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This Week in JAMA
January 20, 1999

This Week in JAMA

JAMA. 1999;281(3):211. doi:10.1001/jama.281.3.211

Orlistat and Weight Reduction

Orlistat, a gastrointestinal lipase inhibitor, blocks the absorption of about one third of ingested fat and may offer a useful approach to the treatment of obesity. Davidson and colleaguesArticle found that patients treated with orlistat, 120 mg 3 times per day, plus a hypocaloric diet (Figure 1 [adapted], lines 1, 2, 3) lost significantly more weight during the first year of a trial than patients who received placebo plus diet (line 4), and regained less weight during the second year of the trial (line 1) than did patients who received a lower dose of orlistat in year 2 (line 2), orlistat followed by placebo (line 3), or placebo for 2 years (line 4). In an editorial, WilliamsonArticle points out shortfalls of obesity studies and important research questions yet to be addressed.

Safety of Pneumococcal Revaccination

Concerns about adverse effects of pneumococcal revaccination may limit its clinical use, despite national recommendations that support revaccination. Jackson and colleaguesArticle compared reaction rates following initial and repeat pneumococcal vaccination in elderly and chronically ill adults and found that revaccination 5 or more years after initial vaccination was associated with a higher rate of local reactions than was first vaccination, but the reactions were localized and self-limited. In an editorial, NicholArticle emphasizes the need to increase pneumococcal vaccination rates in populations at high risk for invasive pneumococcal disease.

Prevalence of Lysosomal Storage Disorders

Few epidemiologic data are available to inform the development of screening and treatment programs for lysosomal storage disorders. In this 16-year retrospective analysis of enzymatic diagnoses of lysosomal storage disorders in Australia, Meikle and coworkers identified 545 cases representing 27 different disorders. Although the occurrence of any individual lysosomal storage disorder was relatively uncommon, the prevalence of these disorders as a group was 1 per 7700 live births.

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Increasing the Supply of Rural Physicians

The Physician Shortage Area Program (PSAP) of Jefferson Medical College (JMC) was started in 1974 to increase the number of physicians in rural areas, which remain seriously underserved. Rabinowitz and coworkers followed up all 206 physicians who graduated from the PSAP program between 1978 and 1991 and found that they accounted for a disproportionately large number of Pennsylvania medical school graduates practicing in rural Pennsylvania. PSAP graduates were much more likely than non-PSAP graduates of JMC to practice in rural or underserved areas and to practice family medicine, and the retention rate of PSAP physicians practicing family medicine in rural or underserved areas during the past 5 to 10 years was high.

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Reduction of Catheter-Related Bloodstream Infections

Chlorhexidine-silver sulfadiazine–impregnated central venous catheters have been associated with a reduction in catheter colonization, but the impact on catheter-related bloodstream infections has been less certain. In this meta-analysis of the results of 13 randomized trials, Veenstra and colleagues found a significant decrease in both central venous catheter colonization and catheter-related bloodstream infection with impregnated central venous catheters compared with nonimpregnated catheters.

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A Piece of My Mind

"The patient, once a warrior who wore the imposing headdress of the Huli bachelor cult and wielded a stone ax, now is in extremis—a balding, defenseless patriarch, a lapun." From "Underlying Cause."

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Medical News & Perspectives

The "new look" in safety requires reconsidering the interaction of patients, professionals, and complex systems.

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Health Law and Ethics

An ethic for mediating conflicts between physician commitment to the well-being of individual patients and social purposes of medicine.

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Brief Report

"Would you say you ‘had sex' with someone if . . . ?"—results from a 1991 survey of undergraduate university students.

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The Patient-Physician Relationship

Physicians often quickly redirect the medical interview before patients complete their statement of concerns. Allowing patients to complete their statement would require on average only 6 seconds more time.

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JAMA Patient Page

For your patients: Health effects of obesity.

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