Recent antibiotic use has been identified as a risk factor for carrying
drug-resistant Streptococcus pneumoniae. In this
randomized clinical trial, Schrag and colleagues found that the risk of penicillin-nonsusceptible S pneumoniae carriage assessed in nasopharyngeal specimens
was significantly lower 28 days after the start of treatment among children
who received a 5-day course of high-dose amoxicillin (90 mg/kg per day) for
respiratory tract illness compared with those who received a standard 10-day
course of amoxicillin (40 mg/kg per day).
Current National Osteoporosis Foundation (NOF) guidelines to select
women for bone mineral density (BMD) screening are broad and may include a
substantial number of women at low risk of osteoporotic fracture. Using data
from the Canadian Multicentre Osteoporosis Study, Cadarette and colleagues
compared the diagnostic properties of the NOF recommendations with those of
4 clinical decision rules to select women for dual-energy x-ray absorptiometry
testing. Two of the decision rules, the Simple Calculated Osteoporosis Risk
Estimation and the Osteoporosis Risk Assessment Instrument, were better than
the NOF guidelines at targeting testing of women at high risk of low BMD.
Preliminary evidence suggests that HMG-CoA reductase inhibitors (statins)
may have direct anti-inflammatory effects independent of their lipid-lowering
properties. In this community-based study to assess the anti-inflammatory
effects of pravastatin, Albert and colleaguesArticle found that among adults with
no prior history of cardiovascular disease, those randomized to receive pravastatin
had significant reductions in C-reactive protein (CRP) levels after 12 and
24 weeks of therapy compared with those who received placebo. The reduction
in CRP levels was not related to pravastatin-induced changes in low-density
lipoprotein cholesterol levels. Similar reductions in CRP levels also were
found in a parallel open-label cohort study among adults with known cardiovascular
disease. In an editorial, SimpsonArticle places the results of this study in context
with other research on CRP and atherosclerosis.
Rates of organ donation are far below the need for organ transplantation,
and the percentage of families of donor-eligible patients that consent to
transplantation is low. To identify factors associated with the decision of
a family to donate or not to donate a family member's organs for transplantation,
Siminoff and colleagues conducted chart reviews and interviews with health
care practitioners, organ procurement organization (OPO) staff, and families
of 420 donor-eligible patients at 9 trauma hospitals between 1994 and 1999.
Many factors were associated with the donation decision, including sociodemographic
and attitudinal characteristics, prior knowledge of the patient's wishes,
conversations with the family about organ donation, contact with OPO staff,
and the quality of the request pattern.
Abciximab, a potent inhibitor of the platelet glycoprotein IIb/IIIa
receptor, is used to reduce the risk of thrombotic complications for patients
undergoing percutaneous coronary intervention (PCI). Akkerhuis and colleagues
analyzed data from 4 large clinical trials and found that abciximab in addition
to heparin and aspirin does not increase the risk of hemorrhagic or nonhemorrhagic
stroke in patients undergoing PCI.
"I . . . walk through the park toward the train station and there is
Brave up ahead, alone, standing apart, keeping his distance from the many
small clusters of men, mostly men, who gather here every night to park their
shopping carts and sleeping rolls, to smoke, swap stories and other things."
From "Brave, Waiting for Pasteur."
At the World Health Assembly in Geneva in June, some of the high-priority
issues discussed included HIV/AIDS, leprosy, the WHO policy on medicines,
and recommendations for feeding infants and young children.
Features of current physician antitrust exemption initiatives at the
state and federal levels and an analysis of the potential impact of physician
antitrust exemption legislation on the balance of power between physicians
and managed care plans.
Policies of THE JOURNAL on reporting authors' financial interests and
relationships between investigators and research sponsors.
For your patients: Information about organ donation.
This Week in JAMA. JAMA. 2001;286(1):9. doi:10.1001/jama.286.1.9