Evidence, especially from observational studies, suggests that initiation
of lipid-lowering therapy with statins within a few days of an acute coronary
syndrome (ACS) event is associated with improved outcomes. However, in this
analysis of outcomes of patients with acute coronary syndrome in 2 randomized
trials comparing aspirin and sibrafiban according to concomitant statin use,
Newby and colleaguesArticle found no association between early initiation of statin
therapy and improved outcomes at 90 days or mortality at 1 year. In an editorial,
Michels and BraunwaldXREF IDREF="JED20025"> evaluate existing data from observational studies and
randomized trials on early initiation of statins for secondary prevention
of cardiovascular disease.
Inappropriate use of antibiotics has contributed to the development
of antimicrobial resistance. From 1980 through 1992, annual rates of antimicrobial
prescribing for children by office-based physicians increased. In contrast,
based on data from the National Ambulatory Medical Care Survey for 2-year
intervals from 1989-1990 through 1999-2000, McCaig and colleaguesArticle found that
the population-based and visit-based rates of antimicrobial prescribing by
office-based physicians for children and adolescents overall and for respiratory
tract infections have decreased significantly. Perz and colleaguesArticle conducted
a community-wide educational intervention directed toward health care practitioners,
parents of young children, and the public to reduce antibiotic use among children
in Knox County, Tennessee, which has very high levels of antibiotic resistance
among invasive Streptococcus pneumoniae. Compared
with antibiotic prescription rates in the preintervention year, rates in the
postintervention year decreased 19% among children in Knox County and 8% in
3 other major urban counties in Tennessee (control counties), yielding a statistically
significant intervention-attributable decline of 11%. In an editorial, PichicheroArticle
considers factors that affect antibiotic prescribing and discusses key points
to guide appropriate antibiotic use.
Some studies have found an association between vasectomy and increased
risk of prostate cancer, but evidence has been inconsistent. Cox and colleagues
conducted a national population-based case-control study using data from the
New Zealand Cancer Registry to identify cases of prostate cancer among men
aged 40 to 74 years. They found no association between vasectomy and risk
of prostate cancer even 25 years or more after vasectomy.
In part 1 of this 2-part article on vitamins, Fairfield and FletcherArticle
review the biological effects, food sources, deficiency syndromes, and potential
for toxicity of clinically important vitamins and evaluate evidence on the
relationship between vitamin intake and chronic diseases. In part 2Article, the authors
discuss risk of chronic diseases associated with suboptimal levels of vitamins—levels
above those that cause classic vitamin deficiency syndromes—and recommendations
for vitamin supplementation.
"This morning I saw a mismatch between the tools and systems in use
at medicine's front door and the tools and systems needed to achieve a high-octane,
high-performance health care system." From "First Morning Back."
Reports at the American Society of Clinical Oncology meeting describe
an expanded role for a drug that targets a molecular glitch in leukemia cells
and possible strategies for reducing cancer risk in people predisposed to
malignancies such as lung, breast, and ovarian cancers.
In a content analysis of newspaper and television stories reporting
on events related to mammography and tamoxifen for primary prevention of breast
cancer, attitude toward the preventive strategy, level of uncertainty about
benefit, and how benefits and harms were presented differed for the 2 preventive
A study examining changes in mood state and empathy in a cohort of internal
medicine residents during internship launches a new JAMA section of research
articles on issues in graduate medical education edited by a panel of resident
For your patients: A primer on vitamins.
This Week in JAMA. JAMA. 2002;287(23):3043. doi:10.1001/jama.287.23.3043