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This Week in JAMA
August 21, 2002

This Week in JAMA

JAMA. 2002;288(7):801. doi:10.1001/jama.288.7.801
Ginkgo and Cognitive Function in Older Adults

Over-the-counter preparations of ginkgo have been promoted as improving memory and other cognitive functions even though evidence supporting such claims is limited. In this randomized trial among adults older than 60 years, Solomon and coauthors found that outcomes on standardized neuropsychological tests of learning, memory, attention and concentration, and expressive language in the ginkgo group were not significantly different from those in the placebo group after 6 weeks of treatment. Self-reported memory function and caregiver global impression of change were also not significantly different in the 2 study groups.

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Cataract Surgery and Risk of Motor Vehicle Crash

Risk of motor vehicle crash is elevated in older drivers with cataract. Owsley and colleaguesArticle followed up patients with cataract aged 55 to 84 years and found that among patients who had cataract surgery, the rate of motor vehicle crash occurrence during the 4 to 6 years after surgery was significantly lower than among patients who did not undergo cataract surgery. In an editorial, KleinArticle points out risks associated with cataract surgery, in addition to potential benefits, that should be assessed when considering cataract surgery for an individual patient.

Changes in Methadone Treatment Practices, 1988-2000

Studies of US methadone maintenance programs in the early 1990s indicated that most programs did not meet established standards of care for heroin users, often using suboptimal doses of methadone. In this analysis of data from surveys of US methadone treatment programs in 1988, 1990, 1995, and 2000, D'Aunno and Pollack found that the percentage of patients in each treatment program receiving methadone dosage levels less than the recommended 60 mg/d decreased from 79.5% in 1988 to 35.5% in 2000.

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Pain Response in Newborns With Repeated Heel Lances

In this prospective cohort study, Taddio and colleagues assessed whether hospitalized infants who undergo repeated painful procedures learn to anticipate pain and exhibit more intense pain during subsequent procedures. They found that full-term newborns born to mothers with diabetes who underwent repeated heel lances in the first 24 to 36 hours of life had significantly higher grimacing and visual analog scale scores during skin cleansing and higher grimacing, crying, and visual analog scale scores during routine venipuncture after the first day of life compared with newborns of mothers with uneventful pregnancies who did not undergo repeated invasive procedures. Pain measures in response to intramuscular vitamin K injection were not significantly different.

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Low-dose Corticosteroid Therapy for Septic Shock

Recent studies suggest that severe sepsis may be associated with relative adrenal insufficiency. In this randomized trial, Annane and colleaguesArticle found that among patients with septic shock and relative adrenal insufficiency, 28-day mortality and duration of vasopressor therapy were significantly reduced in those who received a 7-day course of hydrocortisone and fludrocortisone compared with those who received placebo. Among patients with septic shock but without relative adrenal insufficiency, no significant differences in mortality or duration of vasopressor therapy were observed. In an editorial, Abraham and EvansArticle outline directions for future research on corticosteroid therapy for septic shock and advise using corticosteroids only for critically ill patients with septic shock who have documented abnormalities in adrenal reserve.

A Piece of My Mind

"I am a physician, but my strongest diagnostic tool—the patient history—is rendered completely ineffective by the tangled neurons of Alzheimer dementia." From "Cries and Whiskers."

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Medical News & Perspectives

What genes mean for the prediction, diagnosis, and treatment of disease is discussed in 2 articles, the firstArticle on genetic information privacy and counseling and the secondArticle on how genes' effect on therapeutic response may help physicians learn which agents offer the most help and least harm to patients with cancer.

CLINICIAN'S CORNER

In part 1Article of this article, benefits and harms of postmenopausal hormone replacement therapy for primary prevention of chronic conditions are assessed based on a systematic review of published studies. Four clinical situations presented in part 2Article illustrate management considerations for initiating and discontinuing hormone replacement therapy using current evidence.

Innovations in Primary Care

This first article in a series on innovations in primary care examines why primary care is important, why it is under stress, and why its redesign is necessary.

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JAMA Patient Page

For your patients: Information about hormone replacement therapy.

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