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This Week in JAMA
January 16, 2002

This Week in JAMA

JAMA. 2002;287(3):279. doi:10.1001/jama.287.3.279
Laparoscopic-Assisted vs Open Colectomy

In this analysis of quality-of-life outcomes from the Clinical Outcomes of Surgical Therapy trial, an ongoing trial comparing laparoscopic-assisted colectomy (LAC) with open colectomy for resection of colon adenocarcinoma, Weeks and colleaguesArticle found that symptoms or quality of life in the immediate postoperative period or during 2 months of follow-up were not statistically significantly different after LAC than after open colectomy. Duration of postoperative in-hospital analgesia and length of hospital stay were slightly reduced in the LAC group. In an editorial, PetrelliArticle emphasizes that curative resection of colon cancer by LAC should not be performed outside of randomized controlled trials until the efficacy and safety of the procedure have been definitively established.

Dementia in Relatives of Alzheimer Disease Patients

Risk factors for Alzheimer disease (AD) have been well established in white populations, but evidence suggests that risk factors for AD may vary considerably in other populations. Green and colleagues conducted a risk analysis based on data collected at 17 medical centers from white and African American probands meeting criteria for definite or probable AD and from their families. First-degree biological relatives of African Americans with AD had a significantly higher cumulative risk of dementia by age 85 years than did relatives of whites with AD. The additional risk of dementia conferred by being a first-degree biological relative, by being female, or by the probability of having an APOE ∊4 allele was similar in African American and white families.

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Medication Use by US Adults

To assess the use of prescription and over-the-counter drugs in the United States, Kaufman and colleagues are conducting an ongoing telephone survey of a population-based sample of noninstitutionalized US adults. In this report of data collected in 1998 and 1999, 81% of respondents used at least 1 medication (prescription or over-the-counter drug, vitamin/mineral, or herbal/supplement) during the week preceding the survey. Fifty percent of respondents took at least 1 prescription drug, and 7% took 5 or more prescription drugs. Forty percent of the survey population took at least 1 vitamin/mineral, and 14% took at least 1 herbal/supplement.

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Survival of Patients Receiving Mechanical Ventilation

Factors that influence the survival of patients receiving mechanical ventilation have been identified in previous studies, but most of these studies have included patients receiving mechanical ventilation for a specific medical indication. To assess the relative importance of multiple factors that might influence survival, Esteban and colleagues conducted a multicenter, prospective study in a heterogeneous population of adult patients who received mechanical ventilation for more than 12 hours. Survival of patients who received mechanical ventilation was 69%. Factors associated with increased mortality included factors present at the start of mechanical ventilation, factors related to patient management, and clinical complications during the course of mechanical ventilation.

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Prevalence of the Metabolic Syndrome in US Adults

Based on an analysis of data from the Third National Health and Nutrition Examination Survey (1988-1994), an estimated 22% of US adults have the metabolic syndrome, a group of clinical features associated with increased risk of developing diabetes mellitus and cardiovascular disease and of cardiovascular and all-cause mortality.

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A Piece of My Mind

"There are certain potent experiences in life that become prisms through which our past and future are filtered and redefined, turning points according to which our lives are permanently rearranged in a before-and-after era." From "The Body Politic."

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Medical News & Perspectives

In the first large-scale attempt to determine whether US physicians' working conditions may contribute to the frequency and severity of medical errors, 2 forthcoming studies will gather systematic data on fatigue in medical settings.

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CLINICIAN'S CORNER: Hypoglycemic Therapy for Type 2 Diabetes

Part 1 of this 2-part article, first in the new JAMA series "Scientific Review and Clinical Applications,"Article systematically reviews recent evidence on the efficacy of oral hypoglycemic agents for the treatment of type 2 diabetes mellitus. In part 2Article, 4 clinical scenarios illustrate important considerations when choosing a specific antidiabetic pharmacological treatment regimen.

Scientific Review and Clinical Applications

In this issue, JAMA begins a new series of articles designed to provide physicians with the best available information and resources to guide clinical care. Part 1 of each article reviews and synthesizes the most recent evidence on a common clinical topic. In the second part, typical patient cases illustrate the application of this information in clinical practice.

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JAMA Patient Page

For your patients: Information about laparoscopy.

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