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This Week in JAMA
June 19, 2002

This Week in JAMA

JAMA. 2002;287(23):3043. doi:10.1001/jama.287.23.3043
Early Initiation of Statin Therapy After ACS

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.

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Pediatric Antimicrobial Prescribing

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.

Vasectomy and Risk of Prostate Cancer

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.

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CLINICIAN'S CORNER

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.

A Piece of My Mind

"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."

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Medical News & Perspectives

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.

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Breast Cancer Prevention in the News

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 strategies.

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On Call: Issues in Graduate Medical Education

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 physicians.

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JAMA Patient Page

For your patients: A primer on vitamins.

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