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This Week in JAMA
February 12, 2003

This Week in JAMA

JAMA. 2003;289(6):663. doi:10.1001/jama.289.6.663
Cognitive Function of VLBW Infants Over Time

Recent evidence suggests that cognitive performance of preterm infants may improve throughout early and middle childhood. Ment and colleaguesArticle conducted serial evaluations of cognitive and verbal skills of very low-birth-weight infants who had participated in a randomized trial of intraventricular hemorrhage prevention. Most of the children had improvement in receptive verbal ability and IQ test scores from 36 through 96 months of corrected age. Children with early-onset intraventricular hemorrhage and subsequent serious central nervous system injury, however, had low receptive verbal ability scores that declined over time. In an editorial, AylwardArticle suggests that future research on outcomes of prematurity should consider both biological and environmental risks and include longer term follow-up and a broader range of functions and practical outcomes.

β-Blockers, Cardiac Resynchronization for Heart Failure

β-Blockers have been shown to improve heart failure outcomes, but concern about risks associated with initiation of β-blocker therapy in patients with heart failure and decreased left ventricular function may result in their underutilization. Krum and colleaguesArticle analyzed data from the first 8 weeks of treatment in the COPERNICUS study, a randomized trial of carvedilol for patients with severe heart failure in which the risk of death was significantly lower in the carvedilol group than in the placebo group after a mean follow-up of 10 months. Rates of death, hospitalization, or study drug withdrawal during initiation of therapy were not significantly different from those observed during the entire trial. In a meta-analysis of trials of cardiac resynchronization for treatment of progressive heart failure, also reported in this issue of THE JOURNAL, Bradley and colleaguesArticle found that heart failure mortality during 3 to 6 months of follow-up was significantly reduced among patients who received cardiac resynchronization compared with controls. In an editorial, PinskiArticle discusses clinical evidence supporting the use of these therapies for severe heart failure.

Predictors of Broad-Spectrum Antibiotic Prescribing

Broad-spectrum antibiotics are frequently prescribed for acute respiratory tract infections (ARTIs), including ARTIs for which antibiotics are not indicated at all, such as the common cold and uncomplicated acute bronchitis. In this analysis of data from the National Ambulatory Medical Care Survey between 1997 and 1999, Steinman and colleagues found that antibiotics were prescribed to 63% of patients with ARTIs, and 54% of prescriptions for ARTIs were for broad-spectrum antibiotics. Internal medicine specialists were more likely than general or family physicians to prescribe a broad-spectrum antibiotic, and rates of broad-spectrum antibiotic prescribing were higher in the northeastern and southern United States compared with the West. Patient factors associated with lower rates of broad-spectrum antibiotic prescribing included black race, lack of health insurance, and health maintenance organization membership.

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Contamination of Blood Cultures

A positive blood culture result is the criterion standard for identifying children with bacteremia, but false-positive blood culture results are common. Norberg and colleagues compared contamination rates of blood culture specimens obtained in a children's hospital emergency department that were drawn through a newly inserted intravenous catheter with contamination rates of blood culture specimens drawn from a separate and dedicated venipuncture site. Contamination rates of blood culture specimens drawn from a separate site were significantly lower than contamination rates of specimens obtained through a newly inserted intravenous catheter.

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A Piece of My Mind

"Most people know, sometimes from bitter personal experience, that medical science is not perfect." From "Where We Draw the Line."

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Medical News & Perspectives

The first phase of a federal program to vaccinate emergency department personnel and members of special smallpox response teams is under way, amid concerns raised by an Institute of Medicine panel and unions representing health care workers.

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Industry and Academia

Johns and colleagues discuss strategies for addressing institutional financial conflicts of interest in industry-academia relationships that would both promote scientific innovation and restore public trust in the research enterprise.

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CLINICIAN'S CORNER

A review of the causes, evaluation, treatment, and prevention of acute renal failure.

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Thank You to Reviewers and Authors

JAMA extends its gratitude and appreciationArticle to the 3443 peer reviewersArticle who evaluated manuscripts in 2002 and to the authors of the 4615 manuscripts we received.

JAMA Patient Page

For your patients: Information about care of premature infants.

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