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This Week in JAMA |

This Week in JAMA FREE

JAMA. 1998;280(14):1209. doi:10.1001/jama.280.14.1209.
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CONTROLLING ANTIBIOTIC RESISTANCE

A 1-year hospital-wide program severely restricting all cephalosporin use was associated with a significant decrease in the incidence of cephalosporin-resistant Klebsiella infection and colonization compared with the prior year. But, report Rahal and colleaguesArticle, the increased use of imipenem-cilastin during the study period was associated with an increase in incidence of imipenem-resistant Pseudomonas aeruginosa. In an editorial, BurkeArticle comments that optimal antibiotic use based on individual patient information might achieve heterogeneity of antibiotic use, reduce unnecessary use, and help stabilize antibiotic resistance.

LONG-TERM BENEFIT OF EARLY CHILDHOOD INTERVENTION

Olds and colleaguesArticle found that adolescents from high-risk families who participated in a prenatal and early childhood nurse home visitation program had a significantly lower incidence of serious antisocial behavior and substance use in a 15-year follow-up study compared with adolescents from families who received routine care. In an editorial, EarlsArticle discusses the effects of early intervention on developmental pathways and policy considerations for intervention programs.

AUTOPSIES REVEAL CONSTANT RATE OF DIAGNOSTIC ERROR

In a 10-year retrospective study of more than 1000 autopsies, Burton and colleaguesArticle found that malignancies were either undiagnosed or misdiagnosed in 100 patients and were directly related to the immediate cause of death in 57 of these patients. The 44% discordance rate between clinical and autopsy diagnoses of malignancies is comparable to that in similar studies published in 1923 and 1972. In an editorial emphasizing the importance of autopsies for quality of care, LundbergArticle proposes, in response to a sharp decline in autopsy rates, that Medicare participation and hospital accreditation be tied to mandatory rates of autopsy examinations.

IMPROVING PHARMACOTHERAPY

A computerized drug utilization review program at 13 mail-service pharmacy sites designed to improve prescribing for elderly patients generated more than 40,000 alerts for potentially inappropriate medications in 1 year. Monane and colleagues report that pharmacists were able to contact about half of the prescribing physicians by telephone following an alert. The rate of medication change after telephone discussion was 24% compared with an expected 2% rate of change.

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SELF-PRESCRIBING AMONG RESIDENT PHYSICIANS

In a mail survey of 4 US academic training programs, Christie and coworkers found that over half of internal medicine residents who used prescription medications during their residency reported prescribing medications for their own use. Residents often obtained prescription medications from the drug sample closet and occasionally from pharmaceutical company representatives.

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IS THIS PATIENT HAVING A MYOCARDIAL INFARCTION?

In this Rational Clinical Examination article, Panju and colleagues summarize the clinical and ECG findings most likely to be predictive of myocardial infarction in patients with acute chest pain and highlight the importance of identifying patients with ischemic cardiac conditions associated with a high risk of complications.

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THE COVER

". . . which nearly out-baroques the Baroque." Michiel van Musscher, Portrait of an Artist in Her Studio, c 1680-1685, Dutch.

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MEDICAL NEWS & PERSPECTIVES

US-funded AIDS research is intensifying vaccine efforts and prevention studies. The new director of the Office of AIDS Research describes his priorities.

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A PIECE OF MY MIND

"Living with a disease on a daily basis cannot be learned from a textbook or in a busy clinic." From "Call of the Loon."

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PUBLIC OPINION AND HEALTH CARE

An analysis of data from public opinion polls on tobacco regulation explains in part the recent failure to pass comprehensive tobacco legislation and identifies factors likely to improve the success of future legislation.

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JAMA PATIENT PAGE

For your patients: Understanding antibiotic resistance.

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