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This Week in JAMA |

This Week in JAMA FREE

JAMA. 1998;279(17):1328. doi:10.1001/jama.279.17.1328.
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IMPROVING QUALITY OF CARE FOR PATIENTS WITH MI

Can quality of care and outcomes for elderly patients with acute myocardial infarction be improved? Dr Marciniak and colleagues show that feedback of quality data from HCFA peer review organizations to hospitals and physicians in 4 states resulted in improved process of care, reduced length of stay, and decreased mortality for Medicare patients with myocardial infarction.

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CAN LOCAL OPINION LEADERS CHANGE PHYSICIAN PRACTICE?

Practice guidelines often do not change physician behavior. Dr Soumerai and colleagues assessed whether local opinion leaders could influence pharmacologic treatment of acute myocardial infarction. While use of aspirin and β-blockers increased, other practices either remained unchanged or shifted similarly at both control and test hospitals.

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WHEN SPECIALTY CARE IS PRIMARY CARE

Specialists may provide primary care for their patients, but to what extent? This study of Washington State Medicare outpatient visits evaluates the amount and type of primary care specialists provide for their patients. Based on their quantitative indices of primary care attributes, Dr Rosenblatt and colleagues found that pulmonologists, rheumatologists, oncologists, general surgeons, and gynecologists provided substantial amounts of primary care, but most specialists did not take on a generalist role.

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COST-EFFECTIVENESS OF ROTAVIRUS IMMUNIZATION

Rotavirus causes considerable morbidity and expense but little mortality, so use of a vaccine against this pathogen will be influenced by its cost-effectiveness. Dr Tucker and colleagues provide such an analysis, finding that a universal 3-dose vaccination program would cost the US health care system $107 million but save society $296 million.

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MEASURING HEALTH PLAN QUALITY

Measuring quality of care in the context of diverse health care organizations is a critical need. Dr Landon and colleagues suggest that traditional health plan definitions are inadequate to assess the organizational characteristics that affect quality of care. They recommend new conceptual models to characterize aspects of health care organizations that either facilitate or impose barriers to quality of care and influence physician behavior.

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HAVE HYPERTENSION? HOLD THE SALT

Should restricted salt intake be recommended for the general population? In a meta-analysis, Dr Graudal and colleagues found that sodium reduction is not helpful for the general population but is a useful adjunct for individuals with hypertension.

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THE COVER

"Unthought of harmonies come forward, or perhaps they have always existed in some forgotten memory . . ." Jacques Villon, Maternité, c 1948, French.

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MEDICAL NEWS & PERSPECTIVES

Men's sexual quality of life is the focus of a report from the Congress of the European Association of Urology.

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A NEW CONTEMPO

Our annual Contempo issue is now a regular series of brief updates that highlight important advances shaping clinical practice and public health. This week, Drs Volberding and Deeks review progress and problems in the antiretroviral treatment of HIV infection.

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A PIECE OF MY MIND

"Any number of people have asked me how it feels to be retired. Sometimes I say it feels great, other times I say it's OK, but mostly I say ask me next year." From "Identity Matters (or Does It?)."

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THE JAMA PATIENT PAGE

This week's JAMA Patient Page covers the basics about heart attacks. We invite readers to copy this page, a patient-friendly look at a topic covered by a study in each week's JOURNAL, and make it available to interested patients.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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