Requirements for Authors.—Congress recently passed The Copyright Revision Act of 1976 which affects JAMA's procedure for acceptance of manuscripts. Please New
refer to the "Instructions for Authors" page for details.
Prevention of Bacterial Endocarditis Bacterial endocarditis is a preventable disease if physicians and susceptible patients cooperate in exercising diligent prophylaxis.
prevention is easier and more certain than cure, it is on physicians to denote persons at risk and to institute preventive chemotherapy under appropriate circumstances. Since
incumbent
Structural abnormalities of the heart or great vessels create susceptibility; manipulations that free bacteria into the bloodstream increase the risk of the disease. Most commonly, bacterial endocarditis follows dental procedures or genitourinary and gastrointestinal tract surgery or instrumentation. The most frequent infecting organism is the a-hemolytic Streptococcus, and therefore, the most effective prophylaxis is penicillin. For a small minority of those afflicted with bacterial endocarditis, penicillin may not be the most effective drug, and these patients offer a special challenge to the physician's therapeutic skill. The importance of preventing bacterial endocarditis is such that the American Heart Association has revised and updated its statement on this subject. The latest statement by the Committee on Prevention of Rheumatic Fever and Bacterial Endocar¬ ditis of the American Heart Association appears in the July issue of Circulation and deserves the careful attention of all physicians and dentists. William R. Barclay, MD
Diagnosis of Fetal Maturity as Requisite for Elective Obstetrical Delivery The neonatal intensive care unit, an integral part of regional planning in maternal and child care, has enhanced the lowering of perinatal mortality to 14.9 per 1,000 live births in 1977. Associated with regional planning is the outcome assessment by audit of risks and benefits of medical care. Maisels et al (p 2036) have audited and identified elective delivery of the fetus as an obstetrical hazard when fetal maturity is not established and verified before delivery. The use of "elective" delivery by patient request or for hospital service and physician's convenience requires reexamination for its merit. Newer audit outcome not previously identified by widely diversified centers with low local incidence of complication, when combined and examined by regional data, seems unacceptable when iatrogenically caused asphyxia, respiratory distress syndrome, pneumothorax, pneumomediastinum, and large financial costs are reported. In addition, parenting disorders, failure of normal growth and development, subsequent unexplained death syndromes, failure to thrive, and mental-motor deficiency may occur from elective delivery, which results in an immature fetus requiring intensive support. Address editorial communications to the
positive note, delivery with optimum staffing, avail¬ ability monitoring facilities and techniques, as well as nursing personnel are valid considerations for making a judg¬ ment with regard to timing of delivery. A balanced program for selecting the patient, the time, and the facility for elective delivery necessitates the following: (l) documentation of fetal lung maturity by lecithin/sphingomyelin ratio, (2) documentation of gestational maturity by ultrasound, and (3) assessment of cost/benefit, risk/benefit using a documentation process as it relates to outcome. The responsible physician must be aware of and consider all aspects of the following when pressured for early delivery: parenting disorders, prevention of accidental anesthesia risk, convenience to hospital setting, decreased tension waiting for labor, assurance of attending physician's presence, optimal facility staffing, and now documentation of fetal maturity. On
a
of
The medical profession should encourage medical evaluation and corrective educational programs if this is an identified problem in a physician's locality. Howard G. McQuarrie, MD Western
Salt Lake
Gynecological City
and Obstetrical Clinic Inc
Hybrid Words The duty owed by every educated speaker of a language is to let it live its own life without undue interference from authoritarian proscriptions. Elsewhere in this issue (p 2043), Dirckx has undertaken to say what may be the best last word on a problem of vocabulary formation that has been coming up for discussion periodically ever since the first physician with a classical education found a need to coin a word out of familiar elements drawn from Greek and Latin. Thus, the GE tract is not that but the GI tract. To say that GI ought to be GE is like making rules for birds to follow during their brief habitation of trees. Our language is not given but bailed to us, and we owe it a duty of due care while it is in our fleeting possession. Our solemn charge as editors and writers is not to violate its reasonable rules of grammar and syntax, nor to unprofitably dilute its useful distinctions by failing to know and observe them, nor to blur its striking silhouettes with careless substitutions, nor to blunt its force with esoteric and unfamiliar words when good vernacular is available. We do not have leave to change it about or take away part of it, or to let it go lame or fat. To redeliver this most liquid of assets, free of impediments and sound of wind-this is the plain common sense of duty of each gener¬ ation as it dies.
Editor, 535 N Dearborn St, Chicago 60610
Downloaded From: http://jama.jamanetwork.com/ by a New York University User on 05/23/2015
James Ransom, PhD Lange Medical Publications Los
Altos, Calif
refer to the "Instructions for Authors" page for details.
