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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
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
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.
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.
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
"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
The "new look" in safety requires reconsidering the interaction of
patients, professionals, and complex systems.
An ethic for mediating conflicts between physician commitment to the
well-being of individual patients and social purposes of medicine.
"Would you say you ‘had sex' with someone
if . . . ?"—results from a 1991 survey of
undergraduate university students.
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.
For your patients: Health effects of obesity.
This Week in JAMA. JAMA. 1999;281(3):211. doi:10.1001/jama.281.3.211
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