Using data from 3 liver transplantation centers, Showstack and
colleaguesArticle found that factors associated with higher hospital resource
use from the day of transplantation through hospital discharge included
more severe illness at the time of liver transplantation, donor age of
60 years or older, and alcoholic liver disease. Length of hospital stay
and resource use varied significantly between the 3 centers. In an editorial, RussellArticle contrasts the clinical, ethical, and economic implications of a donor organ allocation policy based on clinical urgency criteria, as recently recommended by the United Network for Organ Sharing, and one that incorporates criteria of cost and resource use.
Limiting egg consumption has been recommended to lower blood
cholesterol levels and reduce atherosclerosis, but there is little
epidemiologic evidence on the relationship between egg consumption and
the risk of coronary heart disease (CHD). Hu and colleagues report that
the consumption of up to 1 egg per day was not associated with an
increased incidence of nonfatal myocardial infarction, fatal CHD, or
ischemic or hemorrhagic stroke among healthy individuals in 2 large
prospective cohort studies, the Health Professionals Follow-up Study
and the Nurses' Health Study. Egg consumption was found to be
associated with a higher risk of CHD only in a subgroup analysis of
subjects with diabetes mellitus.
Marked variation in the natural history of prostate cancer complicates
treatment decisions for this disease. In a study of morphologic
characteristics of radical prostatectomy specimens from men with
peripheral zone prostate cancers treated with surgical excision alone,
Stamey and colleagues found that the proportion of each cancer scored
as Gleason grade 4/5 (poorly differentiated) and cancer volume were
strong independent predictors of prostate cancer progression as
indicated by an increasing prostate-specific antigen level. Other
independent predictors of prostate cancer progression included positive
lymph node findings and intraprostatic vascular invasion.
The cholinergic hypothesis of Alzheimer disease states that cholinergic
deficits occur early and their treatment should ameliorate symptoms of
the disease. However, in a postmortem study of the brains of elderly
patients, Davis and coworkersArticle found that subjects with mild functional
and cognitive impairment during the 6 months prior to death had no
evidence of either choline acetyltransferase or acetylcholinesterase
deficiency. Only patients with severe dementia had a significant
reduction in cholinergic markers compared with patients without
dementia. In an editorial, DaviesArticle notes an alternative hypothesis of
neuronal degeneration in the hippocampus to explain the early symptoms
of Alzheimer disease and considers pharmacologic strategies to slow or
prevent neuronal degeneration as alternatives to the
acetylcholinesterase inhibitors currently available.
Vitamin C (L-ascorbic acid) is a specific cofactor
for the optimal performance of enzymes in several metabolic pathways;
it enhances the gastrointestinal absorption of iron and has
demonstrated antioxidant activity. Levine and colleagues review recent
biochemical, epidemiologic, and clinical evidence as the basis for
updating recommendations for the dietary intake of
Sunscreens, in-office dispensing of nonprescription health products,
and future directions for the specialty were explored at this year′s
American Academy of Dermatology meeting.
A review of clinical trials of platelet glycoprotein IIb/IIIa receptor
antagonists for the treatment of patients undergoing percutaneous
coronary interventions and patients with acute coronary syndromes.
Mandatory disclosure of physician financial incentives in managed care
plans: legal, policy, and ethical considerations.
JAMA acknowledges with gratitudeArticle the contributions of the 3555
peer reviewersArticle who participated in manuscript reviews in 1998. More
than 4000 manuscripts were received.
For your patients: Facts about vitamin C.
This Week in JAMA. JAMA. 1999;281(15):1357. doi:10.1001/jama.281.15.1357