In this analysis of data from the National Registry of Myocardial Infarction,
Welch and colleagues found that patients with acute myocardial infarction
(AMI) and normal or nonspecific initial electrocardiograms (ECGs) were at
lower risk for in-hospital death than those with diagnostic initial ECGs.
But the rate of the composite outcome of mortality and life-threatening adverse
events among patients with normal or nonspecific initial ECGs was still unexpectedly
A quality improvement project for the treatment of patients with peptic
ulcer disease (PUD), based on 1994 National Institutes of Health recommendations,
was performed by 5 state peer review organizations in a cohort of Medicare
beneficiaries hospitalized with a diagnosis of PUD. Brock and colleaguesArticle report
that rates of screening for and treatment of Helicobacter
pylori infection increased in all 5 states between 1995 and 1997. Detection
of H pylori infection did not increase, however,
despite increased screening, and treatment of H pylori
infection was not associated with reductions in 1-year rehospitalization for
PUD or all-cause mortality. Screening for and counseling about nonsteroidal
anti-inflammatory drug (NSAID) use did not increase, but counseling about
NSAID use was associated with reductions in both rehospitalization and subsequent
mortality. In an editorial, ButlerArticle and coauthors note that quality improvement
efforts provide information necessary for delivering evidence-based medical
care appropriate for the individual patient.
In 1992, McMaster University Department of Medicine implemented a policy
restricting contact between residents and pharmaceutical company representatives
(PCRs) during daytime hospital activities. In this survey of former McMaster
and University of Toronto trainees, McCormick and colleagues found that physicians
who completed their residencies at McMaster after implementation of this policy
were less likely to find information from PCRs helpful in guiding their practice
than were physicians who completed their training at McMaster before policy
implementation or who trained at the University of Toronto, which never had
such a policy. Current office contact with PCRs was lowest among postpolicy
In a previously published study, Gardin and colleagues found that use
of the anorexigens dexfenfluramine and phentermine/fenfluramine was associated
with increased prevalence of echocardiographic aortic regurgitation. Reevaluation
of patients in this study 1 year after the initial echocardiogram showed no
evidence of progression of aortic regurgitation among those who had used anorexigens
and no differences in other valvular parameters or in new cardiovascular symptoms,
physical findings, or events compared with control patients.
During an evaluation for a persistent dry, hacking cough that developed
after a visit to Bangladesh, Mr Z had a positive PPD skin test result and
normal findings on a chest radiograph. Iseman discusses the uses and limitations
of tuberculin skin testing and the treatment of latent tuberculosis infection.
A review of medications that may affect glucose metabolism: thiazide
diuretics, β-blockers, protease inhibitors, and atypical antipsychotics.
On the 125th anniversary of the founding of the Association of American
Medical Colleges, current president Jordan J. Cohen, MD, recalls the history
and relates future plans of the "Champion of Medical Education."
A review of recent evidence indicates that current tests available for
universal newborn hearing screening can improve identification of newborns
with profound, bilateral permanent hearing loss, but evidence on the effects
of screening or of early identification and treatment on long-term language
outcomes is limited.
For your patients: Information about peptic ulcers.
This Week in JAMA. JAMA. 2001;286(16):1937. doi:10.1001/jama.286.16.1937