Drug and psychosocial therapies for panic disorder have been shown to
be efficacious, but these treatments have not been adequately compared alone
or in combination. In this multicenter trial, Barlow and colleaguesArticle randomly
assigned 326 patients with panic disorder to 1 of 5 treatment arms: imipramine
alone; cognitive-behavioral therapy (CBT) alone; placebo alone; imipramine
plus CBT; or placebo plus CBT. Outcomes for treatment with imipramine alone
and CBT alone were similar in both acute and maintenance phases of treatment
and better than with placebo. Outcomes for combined therapy were generally
better than for either therapy alone in the maintenance phase. In evaluations
6 months after treatment was discontinued, benefit from CBT alone or in combination
with placebo was most durable. In an editorial, GlassArticle urges recognition that
panic disorder is a syndrome with reliable diagnostic criteria for which effective
treatment is available.
In this analysis of data from the World Health Organization/International
Union Against Tuberculosis (TB) and Lung Disease drug-resistance surveillance
project, Espinal and colleaguesArticle report that in 6 countries/regions with a
large number of cases of multidrug-resistant TB, the failure rate for standard
short-course chemotherapy was significantly higher among new multidrug-resistant
TB cases than new susceptible cases, even in countries using 100% directly
observed therapy. In an editorial, HorsburghArticle stresses that containing multidrug-resistant
TB is a global public health emergency and outlines 3 commitments necessary
for an effective response to this crisis.
To determine whether hostility is associated with coronary artery calcification,
a marker of early subclinical atherosclerosis, Iribarren and colleagues analyzed
data from 374 young adults enrolled in the prospective Coronary Artery Risk
Development in Young Adults study. After 10 years, the percentage of persons
with coronary artery calcification, as measured by electron-beam computed
tomographic scans, and the proportion with more severe coronary artery calcification
(coronary artery calcium score of 20 or higher) increased with increasing
hostility score at baseline.
Epidemiologic studies have reported an association between diabetes
mellitus and risk of pancreatic cancer, but the role of abnormal glucose metabolism
in the etiology of pancreatic cancer is uncertain. In this analysis of data
from the Chicago Heart Association Detection Project in Industry, which included
25 years of follow-up and 139 pancreatic cancer deaths among 35,658 adults
without diabetes at baseline, Gapstur and colleagues found that the risk of
pancreatic cancer mortality increased as postload plasma glucose level increased
above 6.6 mmol/L (119 mg/dL) and was 2.2-fold higher for participants whose
postload plasma glucose level was at least 11.1 mmol/L (200 mg/dL) at baseline
compared with those whose level was less than or equal to 6.6 mmol/L (119
Data on the effectiveness of pulmonary artery catheters (PACs) for monitoring
critically ill patients are inconsistent, and appropriate PAC use is controversial.
In this retrospective study of PAC use among 831 (8.1%) of 10,217 nonoperative
patients treated in 34 intensive care units (ICUs) at 27 US hospitals, Rapoport
and colleaguesArticle found that PAC use varied with organizational characteristics
of ICUs, insurance reimbursement, and race, as well as clinical variables.
Probability of PAC use was reduced with full-time ICU physician staffing and
was increased with white race, private insurance coverage, and admission to
a surgical ICU. In an editorial, HallArticle describes the debate since PAC use was
challenged 4 years ago and emphasizes the importance of rigorous evaluation
of technologies for caring for critically ill patients.
See related article Article
"Like a band of zebras, the students shift to stay farthest from any
danger, constantly reassessing their positions between the patient, the son,
and the doctor." From "A Simple Observation."
A controversial marketing campaign saying a cigarette-like product is
less likely than conventional cigarettes to cause cancer and other smoking-related
illnesses is drawing fire from public health officials, scientists, and antismoking
Recommendations to improve use and safety of the pulmonary artery catheter
in critically ill patients: a consensus statement from an expert workshop
sponsored by the National Heart, Lung, and Blood Institute and the US Food
and Drug Administration.
See Article and related articles Article
How health care organizations can address socioeconomic, racial, and
ethnic disparities in health care through quality assurance programs.
For your patients: Information about panic disorder.
This Week in JAMA. JAMA. 2000;283(19):2493. doi:10.1001/jama.283.19.2493