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This Week in JAMA
June 12, 2002

This Week in JAMA

JAMA. 2002;287(22):2907. doi:10.1001/jama.287.22.2907

Patient Complaints and Malpractice Risk

Previous research suggests that patient dissatisfaction with care is associated with malpractice risk. Hickson and colleaguesArticle report that risk management experiences of physicians in a large multispecialty medical group were significantly related to their total numbers of unsolicited patient complaints recorded by the patient affairs office at their medical center, even after adjustment for clinical activity. In an editorial, Sage discusses the importance of incorporating patient perspectives into patient safety activities.

Early Detection of

Pseudomonas aeruginosa pulmonary infection accounts for much of the morbidity associated with cystic fibrosis (CF). Early identification of P aeruginosa infection may increase the likelihood of eradicating this organism before irreversible lung disease occurs, but the temporal sequence of events that result in P aeruginosa infection has not been clear. In this longitudinal study of 68 young children with CF considered to be free of P aeruginosa infection at study entry, West and colleagues found that a rise in P aeruginosa–specific antibodies, indicative of initial P aeruginosa infection, occurred 6 to 12 months before the organism was isolated from respiratory secretions. Clinical indicators of pulmonary infection also preceded isolation of P aeruginosa from respiratory samples.

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Rupture Risk of Large Abdominal Aortic Aneurysm

Elective repair of abdominal aortic aneurysm (AAA) is usually deferred in patients with high operative risk until the risk of rupture is thought to exceed operative risk. In this prospective study, Lederle and colleagues determined the incidence of AAA rupture in patients with AAA of at least 5.5 cm in diameter who refused repair or who had medical contraindications to elective repair. The 1-year incidence of probable AAA rupture was 9.4% for an initial diameter of 5.5 to 5.9 cm and increased to 32.5% for an initial diameter of 7.0 cm or more.

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Quality Measures and Estimates of Treatment Effect

In meta-analyses, investigators often use measures of trial quality to divide high-quality from low-quality studies when assessing strength of treatment effect. Balk and colleagues evaluated randomized controlled trials in meta-analyses from 4 medical areas using 24 specific quality measures. None of the individual quality measures was significantly associated with estimates of treatment effect.

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Tobacco Advertising: Strategies and Counterstrategies

The tobacco industry has effectively used advertising and marketing to maintain or increase sales. In their analysis of tobacco industry marketing research reports and other documents that focused on young adult smokers, Ling and GlantzArticle identified research and strategies that could be used to improve clinical and public health tobacco-control interventions. Bayer and coauthorsArticle discuss Lorillard Tobacco Co. v Reilly, a recent Supreme Court case that struck down public health regulation of tobacco advertising as a violation of the First Amendment, and the constitutional history of commercial speech regulation. They propose a comprehensive system of taxation and regulation designed to increase public appreciation and comprehension of the health risks of cigarettes. In a commentary, MorrisonArticle discusses constitutional and practical aspects of proposed strategies to counteract cigarette advertising and of possible funding mechanisms.

A Piece of My Mind

"This pregnancy was barely half its full gestation. It would take everything just to keep this child alive out of the womb, to our table in the delivery room, back to the NICU." From "Everything."

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Contempo Updates

Advances in pharmacotherapeutics, resective surgical therapies, and other treatment strategies for epilepsy.

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Medical News & Perspectives

Cataloging the many proteins in the body and discovering how they function in tissues may lead researchers to an understanding of protein networks in cancer cells and foster discovery of new therapies.

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Clinician's corner

This case presentation of a 79-year-old woman with temporal arteritis highlights some of the unusual ways in which this panarteritis may present.

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JAMA Patient Page

For your patients: Information about temporal arteritis.

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