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This Week in JAMA
October 24/31, 2001

This Week in JAMA

JAMA. 2001;286(16):1937. doi:10.1001/jama.286.16.1937
Predictive Value of a Normal ECG in Patients With AMI

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 high.

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Peptic Ulcer Disease Quality Improvement Project

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.

Residents and Pharmaceutical Company Reps

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 McMaster trainees.

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Echocardiographic Follow-up After Anorexigen Use

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.

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A 52-Year-Old Man With a Positive PPD

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.

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Contempo Updates

A review of medications that may affect glucose metabolism: thiazide diuretics, β-blockers, protease inhibitors, and atypical antipsychotics.

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Medical News & Perspectives

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."

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Universal Newborn Hearing Screening

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.

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JAMA Patient Page

For your patients: Information about peptic ulcers.

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