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This Week in JAMA
March 7, 2001

This Week in JAMA

JAMA. 2001;285(9):1121. doi:10.1001/jama.285.9.1121
Drug Combinations for Initial Treatment of HIV Infection

Monotherapy with abacavir, a potent inhibitor of HIV reverse transcriptase, has been shown to have antiretroviral activity comparable with that of protease inhibitors among treatment-naive patients infected with HIV. Staszewski and colleaguesArticle compared an abacavir-containing triple nucleoside analogue regimen (abacavir-lamivudine-zidovudine) with a conventional protease-containing regimen (indinavir-lamivudine-zidovudine) among adults infected with HIV who had not received prior antiretroviral treatment and who had a plasma HIV RNA level of at least 10 000 copies/mL and a CD4 cell count of at least 100 × 106/L. After 48 weeks, the proportion of patients who achieved a plasma HIV RNA level of 400 copies/mL or less was 51% in both the abacavir and indinavir groups. In an editorial, Djulbegovic and ClarkeArticle discuss how clinical trials like this one, designed to show that 2 treatments are the same (equivalence trials), differ from trials designed to test whether one treatment is better than another (superiority trials).

Trauma Center Volume and Patient Outcomes

For some areas of complex surgical care, higher surgical volume has been associated with better patient outcomes. In this retrospective study, Nathens and colleagues evaluated the association between trauma center volume and outcomes of patients with 2 types of trauma—penetrating abdominal injury and multisystem blunt trauma. Inpatient mortality was significantly lower at high-volume trauma centers (>650 trauma admissions/y) among patients at high risk for adverse outcomes (severe injury plus shock or coma) than among those admitted to low-volume centers. Patients with severe penetrating abdominal injury and all patients with multisystem blunt trauma admitted to high-volume centers had shorter hospital length of stay compared with patients admitted to low-volume centers.

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Internet-Based Weight Loss Program

Internet access provides an opportunity for computer-mediated health care interventions. Tate and colleagues studied the efficacy of an Internet behavioral weight loss program that provided educational resources, weekly behavioral weight loss lessons and individualized feedback in response to self-monitoring diaries of daily diet and exercise submitted electronically, and access to an electronic bulletin board for support. Overweight adult volunteers randomly assigned to the Internet behavior therapy group lost more weight at 3 and 6 months and had greater decreases in waist circumference than those assigned to a control intervention using only the educational and self-monitoring Web resources.

Vitamin E and Lipid Peroxidation

Oxidative damage appears to be important in the pathogenesis of many common diseases, but research findings on the benefits of antioxidants have been contradictory and until recently, quantitative indices of free radical–induced modification of lipids, proteins, and DNA in vivo have not been available. Meagher and colleagues randomly assigned healthy adult volunteers to receive 200, 400, 800, 1200, or 2000 IU/d of vitamin E or placebo for 8 weeks, followed by an 8-week washout period. Serum vitamin E levels increased in a dose-dependent manner during the study and reached a steady-state by 8 weeks, but no significant effect of vitamin E on 3 quantitative indices of lipid peroxidation was observed.

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Time Trends in Autism and MMR Immunization

Measles-mumps-rubella (MMR) immunization has been proposed as a possible cause for the marked increase in the caseload of children with autism enrolled in the California Department of Developmental Services system over the past 2 decades. In this analysis of data from California for birth cohorts from 1980 through 1994, Dales and colleagues found no correlation between trends in early MMR immunization coverage and the caseload of children with autism.

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A Piece of My Mind

"How can patients know what answers are available to questions they did not even know to ask?" From "Moral Wounds: Complicated Complications."

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Medical News & Perspectives

Alan Leshner, PhD, director of the National Institute on Drug Abuse, talks with a Medical News reporter about his institute's current mandate and future role.

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HIV Infection in US Women

A comprehensive review of the clinical literature on HIV infection in women in the United States.

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AEDs and Survival After Sudden Cardiac Arrest

Recent advances in automated external defibrillator (AED) technology and a review of AED effectiveness and the role of public access defibrillation.

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Safety of Participants in Clinical Research

Recommendations to update the current system for protecting human subjects in clinical research consonant with recent changes in the conduct of clinical trials.

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Approaches to health care for displaced populations.

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JAMA Patient Page

For your patients: Information about automated external defibrillators.

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