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This Week in JAMA |

This Week in JAMA FREE

JAMA. 2001;286(1):9. doi:10.1001/jama.286.1.9.
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5-DAY, HIGH-DOSE AMOXICILLIN AND DRUG RESISTANCE

Recent antibiotic use has been identified as a risk factor for carrying drug-resistant Streptococcus pneumoniae. In this randomized clinical trial, Schrag and colleagues found that the risk of penicillin-nonsusceptible S pneumoniae carriage assessed in nasopharyngeal specimens was significantly lower 28 days after the start of treatment among children who received a 5-day course of high-dose amoxicillin (90 mg/kg per day) for respiratory tract illness compared with those who received a standard 10-day course of amoxicillin (40 mg/kg per day).

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DECISION RULES TO TARGET BONE MINERAL DENSITY TESTING

Current National Osteoporosis Foundation (NOF) guidelines to select women for bone mineral density (BMD) screening are broad and may include a substantial number of women at low risk of osteoporotic fracture. Using data from the Canadian Multicentre Osteoporosis Study, Cadarette and colleagues compared the diagnostic properties of the NOF recommendations with those of 4 clinical decision rules to select women for dual-energy x-ray absorptiometry testing. Two of the decision rules, the Simple Calculated Osteoporosis Risk Estimation and the Osteoporosis Risk Assessment Instrument, were better than the NOF guidelines at targeting testing of women at high risk of low BMD.

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STATIN THERAPY AND C-REACTIVE PROTEIN LEVELS

Preliminary evidence suggests that HMG-CoA reductase inhibitors (statins) may have direct anti-inflammatory effects independent of their lipid-lowering properties. In this community-based study to assess the anti-inflammatory effects of pravastatin, Albert and colleaguesArticle found that among adults with no prior history of cardiovascular disease, those randomized to receive pravastatin had significant reductions in C-reactive protein (CRP) levels after 12 and 24 weeks of therapy compared with those who received placebo. The reduction in CRP levels was not related to pravastatin-induced changes in low-density lipoprotein cholesterol levels. Similar reductions in CRP levels also were found in a parallel open-label cohort study among adults with known cardiovascular disease. In an editorial, SimpsonArticle places the results of this study in context with other research on CRP and atherosclerosis.

DECISION TO CONSENT FOR ORGAN DONATION

Rates of organ donation are far below the need for organ transplantation, and the percentage of families of donor-eligible patients that consent to transplantation is low. To identify factors associated with the decision of a family to donate or not to donate a family member's organs for transplantation, Siminoff and colleagues conducted chart reviews and interviews with health care practitioners, organ procurement organization (OPO) staff, and families of 420 donor-eligible patients at 9 trauma hospitals between 1994 and 1999. Many factors were associated with the donation decision, including sociodemographic and attitudinal characteristics, prior knowledge of the patient's wishes, conversations with the family about organ donation, contact with OPO staff, and the quality of the request pattern.

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ABCIXIMAB THERAPY WITH PCI AND STROKE RISK

Abciximab, a potent inhibitor of the platelet glycoprotein IIb/IIIa receptor, is used to reduce the risk of thrombotic complications for patients undergoing percutaneous coronary intervention (PCI). Akkerhuis and colleagues analyzed data from 4 large clinical trials and found that abciximab in addition to heparin and aspirin does not increase the risk of hemorrhagic or nonhemorrhagic stroke in patients undergoing PCI.

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A PIECE OF MY MIND

"I . . . walk through the park toward the train station and there is Brave up ahead, alone, standing apart, keeping his distance from the many small clusters of men, mostly men, who gather here every night to park their shopping carts and sleeping rolls, to smoke, swap stories and other things." From "Brave, Waiting for Pasteur."

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MEDICAL NEWS & PERSPECTIVES

At the World Health Assembly in Geneva in June, some of the high-priority issues discussed included HIV/AIDS, leprosy, the WHO policy on medicines, and recommendations for feeding infants and young children.

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PHYSICIAN ANTITRUST EXEMPTION LEGISLATION

Features of current physician antitrust exemption initiatives at the state and federal levels and an analysis of the potential impact of physician antitrust exemption legislation on the balance of power between physicians and managed care plans.

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REPORTING FINANCIAL CONFLICTS OF INTEREST

Policies of THE JOURNAL on reporting authors' financial interests and relationships between investigators and research sponsors.

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JAMA PATIENT PAGE

For your patients: Information about organ donation.

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