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This Week in JAMA
November 17, 2004

This Week in JAMA

JAMA. 2004;292(19):2311. doi:10.1001/jama.292.19.2311
Reducing LVH Improves Cardiac Risk

Left ventricular hypertrophy (LVH) is associated with increased blood pressure, and prior studies have documented regression of LVH in patients receiving antihypertensive therapy. However, whether reduction in LVH is associated with improved cardiac outcomes is not clear. Results from the Losartan Intervention For Endpoint Reduction in Hypertension (LIFE) study, which randomized patients with hypertension and LVH to losartan- or atenolol-based treatment regimens, address this question and are reported in 2 articles ArticleArticle in this issue of JAMA. After a mean follow-up of 4.8 years, the LIFE investigators found that hypertension treatment-related reductions in LVH, assessed by electrocardiogram and echocardiogram, were correlated with reductions in cardiovascular morbidity and mortality. In an editorial,Article Gardin and Lauer discuss the importance of evaluating for LVH at the time of hypertension diagnosis and in considering changes in left ventricular mass when adjusting long-term antihypertensive therapy.

Neurodevelopment Following Neonatal Infection

Infections are common complications in the care of extremely low-birth-weight (ELBW) neonates. Whether early childhood neurodevelopment and growth are compromised by these infections is not known. Stoll and colleaguesArticle analyzed data from a national registry of very low-birth-weight infants to assess neurodevelopmental and growth outcomes in early childhood in relation to neonatal infection. They found that ELBW infants with a history of neonatal infection were more likely to have adverse neurodevelopmental outcomes and impaired head growth compared with those not infected. In an editorial,Article Msall discusses the challenges of preventing adverse neurodevelopmental outcomes in ELBW infants.

Computerized Intervention and Vaccination Rates

Prior studies document an increase in influenza and pneumococcal vaccination rates with computerized reminder systems. Potential benefits from a computerized standing order system have not been evaluated. Dexter and colleagues conducted a randomized trial that enrolled hospital inpatients eligible to receive influenza and/or pneumococcal vaccine. The authors compared vaccination rates for patients with computerized standing orders—directing a nurse to administer the vaccine at time of discharge—with those for patients whose physicians received computerized vaccination reminders during routine order entry. They found that patients with a standing order were significantly more likely to receive the needed vaccine than were patients with a physician reminder.

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Ozone Levels and Short-term Mortality

Exposure to ozone has been associated with a number of adverse health effects, but the relationship of ozone exposure to mortality is inconclusive. Bell and colleagues used national air quality and mortality data of 95 large urban areas from 1987 through 2000 to investigate whether daily and weekly exposure to ambient ozone is associated with mortality. In analyses adjusted for particulate matter, weather, seasonality, and long-term trends, they found that a 10-ppb increase in daily ozone levels for the previous week was associated with a 0.52% increase in daily mortality or an estimated 3767 additional deaths annually for the 95 communities studied.

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Medical News & Perspectives

A federal task force is recommending that all states screen newborns for 29 treatable inherited disorders that can be detected through blood analysis.

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Prone Position in Hypoxemic ARF

Patients with hypoxemic acute respiratory failure (ARF) placed in the prone position had improved oxygenation and less ventilator-associated pneumonia but similar mortality outcomes as patients in the supine position.

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Clinical Review
Pharmacological and nonpharmacological interventions that benefit patients with fibromyalgia syndrome.

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JAMA Patient Page

For your patients: Information about left ventricular hypertrophy.

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