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This Week in JAMA
September 18, 2002

This Week in JAMA

JAMA. 2002;288(11):1319. doi:10.1001/jama.288.11.1319
Motor Development Curves for Cerebral Palsy

Information on patterns of motor development of children with cerebral palsy is necessary for prognostic counseling, planning interventions, and judging progress over time, but such information has been limited. Rosenbaum and colleaguesArticle used longitudinal observations of children aged 1 to 13 years with cerebral palsy to create motor development curves that chart the rates and limits of gross motor function by severity of motor impairment. In an editorial, KinsmanArticle discusses how to use this prognostic information when communicating with families of children with cerebral palsy.

Extracorporeal Shock Wave Therapy for Plantar Fasciitis

Many types of treatment are advocated for plantar fasciitis despite limited evidence to support the use of these treatments. Buchbinder and colleagues conducted a randomized controlled trial among patients with ultrasound-proven plantar fasciitis to assess whether ultrasound-guided extracorporeal shock wave therapy given weekly for 3 weeks would reduce pain and improve function 6 and 12 weeks after completion of therapy. Pain and function improved in both the active treatment and placebo groups at 6 and 12 weeks. The degree of improvement was not statistically significantly different between treatment groups for any measured outcome.

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Labor Support by Nurses and Childbirth Outcomes

Evidence from prior trials suggests that continuous labor support during childbirth is associated with improved outcomes, including reduction in the likelihood of cesarean delivery. In this randomized trial, however, Hodnett and colleagues found that the rate of cesarean delivery among women who received continuous labor support by a trained labor support nurse was not statistically significantly different from that among women who received usual care by a nurse who had not received labor support training. Differences in other medical and psychosocial outcomes during labor and delivery, immediately postpartum, and 6 to 8 weeks after childbirth were also not significant.

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In part 1Article of this article, recent evidence on the effectiveness of interventions for primary and secondary stroke prevention is systematically reviewed. Two clinical situations presented in part 2Article illustrate how to apply evidence to individual patients in a process of shared decision making for stroke prevention.

Discontinuation of Antidepressant Therapy: The Patient-Physician Relationship

Current guidelines for treatment of depression recommend continuing antidepressant therapy for at least 4 to 9 months, but many patients receiving antidepressants discontinue medication within 3 months after the start of therapy. Bull and colleagues conducted surveys of patients with depression who recently began taking a selective serotonin reuptake inhibitor and of their prescribing physicians. Most physicians reported usually asking patients to continue using antidepressants for at least 6 months, but only about one third of patients reported being told to use antidepressants for this duration. Patients who reported discussing adverse effects with their physicians and patients with 3 or more follow-up visits were less likely to discontinue taking the initially prescribed antidepressant medication.

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A Piece of My Mind

"While my boss was staying up late trying to perfect a lecture, returning patients' calls, or writing up the latest results of one of his studies, he had been neglecting his administrative chores." From "The Three-Legged Stool."

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Medical News & Perspectives

Contention over whether simian virus 40 causes cancer in humans—and whether humans can transmit it to each other—may veer in a new direction after a reported finding of the virus in sewage samples.

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Evidentiary Standards for Medical Testimony: Health Law and Ethics

Kassirer and Cecil examine inconsistencies in evidentiary standards for medical testimony and discuss ways in which the medical community can participate in strengthening the presentation of medical testimony in court.

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Call for Papers: Depression

Original research on depression, including randomized trials of treatment interventions and studies of epidemiologic, biological, psychosocial, and health services aspects of depression, are invited for a JAMA theme issue scheduled for June 2003.

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JAMA Patient Page

For your patients: Information about birth labor.

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