In a retrospective analysis of data from the linked Surveillance,
Epidemiology, and End Results (SEER)–Medicare database, Begg and
colleaguesArticle found that the 30-day mortality after complex surgical
oncology procedures was significantly lower at hospitals with high
volumes of these cases. In a related editorial, Hillner and SmithArticle
suggest that high-risk oncologic surgery should be concentrated in
designated high-volume centers to improve patient outcomes.
Few trials of medications for the treatment of obsessive-compulsive
disorder (OCD) have been conducted in children and adolescents, even
though this population constitutes about half of all patients with OCD.
In this 12-week multicenter trial, March and colleaguesArticle found that
children and adolescents treated with sertraline had significant
symptomatic improvement compared with those who received placebo. In a
related editorial, RapoportArticle discusses the importance of further
research on the neurobiology and pharmacotherapy of OCD in children.
Type 2 diabetes is often undetected until after the development
of microvascular complications. The CDC Diabetes Cost-Effectiveness
Study Group developed a computer simulation model to estimate the
cost-effectiveness of early diagnosis and treatment of type 2 diabetes.
They found that a 1-time population-based screening program of
individuals aged 25 years and older would be most cost-effective in
younger individuals and those at high risk of developing major
In a retrospective analysis of data from more than 18,000
patients with end-stage renal disease receiving hemodialysis, Owen and
colleagues found that the association between the urea reduction ratio
(the usual measure of dialysis dose) and survival varied according to
race and sex subgroups. In white women, mortality risk increased
steeply as the urea reduction ratio decreased below 60%, but this
association was weak among black men.
The risk of torsades de pointes arrhythmias with antiarrhythmic drugs
is greater in women than men, but this association has not been studied
in other drug classes. In this 2-part study, Drici and colleagues found
that voluntary reports of cardiac arrhythmias associated with
erythromycin submitted to the FDA MEDWATCH
Spontaneous Reporting System were more frequent for women than men. In
studies of isolated rabbit hearts perfused with erythromycin,
QT-prolongation was significantly greater in female than in male rabbit
In a meta-analysis of data from 1984 patients in 12 trials of tacrine
for the treatment of Alzheimer disease, Qizilbash and colleagues found
that patients treated with tacrine had a slower rate of cognitive
decline at 12 weeks than patients who received placebo. Improvements in
behavioral disturbance in patients treated with tacrine were of
uncertain clinical significance and there were no significant effects
on functional autonomy.
George Caleb Bingham, The Verdict of the People, c 1854-1855,
Two new drugs—still in trials—hold the first real promise for
Changes in the health care system are shaping interactions between
managed care plans and public health agencies.
Original research, reviews, and commentaries are invited for the annual
JAMA theme issue on medical education scheduled for September
Access to care for poor children is improved by Medicaid coverage, but
it is still inferior to that of nonpoor children with private health
Determining criteria for the selective screening of asymptomatic young
women for Chlamydia trachomatis infection.
For your patients: A guide to obsessive-compulsive disorder.
This Week in JAMA. JAMA. 1998;280(20):1727. doi:10.1001/jama.280.20.1727