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Muscle wasting and fatigue contribute to the morbidity and
mortality experienced by individuals undergoing hemodialysis and by
those infected with human immunodeficiency virus (HIV). Johansen and
colleaguesArticle report that patients undergoing hemodialysis with evidence
of malnutrition or poor quality of life who were treated for 6 months
with weekly injections of the anabolic steroid nandrolone decanoate had
significantly greater increases in lean body mass and improvements in
functional capacity than patients who received placebo. In an 8-week
study of eugonadal men infected with HIV who had prior weight loss,
Strawford and coworkersArticle found that increases in nitrogen retention,
lean body mass, and strength were greater among subjects treated with
the anabolic steroid oxandrolone along with a physiologic replacement
dose of testosterone and progressive resistance exercise compared with
subjects treated with testosterone and exercise alone. In an editorial,
DobsArticle points out that adequate energy intake and resistance exercise are
baseline interventions for patients with decreased lean body mass
secondary to chronic disease and that more research is needed to define
the role of anabolic steroids.
Individuals with diabetes have not experienced the same recent declines
in heart disease mortality as individuals without diabetes. Gu and
colleagues determined mortality rates in nationally representative
adult cohorts during 2 periods, 1971 through 1975 and 1982 through
1984. Each cohort was followed up for 8 to 9 years. Age-adjusted heart
disease mortality decreased more between the 2 periods for men without
diabetes (36.4%) than for men with diabetes (13.1%). Age-adjusted
mortality declined 27% for women without diabetes but increased 23%
for women with diabetes.
Measures of health-related quality of life may be a useful and
noninvasive clinical tool for the assessment of risk prior to coronary
artery bypass graft (CABG) surgery. In a multicenter Veterans Affairs
prospective study, Rumsfeld and coworkers found that the preoperative
Physical Component Summary score on the self-administered Short Form 36
health status survey was a significant independent predictor of
all-cause 6-month mortality following CABG surgery.
Smyth and colleaguesArticle report that patients with asthma or rheumatoid
arthritis who wrote about the most stressful experience in their life
for 20 minutes on 3 consecutive days had significantly greater
reductions in symptoms 4 months after the intervention than patients in
the control group who wrote about their daily plans. In an editorial,
SpiegelArticle summarizes the recent literature on the relationship between
stress and health outcomes.
Using patient outcome data from the Maryland Uniform Health Discharge
Data Set and survey data from intensive care unit (ICU) medical
directors, Pronovost and coworkersArticle found that daily rounds with an ICU
physician were associated with a 3-fold decrease in in-hospital
mortality after abdominal aortic surgery. Organizational features and
processes of care associated with increased ICU length of stay
and/or hospital length of stay included no daily rounds with
an ICU physician, ICU nurse-to-patient ratio of less than 1:2, no
monthly review of morbidity and mortality, and extubation of patients
in the operating room. In an editorial, RandolphArticle comments that certain
ICU organizational changes anticipated to decrease costs may actually
increase costs if adverse patient outcomes result in increased resource
Helical computed tomography offers innovative imaging possibilities,
such as virtual colonoscopy for the noninvasive detection of colorectal
polyps (Figure 1).
Use of low-dose oral contraceptives does not appear to increase
stroke risk, but more information is needed on women with coexisting
risk factors for stroke.
A preview of 2 new traveling exhibitions: "The Changing Face of
Women's Health" at Baltimore's Maryland Science Center and
"Breath of Life" at the National Library of Medicine in Bethesda.
Which drugs are effective for the treatment of alcohol dependence? A
systematic review of the literature.
A recent outbreak of type A botulism in Argentina prompts the
development of a centralized antitoxin release and botulism
For your patients: A primer on problem drinking and alcoholism.
This Week in JAMA. JAMA. 1999;281(14):1249. doi:10.1001/jama.281.14.1249