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This Week in JAMA
September 19, 2001

This Week in JAMA

JAMA. 2001;286(11):1277. doi:10.1001/jama.286.11.1277
Detection of Peripheral Arterial Disease in Primary Care

Peripheral arterial disease (PAD) is associated with an increased risk of cardiovascular ischemic events and death and decreased quality of life. Hirsch and colleaguesArticle conducted a screening of older adult patients in a nationwide sample of primary care clinics using Doppler ankle-brachial index measurement to detect PAD. The prevalence of PAD was 29%, and 55% of patients with PAD alone and 35% of patients with PAD and cardiovascular disease were newly diagnosed during the survey. In an editorial, OurielArticle encourages physicians to perform an ankle-brachial index measurement when examining patients at risk for atherosclerosis.

Cost-effectiveness of QI for Depression

In a previously published trial, quality improvement (QI) interventions for treatment of depression implemented in diverse managed primary care practices improved clinical outcomes compared with usual care. In this cost-effectiveness analysis of the quality improvement efforts, Schoenbaum and colleagues found that over a 2-year period, the incremental costs per quality-adjusted life-year relative to usual care were within the range of accepted medical interventions. Patients in the QI groups had fewer days with depression and were employed more days during the study period.

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Continuous vs Intermittent Sibutramine for Obesity

Prior studies have shown that sibutramine hydrochloride is efficacious for the treatment of obesity. In this randomized trial, Wirth and Krause found that mean weight loss was not significantly different among patients assigned to receive continuous sibutramine therapy compared with patients who received intermittent sibutramine therapy. Weight loss in both sibutramine groups was significantly greater than in the placebo group.

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Cervical Length as Predictor of Preterm Birth

Shortened cervical length has been consistently associated with preterm birth. To determine when in gestation this risk factor becomes apparent, Owen and colleagues performed endovaginal sonography of the cervix at 2-week intervals in women with singleton gestations who had previously experienced a spontaneous birth before 32 weeks of gestation. Cervical length of less than 25 mm on the initial sonogram at 16 to 18 weeks of gestation was a significant predictor of spontaneous preterm birth before 35 weeks of gestation. Using the shortest ever observed cervical length on serial evaluations improved the prediction of preterm birth.

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Influence of Age on Care in the Last Year of Life

Expenditures for Medicare beneficiaries in the last year of life have been shown in several previous studies to decrease with increasing age. In this analysis of Medicare data for beneficiaries aged 65 years or older from Massachusetts and California who died in 1996, Levinsky and colleagues found a similar pattern of decreasing expenditures with increasing age for medical care of the elderly in the last year of life. This pattern appears to result largely from a decrease in the use of aggressive care with increasing age.

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A Piece of My Mind

"I am more aware than ever how human beings are spiritual beings—whether or not they are religious—concerned with meaning, hope, relationship and love, suffering, and life's mystery." From "Toward Meaning."

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Medical News & Perspectives

Native American students who participate in Harvard Medical School's Four Directions Summer Research Program are helped toward their goal of becoming physicians and biomedical researchers.

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Validation of TIMI Risk Score

Thrombolysis in Myocardial Infarction (TIMI) Risk Score, a bedside risk assessment tool for patients with ST-elevation myocardial infarction, demonstrated strong prognostic performance in a community-based population of patients with ST-elevation acute coronary syndromes who had been treated with reperfusion therapy.

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Treatment of Chronic Fatigue Syndrome

Cognitive behavioral therapy and graded exercise therapy showed the most beneficial effect in controlled trials of treatments for patients with chronic fatigue syndromeArticle. But overall, the evidence base was limited—a challenge to the chronic fatigue syndrome research communityArticle.

Bereavement Care

Approaches to the care of bereaved patients are illustrated by the experience of Mrs A, a 77-year-old woman widowed for 2 years.

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JAMA Patient Page

For your patients: Information about peripheral arterial disease.

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