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This Week in JAMA
September 13, 2000

This Week in JAMA

JAMA. 2000;284(10):1207. doi:10.1001/jama.284.10.1207
JAMA-EXPRESS: Selective COX-2 Inhibitors and Gastrointestinal Toxicity

The therapeutic effect of nonsteroidal anti-inflammatory drugs (NSAIDs) is attributed to inhibition of cyclooxygenase (COX)-2, whereas the adverse gastrointestinal effects of NSAIDs are thought to be mediated by inhibition of COX-1. Silverstein and colleaguesArticle report that patients with osteoarthritis and rheumatoid arthritis treated for 6 months with celecoxib, a selective COX-2 inhibitor, in dosages 2 to 4 times the maximum recommended dosages, had a lower combined incidence of ulcer complications and symptomatic ulcers than patients treated with standard dosages of conventional NSAIDs. The decreased rate of ulcer complications and symptomatic ulcers, however, was found only among patients who were not also taking low-dosage aspirin, and overall, rates of ulcer complications alone were similar in the 2 treatment groups. In an editorial, Lichtenstein and WolfeArticle consider how current understanding of the physiologic activity of COX-1 and COX-2 might explain these findings.

Teaching Hospitals and Quality of Care for Acute MI

The cost of medical care at academic health centers is often higher than at nonteaching hospitals, but data on differences in the quality of care between the 2 types of institutions are also necessary to formulate health care policy and quality improvement programs. Allison and colleagues assessed the quality of care for 114,411 fee-for-service Medicare patients with acute myocardial infarction (MI) admitted to teaching and nonteaching hospitals. Quality of care was significantly better among patients admitted to teaching hospitals than among those admitted to nonteaching hospitals on 3 of 4 quality indicators. Unadjusted mortality rates at 30 days, 60 days, 90 days, and 2 years were lowest at major teaching hospitals, intermediate at minor teaching hospitals, and highest at nonteaching hospitals.

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Niacin as Lipid-Modifying Therapy in Diabetes

Niacin treatment may be an effective and safe lipid-modifying therapy even among patients with diabetes. In this analysis of data from the Arterial Disease Multiple Intervention Trial, Elam and colleagues found that participants with and without diabetes who received niacin had increased levels of high-density lipoprotein cholesterol and decreased levels of triglycerides and low-density lipoprotein cholesterol after 18 weeks of treatment. Changes in lipoprotein levels were significantly greater in the niacin treatment group than in the placebo group. Glucose levels were modestly increased among participants with and without diabetes who received niacin. Among participants with diabetes, HbA1c levels were unchanged in the niacin group, but decreased in the placebo group.

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Postlicensure Safety Surveillance for Varicella Vaccine

In this summary of postlicensure safety surveillance for varicella vaccine, Wise and colleagues report that 6574 cases of adverse events in recipients of varicella vaccine were reported to the US Vaccine Adverse Event Reporting System between March 17, 1995, and July 25, 1998, a rate of 67.5 reports per 100,000 doses sold. Approximately 4% of reports described serious adverse events, including 14 deaths, but a vaccine etiology for most of these serious events could not be confirmed.

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Therapy for Clinically Localized Prostate Cancer

In 2 recent trials, combined radiation therapy and androgen suppression therapy for locally advanced prostate cancer (T3, T4) was associated with better cancer-specific survival than treatment with radiation alone. In a retrospective study of men with clinically localized prostate cancer (T1, T2), D'Amico and colleagues found no difference in risk of prostate-specific antigen (PSA) failure between low-risk patients who received treatment with radiation therapy alone and those who also received 6 months of androgen suppression therapy, but risk of PSA failure was significantly reduced among intermediate- and high-risk patients who received combined treatment compared with radiation therapy alone.

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Contempo Updates

A review of recent studies that investigate the relationship between dental and oral diseases and general health.

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Medical News & Perspectives

Results of a recent nationwide survey make it clear that, contrary to general belief, physicians in nearly every state need not fear legal action if they prescribe sterile needles for injection drug users.

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Medical Specialization

An examination of the unstructured, rapid growth of medical specialization in the United States since the early 20th century raises questions about what is a rational balance of generalists and specialists in the physician workforce and how balance should be achieved.

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Users' Guides to the Medical Literature

Fundamental principles of evidence-based medicine that underlie the application of the Users' Guides to patient care.

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JAMA Patient Page

For your patients: A primer on medical research.

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