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This Week in JAMA |

This Week in JAMA FREE

JAMA. 1998;279(20):1593. doi:10.1001/jama.279.20.1593.
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LIPID LOWERING FOR PRIMARY PREVENTION OF HEART DISEASE

Optimal pharmacologic strategiesArticle for preventing coronary heart disease continue to evolve rapidly, as illustrated by AFCAPS/TexCAPS. This randomized controlled trial demonstrates that lipid-lowering therapy reduces acute major coronary events in low-risk patients with average to mildly elevated total and low-density lipoprotein cholesterol levels.

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CHANGING PATTERN OF PRENATAL CARE UTILIZATION

Despite changes in the organization and delivery of medical care, 2 traditional indices find that prenatal care utilization has remained relatively stable. However, 2 new indices, based on American College of Obstetricians and Gynecologists' recommendations, include a more-than-recommended-care category. Applying these measures to US births between 1981 and 1995, Dr Kogan and colleagues foundArticle an increase in prenatal care utilization, especially intensive use.

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OUTPATIENT TREATMENT OF CROUP

Dr Klassen and colleagues studied which of 3 glucocorticoid regimens was most effective in children aged 3 months to 5 years with mild-to-moderate croup. In this randomized controlled trial, they found no difference in change in croup score among oral dexamethasone, nebulized budesonide, or oral dexamethasone with nebulized budesonide. They suggest that oral dexamethasone alone is the preferred regimen because it is less expensive and easier to administer.

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SMOKE DETECTORS SAVE LIVES—EVEN AMONG VULNERABLE POPULATIONS

People are less likely to die in fires if their residences have working smoke detectors. However, these devices have been presumed to be less effective for people who are too young, too incapacitated, or too intoxicated to respond appropriately to the alarm. Dr Marshall and colleagues found the risk of death in a residential fire is reduced even among these groups and show that smoke detectors are most effective when a rescuer is available to assist vulnerable people.

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DO PATIENTS USE PERFORMANCE REPORTS?

Clinical performance and outcome reports cards are popular among health care managers and public policy experts, but patients seem to pay scant attention. Drs Schneider and Epstein found that in 1996 in Pennsylvania, a state that issues comparative reports on mortality for coronary artery bypass grafts, just 12% of patients undergoing the procedure even knew of the existence of such information before surgery. And fewer than 1% knew how their surgeon and hospital ranked and said it affected their selection process.

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A 40-YEAR-OLD WOMAN CONSIDERING CONTRACEPTION

Unwanted pregnancy is a common concern among women aged 40 to 45 years. The patient in this Clinical Crossroads, Mrs B, has had 3 healthy children and is faced with deciding the best way to prevent future pregnancies. Dr Peterson discusses preventing unwanted pregnancy and patients' options for contraception.

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THE COVER

"Undulating hills of an almost tropical green and great, puffy clouds sailing across a blue sky . . ." Hayley Lever, Midday in the Harbor, c 1917, American.

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MEDICAL NEWS & PERSPECTIVES

Will "cosmeceuticals" keep baby boomers blooming? The safety and efficacy of cosmetics said to have druglike effects—but unregulated by the FDA—concern dermatologists.

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CONTEMPO 1998

Critically ill patients at risk—a systematic review of 10 years of studies on risk factors for ICU-acquired pneumonia.

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A PIECE OF MY MIND

"I think the decline in gift giving by patients results from a feeling of distance from their physicians, which paradoxically has been bred by familiarity." From "The Ungifted Physician."

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JAMA PATIENT PAGE

This week's topic: prenatal care.

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