Severe acute respiratory syndrome (SARS) is an emerging infectious disease
that first manifested in humans in China in November 2002. As of April 28,
2003, SARS has been described in 28 countries involving 5050 individuals and
causing 217 deaths. In this retrospective case series, Booth and colleaguesArticle describe the clinical features and short-term outcomes
of 144 patients with a diagnosis of suspected or probable SARS admitted to
10 academic and community hospitals in the greater Toronto area between March
7 and April 10, 2003. In an editorial, Masur and coauthorsArticle compare
characteristics of the SARS outbreaks in Toronto and Hong Kong, consider strategies
to limit in-hospital disease transmission, and discuss the duty of physicians
and other health care professionals to care for patients infected with potentially
Low back pain is extremely common, and few treatments of abnormalities
detected with spine imaging have been shown to have any benefit. Jarvik and
colleaguesArticle conducted a clinical trial among
patients with low back pain whose primary care physicians ordered radiographs
for lumbar spine evaluation to assess whether replacing radiographs with rapid
magnetic resonance imaging (MRI), which may increase detection of incidental
abnormalities, would lead to more interventions and unnecessary morbidity.
Back pain functional disability, pain frequency, and general health 12 months
after randomization were not significantly different in the rapid MRI and
radiograph evaluation groups. More patients had undergone lumbar spine operations
and costs were greater in the rapid MRI group. In an editorial, HadlerArticle contends that imaging and common treatment modalities
for regional back pain are generally ineffective because regional back pain
is not the symptom of an underlying disease but rather a common morbidity
that becomes reportable when patients are unable to cope with it.
Laboratory and epidemiologic evidence suggests that inflammatory processes
may contribute to neuronal damage in Alzheimer disease (AD). In this randomized
placebo-controlled trial, however, Aisen and colleaguesArticle found
that treatment with either of 2 nonsteroidal anti-inflammatory drugs (NSAIDs),
naproxen or rofecoxib, did not decrease the rate of cognitive decline over
1 year among patients with mild-to-moderate AD. In an editorial, LaunerArticle discusses considerations for the design of future
Preliminary evidence that antidepressants that inhibit serotonin reuptake
may reduce menopausal hot flashes suggests that these agents may be an effective
alternative to hormone replacement therapy. In this clinical trial, Stearns
and colleagues randomly assigned women with menopausal hot flashes to receive
the selective serotonin reuptake inhibitor paroxetine controlled release (12.5
mg/d or 25 mg/d) or placebo. After 6 weeks, reductions in hot flash symptoms
in the paroxetine groups were significantly greater than in the placebo group.
Most states have child vehicle restraint laws that only cover children
through age 4 years, and data on the effectiveness of belt-positioning booster
seats for children older than 4 years who have outgrown their child safety
seats are lacking. In this cross-sectional study of children aged 4 to 7 years
who were occupants in an insured vehicle involved in a crash, Durbin and colleagues
found that the risk of injury was significantly lower for children who were
in belt-positioning booster seats than for children in seat belts.
A host of novel medications offer physicians new options for treating
psoriasis and psoriatic arthritis, although concerns remain about their potential
for immunosuppression, and their high cost may limit their use.
A cross-sectional study of home care patients in the 1996 and 1998 National
Home and Hospice Care Surveys indicates that after the 1997 Balanced Budget
Act, length of stay in home care decreased among Medicare patients, particularly
among those receiving care from for-profit home health agencies.
A systematic review of the literature from 1966 to April 2002 indicates
that the rate at which autopsies detect important, clinically missed diagnoses
has decreased over time.
Diagnosis, comorbidities, and management of gout.
For your patients: Information about autopsy.
This Week in JAMA . JAMA. 2003;289(21):2759. doi:10.1001/jama.289.21.2759