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Cognitive Rehabilitation After Traumatic Brain Injury
A variety of cognitive rehabilitation interventions are used for the
treatment of traumatic brain injury (TBI), but most of these interventions
have not been rigorously assessed. Salazar and colleaguesArticle compared comprehensive
interdisciplinary in-hospital rehabilitation to limited home rehabilitation
by randomly assigning active-duty military personnel who had sustained moderate-to-severe
closed head injury to one of these treatment strategies. One year after treatment,
the percentage of patients who had returned to gainful employment and who
were considered fit for military duty was similar in the 2 groups. Among patients
unconscious for more than 1 hour after head injury, the rate of fitness for
duty was higher in the hospital rehabilitation group. In an editorial, JordanArticle
discusses factors to consider when assessing the efficacy of cognitive rehabilitation
Venlafaxine XR for Generalized Anxiety Disorder
Treatment of generalized anxiety disorder with venlafaxine extended
release (XR) has been shown to be efficacious in short-term trials. In this
6-month controlled trial to assess the long-term efficacy and safety of venlafaxine
XR, Gelenberg and colleagues found that adults with generalized anxiety disorder
without coexisting major depressive disorder randomized to receive venlafaxine
XR had higher response rates to treatment than those in the placebo group.
Adverse events in the venlafaxine XR group tended to decrease with continued
Infant Hib Vaccine and
After a statewide Haemophilus influenzae type
b (Hib) infant vaccination program was initiated in Alaska in 1991, the annual
incidence of Hib disease in Alaskan children younger than 5 years markedly
declined. To determine the effect of the vaccination program on unimmunized
Alaskans aged 10 years and older, Perdue and colleagues compared the incidence
of invasive H influenzae disease in this older Alaskan
population in the period before introduction of the Hib vaccination program
(1980-1990) with the incidence after the program was introduced (1991-1996).
The overall incidence of H influenzae disease in
Alaskans aged 10 years and older declined 33% after introduction of the Hib
vaccination program. The incidence of Hib disease decreased 80%, whereas incidence
of invasive disease from other H influenzae serotypes
and nontypeable strains increased.
Exercise Training in Chronic CHF and LV Function
Endurance exercise training programs improve functional work capacity
in patients with chronic congestive heart failure (CHF) by enhancing endothelial
function and aerobic metabolism in skeletal muscle. To determine the effect
of long-term exercise training on left ventricular (LV) function and peripheral
resistance, Hambrecht and colleagues randomly assigned patients with stable
chronic CHF to 2 weeks of in-hospital ergometer exercise followed by 6 months
of home-based ergometer exercise training or to no intervention. After 6 months,
patients in the exercise training group had a significant reduction in total
peripheral resistance at rest and during peak exercise compared with the control
group, a significant increase in stroke volume at rest and at peak exercise,
and a small but significant reduction in left ventricular end diastolic and
end systolic diameters.
Recommendations for Primary Stroke Centers
Recent studies suggest that many hospitals do not have the necessary
organizational features or expertise to rapidly identify patients with acute
stroke or provide optimal treatment. Based on review of the published literature
since 1996 and expert opinion, Alberts and colleaguesArticle developed recommendations
for the formation and operation of primary stroke centers. These centers would
stabilize and provide emergency treatment for patients with acute stroke and
provide referral for further care. In an editorial, Barnett and BuchanArticle describe
community-wide reorganization strategies and resources necessary to develop
primary stroke centers.
A Piece of My Mind
"I had always preached to friends that life is too precious, too short,
and too uncertain. Don't wait to say the things you want to say to those you
love. Make each day count." From "Blood Lines."
Medical News & Perspectives
People exposed to pesticides in the home or garden may have a significantly
higher risk of Parkinson disease, according to a new study. Previously, only
occupational exposure had been studied and found relevant.
The Rational Clinical Examination
A systematic review of the accuracy of history and physical examination
for the diagnosis of carpal tunnel syndrome.
Public Health Law
Justification for public health regulation and proposed systematic evaluation
to assess whether a public health regulation is warranted.
JAMA Patient Page
For your patients: A primer on generalized anxiety disorder.
This Week in JAMA. JAMA. 2000;283(23):3037. doi:10.1001/jama.283.23.3037
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