Prevention of Bacterial Endocarditis Bacterial endocarditis is a preventable disease if physicians and susceptible patients cooperate in exercising diligent prophylaxis.
prevention is easier and more certain than cure, it is on physicians to denote persons at risk and to institute preventive chemotherapy under appropriate circumstances. Since
incumbent
Structural abnormalities of the heart or great vessels create susceptibility; manipulations that free bacteria into the bloodstream increase the risk of the disease. Most commonly, bacterial endocarditis follows dental procedures or genitourinary and gastrointestinal tract surgery or instrumentation. The most frequent infecting organism is the a-hemolytic Streptococcus, and therefore, the most effective prophylaxis is penicillin. For a small minority of those afflicted with bacterial endocarditis, penicillin may not be the most effective drug, and these patients offer a special challenge to the physician's therapeutic skill. The importance of preventing bacterial endocarditis is such that the American Heart Association has revised and updated its statement on this subject. The latest statement by the Committee on Prevention of Rheumatic Fever and Bacterial Endocar¬ ditis of the American Heart Association appears in the July issue of Circulation and deserves the careful attention of all physicians and dentists. William R. Barclay, MD
Diagnosis of Fetal Maturity as Requisite for Elective Obstetrical Delivery The neonatal intensive care unit, an integral part of regional planning in maternal and child care, has enhanced the lowering of perinatal mortality to 14.9 per 1,000 live births in 1977. Associated with regional planning is the outcome assessment by audit of risks and benefits of medical care. Maisels et al (p 2036) have audited and identified elective delivery of the fetus as an obstetrical hazard when fetal maturity is not established and verified before delivery. The use of "elective" delivery by patient request or for hospital service and physician's convenience requires reexamination for its merit. Newer audit outcome not previously identified by widely diversified centers with low local incidence of complication, when combined and examined by regional data, seems unacceptable when iatrogenically caused asphyxia, respiratory distress syndrome, pneumothorax, pneumomediastinum, and large financial costs are reported. In addition, parenting disorders, failure of normal growth and development, subsequent unexplained death syndromes, failure to thrive, and mental-motor deficiency may occur from elective delivery, which results in an immature fetus requiring intensive support. Address editorial communications to the
positive note, delivery with optimum staffing, avail¬ ability monitoring facilities and techniques, as well as nursing personnel are valid considerations for making a judg¬ ment with regard to timing of delivery. A balanced program for selecting the patient, the time, and the facility for elective delivery necessitates the following: (l) documentation of fetal lung maturity by lecithin/sphingomyelin ratio, (2) documentation of gestational maturity by ultrasound, and (3) assessment of cost/benefit, risk/benefit using a documentation process as it relates to outcome. The responsible physician must be aware of and consider all aspects of the following when pressured for early delivery: parenting disorders, prevention of accidental anesthesia risk, convenience to hospital setting, decreased tension waiting for labor, assurance of attending physician's presence, optimal facility staffing, and now documentation of fetal maturity. On
a
of
The medical profession should encourage medical evaluation and corrective educational programs if this is an identified problem in a physician's locality. Howard G. McQuarrie, MD Western
Salt Lake
Gynecological City
and Obstetrical Clinic Inc
Hybrid Words The duty owed by every educated speaker of a language is to let it live its own life without undue interference from authoritarian proscriptions. Elsewhere in this issue (p 2043), Dirckx has undertaken to say what may be the best last word on a problem of vocabulary formation that has been coming up for discussion periodically ever since the first physician with a classical education found a need to coin a word out of familiar elements drawn from Greek and Latin. Thus, the GE tract is not that but the GI tract. To say that GI ought to be GE is like making rules for birds to follow during their brief habitation of trees. Our language is not given but bailed to us, and we owe it a duty of due care while it is in our fleeting possession. Our solemn charge as editors and writers is not to violate its reasonable rules of grammar and syntax, nor to unprofitably dilute its useful distinctions by failing to know and observe them, nor to blur its striking silhouettes with careless substitutions, nor to blunt its force with esoteric and unfamiliar words when good vernacular is available. We do not have leave to change it about or take away part of it, or to let it go lame or fat. To redeliver this most liquid of assets, free of impediments and sound of wind-this is the plain common sense of duty of each gener¬ ation as it dies.
Editor, 535 N Dearborn St, Chicago 60610
Downloaded From: http://jama.jamanetwork.com/ by a New York University User on 05/23/2015
James Ransom, PhD Lange Medical Publications Los
Altos, Calif
