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This Week in JAMA
May 23/30, 2001

This Week in JAMA

JAMA. 2001;285(20):2545. doi:10.1001/jama.285.20.2545
Long-Acting β

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.

Success of Hospital Performance Improvement Efforts

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.

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Evaluation of Health Information on the Internet

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.

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The End of Managed Care?

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.

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A 58-Year-Old Woman Dissatisfied With Her Care

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.

A Piece of My Mind

"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."

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Contempo Updates

Current hypotheses about the etiology of chronic fatigue syndrome.

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Medical News & Perspectives

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.

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Smoking Among Japanese Physicians

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.

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JAMA Patient Page

For your patients: A guide to using health information resources on the Internet.

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