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This Week in JAMA |

This Week in JAMA FREE

JAMA. 2001;286(15):1803. doi:10.1001/jama.286.15.1803.
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DECISION RULE FOR C-SPINE RADIOGRAPHY AFTER TRAUMA

Indications for cervical spine (C-spine) radiography in stable and alert patients who have sustained blunt trauma to the head or neck are controversial, and current clinical practice regarding the use of C-spine radiography is highly variable. Based on the assessment of 8924 trauma patients, Stiell and colleaguesArticle derived a highly sensitive 3-question clinical decision rule for the use of C-spine radiography in alert and stable trauma patients at risk for neck injury. In an editorial, DaffnerArticle notes that this clinical decision rule should help improve identification of trauma patients who can be managed without radiography.

FIRST-LINE VS SECOND-LINE ANTIBIOTICS FOR ACUTE SINUSITIS

Newer and more expensive second-line antibiotics are often prescribed for the treatment of acute sinusitis. In this retrospective study using a pharmaceutical database, Piccirillo and colleagues report that patients with acute uncomplicated sinusitis treated with an older, less expensive (first-line) antibiotic did not have significantly different treatment success rates compared with patients treated with a second-line antibiotic. The cost of care was significantly higher for patients treated with a second-line antibiotic.

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MACROLIDE RESISTANCE AMONG

Macrolide antibiotics are recommended for initial treatment of community-acquired pneumonia in adults. Hyde and colleagues report that macrolide prescription rates increased 13% between 1993 and 1999, and resistance to macrolide antibiotics among invasive isolates of Streptococcus pneumoniae, the most common cause of community-acquired pneumonia, increased from 10.6% in 1995 to 20.4% in 1999.

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TRAUMATIC FETAL INJURY DEATHS

Fetal deaths related to maternal injury are not routinely included in state and national injury surveillance reports, and few studies have reported data on trauma as a cause of fetal deaths. Weiss and colleagues analyzed fetal death certificates from 1995 through 1997 obtained from 16 states and found that the rate of traumatic fetal deaths during this period was 3.7 per 100 000 live births per year. Motor vehicle crashes accounted for most traumatic fetal injury deaths, followed by firearm injuries.

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HIGH-DOSE ANTITHROMBIN III THERAPY FOR SEVERE SEPSIS

In patients with severe sepsis and septic shock, the coagulation system is activated and endogenous anticoagulants are often depleted, predisposing to diffuse microthrombus formation that may result in organ failure and death. Warren and colleagues reportArticle, however, that high-dose administration of antithrombin III, a natural inhibitor of the coagulation cascade, failed to reduce 28-day all-cause mortality in patients with severe sepsis and septic shock compared with placebo. In an editorial, Crowther and MarshallArticle consider why trials of mediator-targeted therapies for sepsis might fail to show significant benefits and discuss the implications for future research.

MENINGIOMAS IN

Lymphangioleiomyomatosis (LAM), a multisystem disorder that occurs predominantly in women of child-bearing age, is characterized by cystic lung disease, abdominal tumors, and other mass lesions in the thorax and brain. This condition is commonly treated with progesterone and other hormonal agents. Moss and colleagues report that on magnetic resonance imaging and/or computed tomography, 8 of 250 women with LAM had evidence of meningiomas, tumors believed to be progesterone sensitive.

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MEDICAL NEWS & PERSPECTIVES

Addressing the psychological aftermath of the terrorist attacks on the World Trade Center and the Pentagon poses a formidable challenge to primary care physicians and mental health care professionals.

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ANTIRETROVIRAL DRUG PATENTS IN AFRICA

A survey of pharmaceutical companies indicates that most antiretroviral drugs are not patented in most countries in Africa.

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RAMIPRIL AND DIABETES

In this analysis of data from participants with vascular disease in the Heart Outcomes Prevention Evaluation trial, the rate of new diagnosis of diabetes was lower in the ramipril group than in the placebo group.

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NARRATIVE MEDICINE

How narrative competence enriches medical practice.

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JAMA PATIENT PAGE

For your patients: Information about neck injuries.

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