Erectile dysfunction is a frequent complication in men with diabetes
mellitus. In this trial by Rendell and colleaguesArticle, men with erectile
dysfunction and type 1 or type 2 diabetes mellitus were randomly
assigned to receive a flexible dose of oral sildenafil or placebo for
12 weeks. Improvement in erectile function was significantly greater in
the sildenafil group than in the placebo group. Cardiovascular adverse
events were uncommon and were similar in the 2 groups. In a commentary,
Lipshultz and KimArticle discuss treatment strategies for erectile dysfunction
in men with diabetes.
If bacterial infections increase the risk of acute myocardial
infarction (MI), then antibiotic use for any reason might decrease the
risk of acute MI. In this large case-control study, Meier and
colleaguesArticle found that individuals with a first MI were much less likely
to have used tetracycline antibiotics or quinolones in the previous 3
years than were matched controls. In an editorial, FolsomArticle emphasizes
that evidence supporting an infectious etiology of atherosclerotic
vascular disease is inconclusive and not sufficient to warrant the
addition of antibiotics to established interventions for the prevention
or treatment of MI.
By altering the availability of medical services and physician practice
patterns, managed care may have system-wide effects that influence the
care of patients whether or not they are enrolled in a managed care
plan. Using regression models to test this hypothesis, BakerArticle found that
increased market share of health maintenance organizations was
associated with decreased expenditures for the care of patients in
traditional Medicare fee-for-service plans. In an editorial, ReinhardtArticle
discusses models of physician behavior that might explain Baker's
Previous studies have suggested an association between blood pressure
and cognitive function in the elderly. In this longitudinal study of
elderly individuals, Glynn and coworkers examined the relationship
between blood pressure and performance on 2 brief tests of cognition
and memory. In general, blood pressure measurements at baseline or 9
years prior to baseline were not predictive of a change in cognitive
function. Slightly increased error rates on 1 of the tests during 6
years of follow-up, however, were observed in individuals with elevated
or low blood pressure at baseline or 9 years before baseline relative
to those with normal blood pressure.
In this Grand Rounds at The Johns Hopkins Hospital, Auwaerter discusses
the case of a previously healthy 42-year-old man who presented with
fever, gastrointestinal symptoms, and fatigue. A prolonged febrile
illness followed with pneumonia, hepatitis, and eventually pharyngitis.
Test results for hepatitis A, B, and C were negative. White blood cell
counts were normal, but inspection of a peripheral blood smear in the
fourth week of illness provided diagnostic clues.
"The presence of a want does not equate with the existence of a
need." From "A Vision of Health Care in the Next Millennium."
George D. Lundberg ousted as editor.
Health care policy experts tell what to expect in the quality arena
this year, including federal legislation, private initiatives, and
Is there a point at which continued growth in medical care is likely to
produce harm? An examination of how more medical care may lead to
unintended harm and how to avoid harmful practices.
JAMA and editorial independence.
Revisiting the history and traditions underlying medicine's symbols:
the white coat, serpents, staffs, and Aesculapius.
For your patients: Basics of high blood pressure.
This Week in JAMA. JAMA. 1999;281(5):399. doi:10.1001/jama.281.5.399