To compare outcomes of primary care provided by nurse practitioners
or by physicians, Mundinger and colleaguesArticle randomly assigned patients to receive
follow-up and ongoing primary care after an emergency department or urgent
care visit from either a nurse practitioner in independent practice or a physician.
Patient satisfaction after the initial appointment, health status at 6 months,
disease-specific physiologic measures for patients with asthma and diabetes,
and health services utilization after 6 and 12 months were similar in the
2 study groups. In an editorial, SoxArticle considers the generalizability of these
findings to long-term care and to other patient populations and clinical practices.
In this evaluation of 68 children who survived burns involving 70% or
more of the body surface, Sheridan and colleagues found that after an average
of 14.7 years after injury, scores on a health-related quality-of-life instrument
were similar to national norms and slightly better in the mental health domain.
Factors associated with higher scores in individual domains included better
functional status of the family, early reintegration with preburn activities,
and consistent follow-up in a multidisciplinary burn clinic for 2 years.
In a cohort of patients infected with human immunodeficiency virus (HIV)
beginning a new antiretroviral regimen, Sulkowski and colleagues found that
severe hepatotoxicity occurred in 31 of 298 patients, including 19 of 158
patients coinfected with hepatitis C or B virus, or both. Antiretroviral drug
regimens that included ritonavir were associated with the highest incidence
of severe hepatotoxicity. Coinfection with hepatitis C or B virus was associated
with a significantly increased risk of severe hepatotoxicity among patients
prescribed nonritonavir containing regimens, but most patients with chronic
viral hepatitis did not experience severe hepatotoxicity during antiretroviral
Human papillomavirus (HPV) DNA testing for detection of cervical cancer
may provide an option for screening self-collected specimens and an alternative
to cytologic techniques. In a study of previously unscreened women, Wright
and colleaguesArticle found that testing of patient-collected vaginal swabs for HPV
DNA was as sensitive as Papanicolaou smears of clinician-obtained cervical
samples for detection of high-grade squamous intraepithelial lesions (HSILs)
or invasive cancer, but less specific. In a cohort of women at high risk for
cervical cancer, Schiffman and colleaguesArticle found that a second-generation HPV
DNA test performed best at a positivity cut point HPV DNA level of 1.0 pg/mL
for detection of HSIL and cancer (sensitivity, 88.4%; specificity, 89%; referral
for colposcopic examination, 12.3% of women). Papanicolaou testing using atypical
squamous cells of undetermined significance as the cut point was less sensitive
(77.7%) but more specific (94.2%), and the referral rate was 6.9%. In an editorial,
CuzickArticle points out that the usefulness of HPV DNA testing and self-sampling
depends on the clinical setting in which they are used.
National Cholesterol Education Program (NCEP) guidelines recommend reduction
of low-density lipoprotein cholesterol (LDL-C) to 100 mg/dL (2.59 mmol/L)
or less in patients with coronary heart disease (CHD). Recently, the National
Committee for Quality Assurance (NCQA) established a performance measure that
set an LDL-C target level of less than 130 mg/dL (3.36 mmol/L) for patients
with a major CHD event between 60 and 365 days after hospital discharge. Lee
and colleagues discuss the rationale for each threshold and explain why the
NCEP target level, a clinical goal for the treatment of individual patients,
is consistent with the NCQA target level, a performance measure for the care
"In the field, ‘human rights' is not a theoretical concept or
an abstract set of laws. It is the difference between respect and rape, between
safety and death." From "For What Purpose?"
The new year ushers in a reassessment of goals for the health of the
nation, a major study on heart disease in one minority population, and a renewed
call for care during surgical operations.
A report on 39 community-based projects in the Robert Wood Johnson national
Reach Out program organized by practicing physicians to increase access to
health care for the uninsured and underinsured.
Catherine D. DeAngelis, MD, MPH, new editor of JAMA and editor-in-chief
of Scientific Publications and Multimedia, reaffirms unconditional editorial
independence and academic integrity of JAMA and the ARCHIVES Journals during
The complex nature of pain and approaches to pain management and palliative
For your patients: A primer on burns in children.
This Week in JAMA. JAMA. 2000;283(1):9. doi:10.1001/jama.283.1.9