In previously published results of the Metoprolol CR/XL Randomized Intervention
Trial in Congestive Heart Failure (MERIT-HF), which enrolled 3991 patients
with congestive heart failure (CHF) and systolic dysfunction, total mortality
was 34% lower among patients assigned to receive controlled-release/extended-release
metoprolol (metoprolol CR/XL) in addition to standard therapy than in the
placebo group. In this report on outcomes of the MERIT-HF trial during a mean
follow-up of 12 months, Hjalmarson and colleaguesArticle found that patients in the
metoprolol CR/XL group had a lower risk of total mortality or all-cause hospitalization
and of mortality or hospitalization due to worsening heart failure, improved
symptoms of heart failure, and better quality of life compared with patients
in the placebo group. In an editorial, Califf and O'ConnorArticle discuss why most
patients with heart failure due to systolic dysfunction do not receive β-blocker
therapy despite evidence of its effectiveness and present ways to increase
its use in eligible patients.
Methadone maintenance therapy for opioid dependence has been shown to
be effective but requires indefinite treatment with a dependence-producing
medication and, in the United States, specialty care in methadone maintenance
clinics. In this trial comparing traditional methadone maintenance treatment
with a 180-day program of opioid detoxification supplemented with intense
psychosocial services, Sees and colleaguesArticle found that treatment retention
was higher in the methadone maintenance treatment group than in the detoxification
program, and rates of heroin use and drug-related HIV risk behaviors were
lower. Weinrich and StuartArticle describe 2 large opioid treatment programs in Scotland
that integrate primary care, specialty care, and methadone maintenance. The
proportion of injection drug users enrolled in these programs (60% to 80%
in Edinburgh; 41% to 73% in Glasgow) greatly exceeds that in the United States
(14% of heroin addicts). In an editorial, Rounsaville and KostenArticle discuss issues
of access and quality of care for treatment of opioid dependence.
Using data from the US 1997 National Immunization Survey, Feikema and
colleaguesArticle found that 21% of 22,806 children received an extra immunization
with at least 1 vaccine. In an editorial, DavisArticle observes that these findings
do not warrant a change in current immunization practices, but suggests that
more effort be directed toward creating a complete and accurate immunization
history for each child.
To determine whether women who lose bone mineral density (BMD) during
the first year of treatment for osteoporosis will continue to lose BMD if
the same treatment is continued, Cummings and colleagues analyzed data from
women enrolled in 2 clinical trials who completed 2 years of BMD monitoring
and adhered to study medication—5 mg/d of alendronate sodium in the
Fracture Intervention Trial; 60 or 120 mg/d of raloxifene hydrochloride in
the Multiple Outcomes of Raloxifene Evaluation trial. In both trials, most
women who lost BMD during the first year of treatment gained BMD in the second
year. Women who lost the most BMD in the first year gained the most in year
2, consistent with regression to the mean.
Therapy with permanent magnets is used for the treatment of musculoskeletal
conditions, but few studies have evaluated its effectiveness. In this crossover
trial that enrolled 20 patients with chronic low back pain, Collacott and
colleagues found no differences between treatment with bipolar permanent magnets
and sham magnet devices on measures of pain intensity, pain quality, or lumbosacral
range of motion.
Helicobacter pylori cytotoxin-associated gene
A (cagA) gene and risk of clinical gastrointestinal
disease in persons infected with H pylori.
With the advent of at least partial peace in the Balkans, psychiatrists
from the war-torn region are attempting to help survivors cope with their
residual mental trauma.
Incidence and pattern of injuries among professional jockeys during
official horse races at US tracks.
How selection and timing of antiretroviral therapy for human immunodeficiency
virus infection determine risk of drug resistance and may constrain treatment
options and alter response to future therapy.
For your patients: Information about opioid dependence and treatment.
This Week in JAMA. JAMA. 2000;283(10):1251. doi:10.1001/jama.283.10.1251