In a study of children with acute otitis media seen in an emergency department, Spiro and colleaguesArticle compared rates of antibiotic prescription filling and clinical course for children randomly assigned to a “wait and see prescription” (WASP) approach, for which parents filled the prescription only if symptoms persisted or worsened after 48 hours vs a “standard” approach, for which parents filled the prescription and started antibiotics the day of the emergency department visit. The authors found that compared with the standard approach, significantly fewer antibiotic prescriptions were filled for children in the WASP group and that there were no significant differences by treatment assignment in the frequencies of fever, otalgia, or unscheduled medical visits. In an editorial, LittleArticle discusses advantages and alternatives to delayed use of antibiotics.
Okin and colleagues assessed the incidence of new-onset atrial fibrillation in participants in a hypertension treatment trial who did not have a history or electrocardiographic evidence of atrial fibrillation at baseline. The authors found that regression or continued absence of electrocardiographic left ventricular hypertrophy (LVH) during antihypertensive treatment was associated with a lower likelihood of new-onset atrial fibrillation compared with patients with in-treatment persistence or development of LVH.
To identify risk factors associated with aborted cardiac arrest and sudden cardiac death during adolescence in persons with long-QT syndrome (LQTS), Hobbs and colleagues analyzed data from 2772 patients in an international registry. The authors found that recent syncope, a QTc interval of 530 ms or longer, and male sex—among patients aged 10 to 12 years but not older—were associated with an increased risk of aborted cardiac arrest or sudden cardiac death. Among patients with recent syncope, β-blocker therapy was associated with reduced risks of these outcomes.
In vitro and animal data suggest that green tea consumption may protect against cardiovascular disease (CVD) and cancer, but data from human studies are lacking. Kuriyama and colleagues report results of a prospective cohort study of Japanese adults who had no history of CVD or cancer at baseline. During 11 years of follow-up, the authors found significant inverse associations of green tea consumption with reduced all-cause and CVD mortality, particularly among women, but found no association with cancer mortality.
Extended patent protection is granted to pharmaceutical manufacturers conducting clinical trials of products for children (“pediatric exclusivity”). Benjamin and colleagues report results of a literature review to identify pediatric exclusivity trials conducted in 1998-2004 and to assess labeling changes based on trial outcomes and publication in peer-reviewed journals. The authors found 253 studies that were submitted to the US Food and Drug Administration, of which 113 (45%) were published in peer-reviewed journals. Labeling changes favorable for the drug under study were identified in 50% of studies.
“There was something about watching that large spinal needle being shoved into the patient's back that made me break out in a cold sweat. My knees went weak, and I leaned against the wall for support.” From: “Triggers.”
While total spending on health in the United States continues to rise, the proportion of the health dollar spent on health and medical research is not keeping pace with inflation, according to a new analysis.
Patient history can distinguish migraine from other headache types, and several clinical features identify candidates for neuroimaging.
An article in the Archives of Ophthalmology reviews glaucoma during pregnancy. Higginbotham discusses coordination of care, communication factors, and ocular disease in women.
Clinical research and policy implications of assessing moderators of treatment outcomes in randomized clinical trials.
Authors may submit manuscripts for a JAMA theme issue on malaria.
For your patients: Information about electrocardiograms.
This Week in JAMA . JAMA. 2006;296(10):1203. doi:10.1001/jama.296.10.1203