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This Week in JAMA
June 4, 2003

This Week in JAMA

JAMA. 2003;289(21):2759. doi:10.1001/jama.289.21.2759
JAMA-EXPRESS: Characteristics, Outcomes of SARS Outbreak in Toronto

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 dangerous pathogens.

Rapid MRI vs Radiographs for Low Back Pain

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.

NSAIDs and Progression of Alzheimer Disease

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 AD trials.

Paroxetine Controlled Release Therapy for Hot Flashes

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.

Article
Belt-Positioning Booster Seats and Injury Risk in Crashes

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.

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Medical News & Perspectives

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.

Article
Home Care Stay After Balanced Budget Act

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.

Article
Autopsy-Detected Diagnostic Errors

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.

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CLINICIAN'S CORNER

Diagnosis, comorbidities, and management of gout.

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JAMA Patient Page

For your patients: Information about autopsy.

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