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This Week in JAMA
January 15, 2003

This Week in JAMA

JAMA. 2003;289(3):263. doi:10.1001/jama.289.3.263
Change in Quality of Care for Medicare Beneficiaries

In 2000, Jencks and colleaguesArticle reported national- and state-level performance data on Medicare Quality Improvement Organization indicators of the quality of care delivered to fee-for-service Medicare beneficiaries in 1998-1999. The indicators measure delivery of services that evidence has shown to be effective in preventing or treating breast cancer, diabetes, myocardial infarction, heart failure, pneumonia, and stroke. In this report of follow-up data on care given in 2000-2001, Jencks and colleagues found that the performance of the median state and the weighted national average improved on 20 of 22 indicators. The percentage of patients receiving appropriate care on the median indicator in the median state increased from 69.5% to 73.4%, but performance continued to vary widely across states and by indicator. Relative rankings among states changed little. In an editorial, HsiaArticle discusses opportunities suggested by the quality literature to improve the quality of health care.

Cost-effectiveness of Helical CT Lung Cancer Screening

Helical computed tomography (CT) scanning to screen for lung cancer is being promoted to physicians and patients despite the lack of evidence supporting its use. In this decision and cost-effectiveness analysis of lung cancer screening with helical CT in a hypothetical cohort of 60-year-old adults who are current, quitting, and former heavy smokers, Mahadevia and colleaguesArticle concluded that lung cancer screening with helical CT is unlikely to be highly cost-effective for most heavy smokers without substantial reductions in lung cancer mortality, high rates of adherence, lower rates of overdiagnosis, and lower costs per screening test. In an editorial, Grann and NeugutArticle discuss limitations of cost-effectiveness analysis but still advise caution about accepting the use of helical CT scanning to screen for lung cancer until more data are available.

Effect of Exercise on Body Fat After Menopause

Irwin and colleagues examined the effects of a moderate-intensity exercise intervention on total and intra-abdominal body fat in overweight, sedentary, postmenopausal women using data from the Physical Activity for Total Health study, a randomized trial assessing the effects of exercise on breast cancer biomarkers. After 12 months, reductions in body weight and total, intra-abdominal, and subcutaneous abdominal body fat were greater in the exercise group than in the stretching control group. Body fat loss increased significantly with increasing duration of exercise.

Public Knowledge of Stroke Warning Signs and Risks

Effective acute stroke therapy depends in large part on prompt recognition of stroke symptoms and rapid access to emergency medical care. In this population-based survey of adults in the greater Cincinnati region, a follow-up to a similar survey conducted in 1995, Schneider and colleagues found that public knowledge of stroke warning signs improved significantly from 1995 to 2000, but knowledge of stroke risk factors did not improve. Groups of individuals at highest risk of stroke were the least knowledgeable about warning signs and risk factors.

A Piece of My Mind

"She had been his cardiologist. Now she was his doctor." From "Convictions."

Medical News & Perspectives

Guidance is now available from several sources for physicians faced with providing prophylaxis for patients, other than health care workers, who have been potentially exposed to HIV.

Low-Molecular-Weight Heparins for ACS

Clinical Cardiology

A systematic review of studies on the efficacy and safety of low-molecular-weight heparins compared with unfractionated heparin for the management of acute coronary syndromes (ACS) and as an adjunct to percutaneous coronary intervention.

Clinician's corner

The Rational Clinical Examination

Assessment of the precision and accuracy of the clinical examination for diagnosing Parkinson disease.

JAMA Patient Page

For your patients: Information about lung cancer.