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This Week in JAMA
April 19, 2000

This Week in JAMA

JAMA. 2000;283(15):1931. doi:10.1001/jama.283.15.1931
JAMA-EXPRESS: α-Blocker Benefits Less Than Diuretic for Hypertension

The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) is a multicenter trial comparing treatment with a drug from each of 3 classes of antihypertensive agents (amlodipine, a calcium antagonist; lisinopril, an angiotensin-converting enzyme inhibitor; and doxazosin, an α-adrenergic blocker) with the active control chlorthalidone, a diuretic, in 24,335 adults with hypertension and at least 1 other coronary heart disease (CHD) risk factor. In an interim analysisArticle (median follow-up, 3.3 years), there was no significant difference in rates of fatal CHD or nonfatal myocardial infarction, or in total mortality between the doxasozin and chlorthalidone groups, but rates of stroke and combined cardiovascular disease events were significantly higher in the doxazosin group. Mean systolic blood pressure in the doxazosin group was about 2 to 3 mm Hg higher than in the chlorthalidone group and mean diastolic pressure was the same. In an editorial, LasagnaArticle points out that these results challenge the assumption that drugs that lower blood pressure equally have equal clinical benefit.

Insurance Plans and Use of Lower-Mortality Hospitals

Although risk-adjusted mortality rates for coronary artery bypass graft (CABG) surgery at hospitals in New York State have been available since the early 1990s, Erickson and colleaguesArticle report that from 1993 to 1996, patients with private managed care insurance and Medicare managed care insurance were significantly less likely than patients with private fee-for-service insurance to receive CABG surgery at a lower-mortality hospital. In an editorial, JencksArticle notes that use of comparative performance data by health care purchasers, physicians, and patients must increase if publication of these data is to create an effective market force for improved health care.

Nurse Home Visitation Program: 3-Year Follow-up

In a previously reported trial and 15-year follow-up of a prenatal and infancy home nurse visitation program in a low-income primarily white population in a semirural setting, women who received nurse visits during pregnancy and the first 2 years after the birth of the first child had significant and enduring benefits on maternal life course. Similar benefits were found in a second trial in a low-income primarily black, urban population through the end of the visitation program (2 years postpartum). In this follow-up 3 years after the end of this second program, Kitzman and colleagues found that women who received home visits had significantly fewer subsequent pregnancies, longer intervals between the birth of the first and second child, and lower use of welfare than women in the control group, but the magnitude of many of the benefits on maternal life course was smaller than in the first trial.

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Trauma Systems and Motor Vehicle Crash Mortality

Establishment of comprehensive systems of trauma care at the regional or state level has been promoted since the 1970s, but evidence of the effectiveness of organized trauma systems is limited. In this analysis comparing motor vehicle crash mortality rates before and after implementation of an organized trauma system in 22 states, 1979 through 1995, Nathens and colleagues found that crash-related mortality declined after implementation of an organized trauma system, but not until 10 years after implementation. About 15 years after implementation, crash-related mortality was reduced by 8%.

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Ketoconazole Fails to Improve ARDS Outcomes

Acute respiratory distress syndrome (ARDS) in adults has no proven effective pharmacologic therapy. In this clinical trial, the first reported from the multicenter ARDS Network, treatment of adults with early acute lung injury or ARDS with ketoconazole, a synthetic imidazole with anti-inflammatory activity, did not reduce in-hospital mortality or median number of ventilator-free days compared with placebo.

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A Piece of My Mind

"Anybody who wants to can, we believe, write a 55-word story." From "The Stories."

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Medical News & Perspectives

Advances in the development of polymers hold promise for such biomedical uses as improving vision, implanting drugs, and engineering body parts.

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Anergy Testing With Tuberculin Skin Test

Even in the presence of reactivity to control antigens, a negative tuberculin skin test result does not exclude either latent infection or active disease.

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Meta-analyses of Observational Studies

Recommendations for reporting meta-analyses of observational studies in epidemiology: results from an expert workshop.

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With Appreciation and Thanks

JAMA acknowledges the authors of the 3978 manuscripts received in 1999, sincerely thanks the 3651 peer reviewers, and expresses appreciation to our readers.

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JAMA Patient Page

For your patients: Testing for tuberculosis.

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