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This Week in JAMA
December 16, 1998

This Week in JAMA

JAMA. 1998;280(23):1971. doi:10.1001/jama.280.23.1971
Behavioral Therapy Effective for Urinary Incontinence

Urinary incontinence in older patients is a prevalent condition associated with substantial psychosocial morbidity. In a randomized trial, Burgio and colleagues compared the effectiveness of biofeedback-assisted behavioral treatment, low-dose oxybutynin, and placebo for the treatment of urge or mixed urge and stress urinary incontinence in women aged 55 to 92 years. Both treatments were more effective than placebo, and patient satisfaction was highest in patients treated with behavioral therapy. In a related editorial, Resnick encourages physicians to be proactive in identifying and treating patients with incontinence.

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Lifestyle Changes and Cardiac Outcomes After 5 Years

In a 4-year follow-up of 35 patients with moderate to severe coronary heart disease who had previously participated in a 1-year trial of intensive lifestyle and dietary change, Ornish and colleagues found that patients in the experimental group had continued reduction in coronary artery percent diameter stenosis. In contrast, patients who received usual care had continued progression of coronary atherosclerosis and an increased risk of cardiac events.

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TB Screening of College and University Students

In a survey of a sample of US colleges and universities, Hennessey and coworkers found that most had a tuberculosis (TB) screening program but that screening practices were often inadequate and inefficient. In schools that accepted only Mantoux tests, a positive skin test result was reported in 2.1% of students at schools that screened all new students and in 22.9% of students at schools that screened only international students. The estimated rate of TB cases identified by required screening was less than 5 per 100,000 students screened, but the case rate among international students was about 30 times higher than that among US residents.

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Effects of TPN on Mortality and Morbidity

To assess the relationship between the use of total parenteral nutrition (TPN) in critically ill patients and mortality and morbidity outcomes, Heyland and colleagues conducted a meta-analysis of 26 randomized clinical trials. They found no overall effect of TPN on mortality rates in critically ill and surgical patients. In subgroup analyses, complication rates were significantly lower in patients treated with TPN in studies that included only malnourished patients and in those that did not use lipids. Studies that included only critically ill patients demonstrated a significant increase in mortality and complication rates associated with TPN compared with studies of surgical patients.

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Improving Physician Use of Diagnostic Tests

In a systematic review, Solomon and colleagues incorporated behavioral criteria in the methodologic assessment of 49 studies of interventions designed to influence the diagnostic testing behavior of physicians. They found that methodologic quality was generally low, but the success rate of interventions that targeted more than 1 behavioral factor was higher than that of interventions targeting a single behavioral factor. van Walraven and colleagues conducted a time-series analysis of claims submitted for laboratory tests and found that revision of requisition forms, funding policy changes, and guideline dissemination significantly improved the utilization of specific laboratory tests. In a related editorial, Lundberg outlines an approach to improve physician use of diagnostic tests.

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The Cover

François Boucher, Allegory of Music, 1752, French.

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Medical News & Perspectives

European neurologists focus their attention on the ills expected to beset a growing population of aging persons.

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Contempo 1998

Natriuretic peptides may provide a new approach for the detection and treatment of certain cardiovascular conditions.

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A Piece of My Mind

"I realized, for the first time, that I was seeing the forest for the trees." From "First Attending Rounds."

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JAMA NetSight

Web resources for practicing clinicians on HIV/AIDS.

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The Patient-Physician Relationship

Complexities of caring for colleagues.

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JAMA Patient Page

For your patients: Causes and treatment of urinary incontinence.

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