Gastric acidity is 1 defense against ingested pathogens, and there is
some evidence that acid-suppressive therapy facilitates nosocomial infections.
In a case-control study, Laheij and colleaguesArticle investigated the association
between acid-suppressive drugs and the occurrence of community-acquired pneumonia.
They found that persons currently taking acid-suppressive drugs had an increased
risk of developing pneumonia compared with never users and those who had stopped,
and the risk was greater in users of proton pump inhibitors vs patients taking
H2-receptor antagonists. In an editorial, GregorArticle highlights the
importance of these findings in light of increasing use of gastric acid–suppressing
Developments in technique and adjunctive pharmacologic therapies have
resulted in fewer patients needing emergency coronary artery bypass graft
(CABG) surgery after percutaneous coronary interventions (PCIs). However,
whether it is safe to perform PCI in hospitals without onsite CABG surgery
programs is not clear. To address this question, Wennberg and colleaguesArticle examined
Medicare hospital data to compare in-hospital and 30-day mortality for patients
having PCIs in hospitals with and without onsite CABG programs. They found
that patients whose PCIs were nonemergent (not primary/rescue) and were performed
in hospitals without onsite CABG surgery capabilities had higher mortality
than similar patients who had PCIs in hospitals with CABG surgery programs.
In an editorial, WeaverArticle discusses the need for more data to determine whether
onsite surgical backup is needed in centers performing PCI.
Cognitive-behavior therapy (CBT) and medical management with a selective
serotonin reuptake inhibitor (SSRI) are proven therapies for pediatric obsessive-compulsive
disorder (OCD), but their relative and combined efficacy are not known. The
Pediatric OCD Treatment Study was a randomized, 12-week trial designed to
investigate the efficacy of CBT, medical management with sertraline, or the
2 combined vs placebo for initial treatment of OCD. The investigators found
children and adolescents in the 3 treatment groups had greater symptom relief
than patients taking placebo. Combined treatment was superior to either active
treatment alone and remission was best achieved with combined treatment or
Rates of appendiceal rupture and negative appendectomy in children are
high, but factors associated with these outcomes are not clear. Ponsky and
colleagues analyzed hospital- and patient-level characteristics to identify
factors related to these outcomes. They found the risk of rupture was higher
in Asian and black children compared with whites and uninsured or Medicaid-insured
children had a higher risk of rupture than children covered by private insurance.
Race and insurance status were not associated with negative appendectomy;
however, the negative appendectomy rate declined as hospital appendectomy
In analyses of national data from 2001 through 2003, Majumdar and colleagues
found significant declines in pharmaceutical industry promotion and physician
prescribing of hormone therapy after publication of harmful outcomes and lack
of net clinical benefit in the Women’s Health Initiative Estrogen Plus
After more than a half century of pioneering work that helped to establish
the concept of preventable and modifiable risk factors in cardiovascular disease,
Jeremiah Stamler, MD, continues to elucidate how addressing such risk factors
can improve human health.
An evidence-based review of tests to diagnose shoulder instability and
Budetti describes the deterioration of the US health care system in
the decade since President Clinton’s Health Security Act failed to win
US presidential candidates Senator John KerryArticle and President George W.
BushArticle outline their plans for improving healthcare access and
Photo credit: Kerry-Edwards 2004, Inc; Photo credit:
Bush-Cheney '04, Inc
For your patients: Information about obsessive-compulsive disorder.
This Week in JAMA. JAMA. 2004;292(16):1925. doi:10.1001/jama.292.16.1925