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This Week in JAMA
May 9, 2001

This Week in JAMA

JAMA. 2001;285(18):2291. doi:10.1001/jama.285.18.2291
Long-term Outcomes of Therapies for Severe GERD

In a 2-year trial conducted in the late 1980s, patients with complicated gastroesophageal reflux disease (GERD) who received open Nissen fundoplication had better outcomes than patients who received medical management. In this long-term follow-up of patients who participated in this trial, Spechler and colleaguesArticle found that although patients in the surgical treatment group were less likely to regularly use antireflux medications than patients in the medical antireflux therapy group, the use of antireflux medication in the surgical group was still substantial. There were no significant differences between the groups in grade of esophagitis, incidence of esophageal cancer, frequency of treatment of esophageal stricture, subsequent antireflux operations, or satisfaction with antireflux therapy. Esophageal cancer was an uncommon cause of death in both groups, but long-term survival was significantly less in the surgical treatment group due to excess mortality from heart disease. In an editorial, KahrilasArticle reconsiders the conventional indications for antireflux surgery for patients with severe GERD.

Extended Early Intervention for Low-Income Children

The Chicago Child-Parent Center (CPC) Program provides comprehensive educational, family, and health services to low-income children through age 9 years and their families. In this 15-year follow-up study, Reynolds and colleaguesArticle report that children who participated in the preschool CPC program had a higher rate of high school completion, more years of completed education, and lower rates of juvenile arrest, violent arrest, and school dropout than children who participated in alternative early childhood programs. Both preschool and school-age CPC participation were associated with lower rates of grade retention and special education services. In an editorial, Zigler and StyfcoArticle discuss the importance of expanding early intervention programs to include ongoing and comprehensive health and educational services to improve outcomes among poor children.

Better Compliance With Contraceptive Patch vs Pills

Poor compliance limits the effectiveness of oral contraceptive (OC) pills. Audet and colleagues conducted a randomized trial comparing OC pills with the transdermal combination hormonal contraceptive patch, which is applied weekly for 3 weeks followed by 1 patch-free week. Contraceptive efficacy, the incidence of breakthrough bleeding and spotting, and safety were not significantly different in the 2 groups, but the proportion of cycles with perfect contraceptive compliance was significantly higher in the patch group.

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Outpatient Care and Hospitalizations Among Drug Users

Persons who use illicit drugs are hospitalized much more frequently than comparably aged persons who do not use illicit drugs. Using data from the New York State Medicaid program, Laine and colleagues report that 55.6% of HIV-positive drug users and 37.5% of HIV-negative drug users were hospitalized during federal fiscal year 1997. Among HIV-positive drug users, the adjusted odds of hospitalization was lowest among those with both regular medical and drug abuse care during the preceding year compared with those who received neither type of care. Among HIV-negative drug users, the adjusted odds of hospitalization was lowest among those who received regular drug abuse care treatment alone or with regular medical care.

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Attitudes and Practice After Death with Dignity Act

The Oregon Death with Dignity Act, enacted in October 1997, legalized physician-assisted suicide for competent, terminally ill residents of Oregon. Ganzini and colleagues surveyed Oregon physicians in 1999 who were eligible to prescribe a lethal dose of medication under the Death with Dignity Act. Most respondents who cared for patients with terminal illnesses reported that they had made efforts to improve their knowledge of the use of pain medications for these patients. Many physicians reported having had conversations with patients about assisted suicide. One third of respondents were willing to write a lethal prescription under the law.

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A Piece of My Mind

"I understand now why he never told me how he caught the virus." From "Familial Hepatitis."

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Contempo Updates

Xenotransplantation: current research, immunological barriers, and risks of infectious disease transmission.

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Medical News & Perspectives

Pennsylvania Hospital in Philadelphia— the first hospital in the United States—celebrates its 250th anniversary with a bow to past accomplishments and eyes on the future.

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Prevalence of Atrial Fibrillation

Atrial fibrillation, which is associated with a 5-fold increased risk of stroke, is more common with increasing age. The number of US adults with atrial fibrillation, currently estimated to be 2.3 million, is expected to increase 2.5-fold during the next 50 years as the proportion of elderly individuals increases.

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JAMA Patient Page

For your patients: Information about gastroesophageal reflux.

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