Anesthesia-assisted opioid detoxification with rapid antagonist induction
has been publicized as a fast and painless way to achieve opioid withdrawal,
but its efficacy and safety have not been rigorously assessed. Collins and
colleaguesArticle randomly assigned treatment-seeking
heroin-dependent patients to anesthesia-assisted rapid detoxification with
naltrexone induction, buprenorphine-assisted rapid detoxification with naltrexone
induction, or clonidine-assisted opioid detoxification with delayed naltrexone
induction. The authors found that withdrawal severity, treatment completion
and retention, and proportions of opioid-positive urine specimens during 12
weeks of outpatient treatment were comparable across the 3 methods of detoxification.
Anesthesia-assisted withdrawal was associated with 3 potentially life-threatening
adverse events. In an editorial, O’ConnorArticle discusses
methods of opioid detoxification and the need for effective relapse prevention
Short-term aspirin use prevents recurrent colorectal adenoma, but whether
regular use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) could
offer primary prevention of colorectal cancer is not clear. Chan and colleagues
investigated this question using prospectively collected medication and disease
data from a large cohort of women. They observed a significantly lower risk
of colon but not rectal cancer among women taking 2 or more aspirin or NSAIDs
per week (regular users) compared with nonregular users. The greatest risk
reduction was found among women who reported an aspirin intake of more than
14 tablets per week for 10 or more years.
Iron deficiency without anemia has been associated with neurocognitive
impairment in infants, but hemoglobin level, the current standard for diagnosing
iron deficiency, fails to identify infants who are deficient in iron but not
yet anemic. Ullrich and colleagues assessed reticulocyte hemoglobin content
(CHr) and hemoglobin values in healthy 9- to 12-month-old infants to determine
an optimal CHr threshold for iron deficiency without anemia and to compare
the usefulness of the 2 parameters for detecting iron deficiency. They suggest
an optimal CHr cutoff for iron deficiency of 27.5 pg, which was more accurate
than hemoglobin for detecting iron deficiency in the infants studied.
Imperfect preoperative staging of patients with non–small cell
lung cancer results in an estimated 40% unnecessary thoracotomies. Annema
and colleagues investigated the utility of adding transesophageal ultrasound–guided
fine-needle aspiration to mediastinoscopy compared with mediastinoscopy alone
for preoperative determination of mediastinal tumor invasion and lymph node
metastases. They found that preoperative staging with the combined modes identified
more patients who were not suitable candidates for surgical resection.
Race is often considered in analyses of genetic contributions to health
risks. Bamshad discusses the limitations of using race as a predictor of genetic
similarity and reviews evidence suggesting that geographic ancestry is superior
to race in predicting genetic components of disease risk or treatment response.
A landmark trial published in JAMA 40 years ago helped
establish methadone maintenance as a standard therapy for opioid addiction.
The study, and its outspoken authors, had a lasting impact on the field of
Pain perception is unlikely prior to 29 or 30 weeks’ gestation.
Measures to enhance the safety and monitoring of implantable medical
devices and improved identification of patients at risk of sudden cardiac
death who might benefit from prophylactic placement of an implantable cardioverter-defibrillator
are discussed in 2 commentaries.
For your patients: Information about lung cancer.
“Impact of Varicella Vaccination on Health Care Utilization, 1994-2002,”
published in the August 17, 2005, issue of JAMA,
will be discussed for Author in the Room on September 21, 2005. Register for
the conference and learn more at http://www.ihi.org/IHI/Programs/ConferencesAndTraining/Author+in+the+Room.htm.
This Week in JAMA . JAMA. 2005;294(8):875. doi:10.1001/jama.294.8.875