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This Week in JAMA
September 15, 1999

This Week in JAMA

JAMA. 1999;282(11):1015. doi:10.1001/jama.282.11.1015
Diagnostic Imaging and Appendicitis in Children

The accuracy of limited computed tomography with rectal contrast (CTRC) for the diagnosis of acute appendicitis in adults has been shown to be 98%, but its diagnostic value in children, in whom the diagnosis of acute appendicitis is particularly difficult, is not known. In a prospective study of 139 children aged 3 to 21 years who presented to an emergency department with equivocal clinical findings of acute appendicitis, Peña and colleagues found that a protocol using CTRC after negative or inconclusive results on pelvic ultrasonography was 94% accurate for the diagnosis of acute appendicitis. CTRC correctly changed patient management in 79 (73.1%) of 108 children.

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Prognostic Accuracy of the Duke Treadmill Score

Treadmill exercise testing for the diagnosis of coronary artery disease is less accurate when nonspecific ST-T abnormalities are present on resting ECG. Kwok and colleagues assessed the prognostic accuracy of the Duke treadmill score in 939 patients with symptoms of chest pain or dyspnea who had nonspecific ST-T abnormalities on resting ECG (study group) and 1466 patients who had normal resting ECG results (control group). Seven-year cardiac and overall survival rates among patients classified as high-risk according to the Duke treadmill score were worse than in the intermediate- and low-risk groups in both study and control populations. Within each risk category, rates of cardiac death and overall mortality were generally worse among study patients than among control patients.

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Research Quality and the Accuracy of Results

Using each of 25 different scales developed to identify high-quality trials, Jüni and colleagues reanalyzed a previously published meta-analysis of 17 trials that compared low-molecular-weight heparin with standard heparin for prevention of postoperative thrombosis. Results of the repeated meta-analyses varied depending on which quality scale was used, and, in some instances, reached opposite conclusions about treatment effect. In regression analyses, effect estimates did not differ significantly between high-quality and low-quality trials for any of the scales, and trial quality scores were not correlated with treatment effect. In a second article, Lijmer and colleagues examined 184 studies that evaluated 218 diagnostic tests and identified specific methodological problems and reporting deficiencies associated with overestimation of reported diagnostic accuracy. In an editorial, Berlin and Rennie discuss how quality of studies should be taken into account in the clinical interpretation of research results.

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Medicaid Managed Care and AMCs

Medicaid patients with chronic illnesses may disproportionately select Medicaid managed care organizations sponsored by academic medical centers (AMCs) over other health plans, putting AMCs at increased financial risk. In an analysis using Medicaid claims data from January 1994 through August 1995 for TennCare, the statewide Tennessee Medicaid managed care program, Bailey and colleagues found that the prevalence per 100,000 enrollees of 5 of 6 state-specified high-cost chronic medical conditions was higher for AMC managed care organizations compared with statewide and regional health plans.

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β-Carotene Supplementation and Risk of Type 2 DM

Both biological plausibility and results from observational studies suggest that the antioxidant β-carotene may reduce the risk of developing type 2 diabetes mellitus (DM). In this analysis of data from the Physicians' Health Study, however, Liu and coworkers found that the risk of developing type 2 DM among 10,765 healthy men randomly assigned to receive dietary supplementation with β-carotene for an average of 12 years was similar to that among a group of 10,712 men who received placebo.

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A Piece of My Mind

"I'd never seen a case of polio, measles, or diphtheria, but I had seen children shot, drowned, shaken, and hit by cars." From "Mikey."

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From the

Activation of apoptosis-inducing caspase-3 protein by HIV protease selectively kills HIV-infected cells in vitro, suggesting a novel strategy for the treatment of persons infected with HIV.

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Medical News & Perspectives

Advances in osteoarthritis research are leading toward improved treatment and prevention strategies that will help alleviate suffering and delay onset of this disabling disease.

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Grand Rounds

At the Clinical Center of the National Institutes of Health New therapies that modify T-cell costimulatory pathways may prevent chronic allograft rejection without global immunosuppression.

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Call for Papers: Peer Review Congress

Original research on editorial peer review is invited for the fourth International Congress on Peer Review in Biomedical Publications to be held in September 2001 in Barcelona, Spain.

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Letter From Hlabisa

In a district hospital in Hlabisa, South Africa, the demand for specific health services increased markedly between 1991 and 1998, coincident with rising HIV seroprevalence.

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JAMA Patient Page

For your patients: Appendicitis in children.

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