Mrs G had successful outpatient knee surgery, but she was dissatisfied
with her experience because of a change from a short-acting to a longer-acting
anesthetic agent without her knowledge or consent, difficulty with insertion
of an intravenous line, and lack of supervision and assistance while waiting
for transportation home. DaleyArticle discusses dimensions of quality in health care,
particularly service quality. In an editorial, EisenbergArticle encourages patient-centered
care as a way to maintain both technical quality and service quality.
"As a worried mother, and as an inquisitive physician, out of concern
for African and American girls, I wished to consider the condition of women
within the global community." From "I Have a Girl Child."
Current hypotheses about the etiology of chronic fatigue syndrome.
Although experts have concluded that there is no evidence that receiving
the measles-mumps-rubella vaccine leads to autism in children, some members
of Congress and others continue to search for an association.
A survey of Japanese physicians in 2000 showed that the prevalence of
cigarette smoking was 27.1% for men and 6.8% for women. Among current smokers,
smoking prevalence was highest among men aged 40 to 49 years and among women
aged 70 years or older.
For your patients: A guide to using health information resources on
This Week in JAMA . JAMA. 2001;285(20):2545. doi:10.1001/jama.285.20.2545