In a 2-year trial conducted in the late 1980s, patients with complicated
gastroesophageal reflux disease (GERD) who received open Nissen fundoplication
had better outcomes than patients who received medical management. In this
long-term follow-up of patients who participated in this trial, Spechler and
colleaguesArticle found that although patients in the surgical treatment group were
less likely to regularly use antireflux medications than patients in the medical
antireflux therapy group, the use of antireflux medication in the surgical
group was still substantial. There were no significant differences between
the groups in grade of esophagitis, incidence of esophageal cancer, frequency
of treatment of esophageal stricture, subsequent antireflux operations, or
satisfaction with antireflux therapy. Esophageal cancer was an uncommon cause
of death in both groups, but long-term survival was significantly less in
the surgical treatment group due to excess mortality from heart disease. In
an editorial, KahrilasArticle reconsiders the conventional indications for antireflux
surgery for patients with severe GERD.
The Chicago Child-Parent Center (CPC) Program provides comprehensive
educational, family, and health services to low-income children through age
9 years and their families. In this 15-year follow-up study, Reynolds and
colleaguesArticle report that children who participated in the preschool CPC program
had a higher rate of high school completion, more years of completed education,
and lower rates of juvenile arrest, violent arrest, and school dropout than
children who participated in alternative early childhood programs. Both preschool
and school-age CPC participation were associated with lower rates of grade
retention and special education services. In an editorial, Zigler and StyfcoArticle
discuss the importance of expanding early intervention programs to include
ongoing and comprehensive health and educational services to improve outcomes
among poor children.
Poor compliance limits the effectiveness of oral contraceptive (OC)
pills. Audet and colleagues conducted a randomized trial comparing OC pills
with the transdermal combination hormonal contraceptive patch, which is applied
weekly for 3 weeks followed by 1 patch-free week. Contraceptive efficacy,
the incidence of breakthrough bleeding and spotting, and safety were not significantly
different in the 2 groups, but the proportion of cycles with perfect contraceptive
compliance was significantly higher in the patch group.
Persons who use illicit drugs are hospitalized much more frequently
than comparably aged persons who do not use illicit drugs. Using data from
the New York State Medicaid program, Laine and colleagues report that 55.6%
of HIV-positive drug users and 37.5% of HIV-negative drug users were hospitalized
during federal fiscal year 1997. Among HIV-positive drug users, the adjusted
odds of hospitalization was lowest among those with both regular medical and
drug abuse care during the preceding year compared with those who received
neither type of care. Among HIV-negative drug users, the adjusted odds of
hospitalization was lowest among those who received regular drug abuse care
treatment alone or with regular medical care.
The Oregon Death with Dignity Act, enacted in October 1997, legalized
physician-assisted suicide for competent, terminally ill residents of Oregon.
Ganzini and colleagues surveyed Oregon physicians in 1999 who were eligible
to prescribe a lethal dose of medication under the Death with Dignity Act.
Most respondents who cared for patients with terminal illnesses reported that
they had made efforts to improve their knowledge of the use of pain medications
for these patients. Many physicians reported having had conversations with
patients about assisted suicide. One third of respondents were willing to
write a lethal prescription under the law.
"I understand now why he never told me how he caught the virus." From
Xenotransplantation: current research, immunological barriers, and risks
of infectious disease transmission.
Pennsylvania Hospital in Philadelphia— the first hospital in the
United States—celebrates its 250th anniversary with a bow to past accomplishments
and eyes on the future.
Atrial fibrillation, which is associated with a 5-fold increased risk
of stroke, is more common with increasing age. The number of US adults with
atrial fibrillation, currently estimated to be 2.3 million, is expected to
increase 2.5-fold during the next 50 years as the proportion of elderly individuals
For your patients: Information about gastroesophageal reflux.
This Week in JAMA . JAMA. 2001;285(18):2291. doi:10.1001/jama.285.18.2291