Appropriate use of antibiotics is evaluated in 2 articles in this issue of JAMA. In the first article, Samore and colleaguesArticle report results of a randomized trial that assessed the benefit of adding a clinical decision support system (CDSS) tool to a community education program to reduce inappropriate prescribing of antimicrobials for acute respiratory tract infections. The authors found that overall and acute respiratory tract infection–related antimicrobial use declined and appropriate antibiotic selection improved in communities where physicians were offered the CDSS vs communities with the patient education intervention alone (CI-Alone). In a second article, Linder and colleaguesArticle report results of analyses of national data on physician visits for sore throat among children 3 to 17 years of age. They found that antibiotics were prescribed in 53% of these visits. Testing for group A β-hemolytic streptococci was not optimal but when performed was associated with less prescribing. In an editorial, WeberArticle discusses antimicrobial resistance and the importance of interventions for reducing inappropriate antibiotic use.
Atrial fibrillation is common in patients with mitral valve disease and among patients having mitral valve surgery. Intraoperative radiofrequency ablation (RFA) of the left atrium has emerged as a novel but not proven treatment of coexisting atrial fibrillation. To assess the efficacy of this procedure for restoring sinus rhythm and improving patients’ exercise capacity, Doukas and colleaguesArticle randomly assigned patients with a minimum 6-month history of atrial fibrillation and who were candidates for mitral valve surgery to surgery plus RFA or to valve surgery alone. At 1-year follow-up, patients who had RFA vs those who did not were significantly more likely to be in sinus rhythm and to have greater exercise capacity. In an editorial, Sundt and GershArticle discuss surgical treatment of atrial fibrillation.
Caffeine intake may cause an acute increase in blood pressure, but whether habitual caffeine intake is associated with incident hypertension is not clear. Using data from a large prospective study in women, Winkelmayer and colleagues assessed the relationship between caffeine intake and physician-diagnosed hypertension. They found no association of habitual caffeine consumption with new diagnoses of hypertension. In analyses of individual beverages, the authors found that consumption of cola beverages but not coffee was associated with an increased risk of hypertension.
There is little doubt that vitamin D and calcium are important for bone health. However, their relative importance for calcium homeostasis as reflected in the serum parathyroid hormone (PTH) level is not known. To address this question, Steingrimsdottir and colleagues conducted a cross-sectional study of healthy Icelandic adults and measured dietary calcium and vitamin D intakes, serum levels of 25-hydroxyvitamin D, and intact PTH. They found that vitamin D sufficiency appeared to be more important than high calcium intake in maintaining bone health in this population.
Editors, publishers, and others are seeking ways to improve the standard of published clinical data and expose potential bias and misconduct of study authors.
A review of ricin poisoning with recommendations for response in the event of population exposure.
An article in the Archives of Neurology reports results of genomic analysis conducted prior to immunization with β-amyloid(1-42) in patients with Alzheimer disease (AD), which allowed identification of patients at risk of therapy-related meningoencephalitis and patients likely to benefit from therapy.
Samore discusses use of a clinical decision support system to improve antimicrobial prescribing in an Author in the Room Teleconference on December 21, 2005, from 2 to 3 PM eastern time. Sign up for the teleconference at www.ihi.org/authorintheroom.
For your patients: Information about vitamin D.
This Week in JAMA . JAMA. 2005;294(18):2273. doi:10.1001/jama.294.18.2273