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This Week in JAMA
May 17, 2000

This Week in JAMA

JAMA. 2000;283(19):2493. doi:10.1001/jama.283.19.2493
Drug and Psychosocial Treatments for Panic Disorder

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.

Short-Course Chemotherapy for Drug-Resistant TB

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.

Hostility and Coronary Artery Calcification

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.

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Glucose Metabolism and Pancreatic Cancer Mortality

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 mg/dL).

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Organizational and Patient Factors Related to PAC Use

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.

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A Piece of My Mind

"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."

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Medical News & Perspectives

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 advocates.

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Use of Pulmonary Artery Catheters

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 and Article

Disparities in Health Care: A Quality Issue

How health care organizations can address socioeconomic, racial, and ethnic disparities in health care through quality assurance programs.

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JAMA Patient Page

For your patients: Information about panic disorder.

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