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This Week in JAMA
September 22/29, 1999

This Week in JAMA

JAMA. 1999;282(12):1107. doi:10.1001/jama.282.12.1107
JAMA-EXPRESS: Transmission of Drug-Resistant HIV

Combination antiretroviral therapy without resistance testing is the standard empirical initial treatment of individuals infected with human immunodeficiency virus (HIV), despite evidence of transmission of drug-resistant HIV. In a cohort of 80 individuals newly infected with HIV, Boden and colleagues identified 13 (16.3%) with virus strains with known resistance-conferring mutations to any antiretroviral agent. Fifty-seven of 67 HIV variants had phenotypic drug susceptibility consistent with the genotypic analysis. In a second study, Little and colleagues identified 3 individuals infected with HIV strains with greater than 10-fold reduction in antiretroviral susceptibility among 141 individuals recently infected with HIV. Intermediate drug resistance (greater than 2.5- to 10-fold reduction in susceptibility) was identified in viral isolates from 36 individuals (26%). In an editorial, Pomerantz emphasizes the need to establish the clinical relevance of the levels of phenotypic drug resistance identified in these studies and suggests that resistance testing be used when full viral suppression is not achieved during initial combination antiretroviral therapy.

See Article and Article and editorial Article

Rehospitalization After Early Newborn Discharge

To assess outcomes of early newborn hospital discharge in low-income populations, Kotagal and colleagues reviewed Ohio Medicaid claims data linked to vital statistics files from 102,678 full-term healthy newborns born to women receiving Medicaid for at least 30 days after birth. The mean hospital length of stay for newborns decreased from 2.2 days in 1991 to 1.6 days in 1995, and the proportion of newborns discharged after a short stay (less than 1 day after a vaginal delivery and less than 2 days after cesarean delivery) increased from 21% to 59.8%. The proportion of newborns who received outpatient care increased significantly during this period, but rehospitalization rates at 7 and 14 days after discharge decreased. In multivariate analyses, short stay was not significantly associated with rehospitalization rates.

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Assessment of Change in Health Status

In clinical trials, the assessment of change in health status is typically derived from calculating the difference between serial measurements, but in clinical practice, change in health status is assessed by retrospective patient report. Fischer and coworkers found that in a longitudinal study of 202 patients starting new therapy for chronic arthritis, the overall agreement of serial measurement of change in health status with retrospective assessment was poor. Retrospective assessment was more sensitive to change than serial measurement and was correlated more strongly with patient satisfaction with change.

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Health Care Fraud and Abuse

Enforcement of health care fraud and abuse laws has been increasing. Kalb describes 3 principal types of fraudulent conduct (false claims, kickbacks, and self-referral), their direct civil and criminal consequences, and their secondary consequences, such as loss of licensure. In an editorial, Sage traces the recent evolution of fraud and abuse law as the health care system has changed and offers common sense advice to physicians.

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A 26-Year-Old Woman Seeking an Abortion

Ms B and her partner had been using periodic abstinence for contraception for 6 years. When she learned she was pregnant soon after missing her menstrual period, she wanted an abortion and was referred to a family planning clinic. Grimes discusses the epidemiology of abortion, access to abortion, psychological outcomes, and new developments in medical and surgical abortion in early pregnancy.

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A Piece of My Mind

"While my wife is in the OR, I will drink dark, bitter coffee in a crowded room as I await the surgeon to give me good news." From "What We Are Made Of."

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Contempo 1999

Pediatric poisoning: Recent epidemiologic trends and treatment advances.

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Medical News & Perspectives

New reports on the surgical treatment of patients with Parkinson disease include the results of several studies around the world focusing on deep brain stimulation and fetal cell transplantation.

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Measuring Quality

A report of the key findings from the National Committee for Quality Assurance Committee on Performance Measurement outlines essential elements of an integrated electronic health information framework to measure clinical performance.

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JAMA Patient Page

For your patients: A primer on newborn care.

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This Week Online

New! The Virtual Mentor Web site, a joint project of MSJAMA and the AMA Institute for Ethics.