The adamantanes, amantadine and rimantadine, are commonly recommended to prevent and treat influenza A virus infections; however, since the mid-1990s, increasing rates of resistance to the adamantanes have been documented. In an analysis of influenza isolates from patients in 26 states that were collected from October 1 through December 31, 2005, Bright and colleaguesArticle found that 193 (92%) of 209 influenza A(H3N2) viruses and 2 (25%) of 8 influenza A(H1N1) viruses analyzed had mutations that confer adamantane resistance. In an editorial, Weinstock and ZuccottiArticle discuss reasons for the increase in adamantane resistance and the need for immediate, worldwide intervention.
Compared with bare metal stents, sirolimus-eluting and paclitaxel-eluting stents markedly reduce the risk of late luminal loss after percutaneous coronary revascularization, but it is not clear if one drug-eluting stent is superior to the other. Morice and colleaguesArticle report results of the multicenter, randomized REALITY trial, which compared the safety and efficacy of a sirolimus-eluting stent vs a paclitaxel-eluting stent in patients with de novo coronary artery lesions. Comparing outcomes by type of drug-eluting stent, the trial investigators found no differences in in-lesion binary restenosis at 8 months, 1-year rates of target lesion and vessel revascularization, or a composite end point of major adverse cardiac events. In an editorial, BrenerArticle discusses what is known and what remains to be determined about the effects of drug-eluting stents.
Specialty board certification is a potential measure of physician competence. In 2 articles in this issue of JAMA, Freed and colleaguesArticleArticle, who are members of the Research Advisory Committee of the American Board of Pediatrics, report results from telephone surveys of hospital and health plan credentialing personnel that examined the role of board certification and recertification in decisions about hospital privileges and health plan credentialing. The authors found that 78% of the hospitals did not require pediatricians to be board certified at initial privileging although 70% required certification at some point during pediatricians' tenure. Among health plans, the authors found that 90% do not require board certification at initial credentialing and 41% required general pediatricians and 40% pediatric subspecialists to be board certified at some point. In an editorial, Cassel and HolmboeArticle discuss the roles of board certification and recertification and monitoring of physician performance in ensuring quality medical care.
Head injuries are common in alpine skiers and snowboarders, but whether helmets can reduce head injuries is not clear. In a case-control study of skiers and snowboarders in Norway, Sulheim and colleagues assessed the effect of wearing a helmet on the risk of head injury. In analyses that controlled for other potential head injury risk factors, the authors found that helmet use was associated with reduced risk of head injury among alpine skiers and snowboarders.
“Within him I sense an eagerness to talk; within myself, a desire, and perhaps an obligation, to listen.” From “Doctors Need Doctors Too.”
Waning immunity after childhood pertussis vaccination has led to a resurgence of this infectious disease. But a newer and safer pertussis vaccine, added to existing tetanus/diphtheria boosters, is now recommended for adolescents and most adults.
Mrs G is a 54-year-old woman who has a several-year history of abdominal pain and discomfort associated with constipation. Lembo discusses the diagnosis of irritable bowel syndrome (IBS), possible causes of constipation-predominant IBS, and its treatment.
Join Anna Taddio, PhD, on Wednesday, March 15, 2006, from 2 to 3 PM eastern time to discuss her study of systemic analgesia and local anesthesia for procedural pain in neonates, published in the February 15, 2006, issue of JAMA . Author in the Room is a teleconference call between the author, JAMA readers, and experts in implementing practice change to help clinicians implement research into practice.
To register, go to http://www.ihi.org/AuthorintheRoom.
For your patients: Information about irritable bowel syndrome.
This Week in JAMA . JAMA. 2006;295(8):859. doi:10.1001/jama.295.8.859