Cardiopulmonary resuscitation (CPR) guidelines provide clear specifications
for CPR performance, but whether these standards are achieved in clinical
settings is not clear. Two articles in this issue of JAMA report data on guideline adherence in out-of-hospital and in-hospital settings. Wik and colleaguesArticle assessed CPR performance
by ambulance personnel in the field and Abella and colleaguesArticle assessed
CPR performance during in-hospital cardiac arrests, using the same monitoring
techniques. In both settings, chest compressions were not administered in
a significant number of events. Compression rates and depth were often less
than recommended and ventilation rates were higher than recommended by the
guidelines. In an editorialArticle, Sanders and Ewy
discuss clinical benefits that could derive from simplifying CPR technique
and training and ways to improve the guideline development process.
An estimated 6% of adolescents have major depression, but few receive
effective treatment in primary care settings. Asarnow and colleagues report
results of a randomized trial that involved care managers to support primary
care physicians in evaluating and managing adolescent depression and provided
training and educational materials for the physicians to increase access to
evidence-based treatments. Six months after randomization, patients in the
intervention group reported fewer depressive symptoms and had greater access
to mental health care, including psychotherapy, than usual care patients.
Folic acid supplementation reportedly reduces systolic and diastolic
blood pressure, but whether folate intake modifies the risk of incident hypertension
is not known. Using food frequency data from women enrolled in 2 prospective
cohort studies, Forman and colleagues examined the risk of incident hypertension
in relation to dietary folate and folic acid supplement intake. During 8 years
of follow-up, the risk of incident hypertension was significantly decreased
in women who consumed at least 1000 μg/d of total folate.
Observational data suggest estrogen therapy may promote gallstone formation
and cholecystitis, but there are limited prospective data assessing this relationship.
Cirillo and colleagues analyzed data from the Women’s Health Initiative
trial to determine the effects of estrogen or estrogen plus progestin therapy
vs placebo on gallbladder disease in healthy postmenopausal women. They found
an increased risk of cholecystitis, cholelithiasis, and cholecystectomy among
women using estrogen alone or in combination with progestin, compared with
women taking placebo.
Many states provide confidential sexual health services to adolescents.
However, little is known about parents’ knowledge that their daughter
has received this care or how adolescent girls would react if parental notification
was required. Jones and colleagues surveyed adolescent females seeking reproductive
health services at family planning clinics and asked whether a parent knew
they were obtaining sexual health services and whether they would still seek
prescription contraception if parental notification was required. Sixty percent
of adolescents surveyed reported a parent or guardian knew they were accessing
reproductive health services. If parental notification was required, 59% would
still use the clinic, but 20% would use no contraception or use less reliable
A new report on global trends in the HIV/AIDS pandemic warns that the
disease is increasingly affecting women and girls and populations in Asia
and Eastern Europe.
Clinical ReviewA simplified approach
to treating non–ST-segment elevation (NSTE) acute coronary syndromes.
Choudhry and Detsky discuss why drug reimportation from Canada is poor
Topol discusses cardiovascular risks associated with cyclooxygenase
2 inhibitors (coxibs) and the consequences of inadequate postmarketing surveillance.
For your patients: Information about cardiopulmonary resuscitation.
This Week in JAMA . JAMA. 2005;293(3):269. doi:10.1001/jama.293.3.269