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).
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.
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
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.
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.
"How can patients know what answers are available to questions they
did not even know to ask?" From "Moral Wounds: Complicated Complications."
Alan Leshner, PhD, director of the National Institute on Drug Abuse,
talks with a Medical News reporter about his institute's current mandate and
A comprehensive review of the clinical literature on HIV infection in
women in the United States.
Recent advances in automated external defibrillator (AED) technology
and a review of AED effectiveness and the role of public access defibrillation.
Recommendations to update the current system for protecting human subjects
in clinical research consonant with recent changes in the conduct of clinical
Approaches to health care for displaced populations.
For your patients: Information about automated external defibrillators.
This Week in JAMA. JAMA. 2001;285(9):1121. doi:10.1001/jama.285.9.1121