A single course of antenatal corticosteroids for women at risk for preterm
delivery has been shown to reduce the incidence of neonatal complications
associated with preterm birth. In clinical practice, however, repeated weekly
courses of antenatal corticosteroids are often used despite the lack of evidence
on the efficacy of this therapy and some indication that weekly administration
is associated with adverse effects on infant growth and development. In this
randomized trial, Guinn and colleaguesArticle found that weekly courses of antenatal
corticosteroids for women at risk for preterm delivery did not reduce neonatal
morbidity compared with a single course. In an editorial, LawsonArticle identifies
important areas of future research on the antenatal use of corticosteroids.
Graduated driver licensing (GDL) systems, which have been adopted in
many states in the United States, limit initial driving privileges for teenage
drivers to low-risk conditions. Two studies in this issue—one by Foss
and colleaguesArticle on the North Carolina GDL system and the other by Shope and
colleaguesArticle on the Michigan system—found that motor vehicle crashes among
16-year-old drivers were substantially reduced after implementation of GDL
systems. In an editorial, McCarttArticle considers which elements of GDL systems
reduce the risk of motor vehicle crashes among teenage drivers.
Intermittent claudication is considered a classic symptom of peripheral
arterial disease (PAD). In this study of clinical characteristics and functional
limitations associated with PAD, McDermott and colleagues found that leg symptoms
other than intermittent claudication commonly occur in patients with PAD and
are also associated with serious functional impairment.
Cisapride, an agent for the treatment of gastroesophageal reflux disease,
was removed from the market because of serious cardiac arrhythmias and deaths
associated with its use in combination with other drugs. Drug label changes
and physician notification letters issued before removal of cisapride identified
drugs that interact with cisapride and predispose to adverse reactions if
coadministered. Jones and colleagues report that when a cisapride prescription
overlapped with a contraindicated drug, 89% were dispensed in the same pharmacies,
50% were prescribed by the same physicians, and 17% were dispensed on the
How to assess whether a patient with knee complaints has a torn meniscus
or ligament injury.
As deadlines draw near for implementation of the Health Insurance Portability
and Accountability Act, experts consider how to comply with this federal legislation.
Ziegelstein discusses the case of a 56-year-old man with symptoms of
depression after experiencing a first myocardial infarction (MI) and the possible
association between post-MI depression and increased mortality risk.
Genetic information and disease prevention.
For your patients: Information about teenage drivers and automobile
This Week in JAMA. JAMA. 2001;286(13):1545. doi:10.1001/jama.286.13.1545