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This Week in JAMA
October 10, 2001

This Week in JAMA

JAMA. 2001;286(14):1677. doi:10.1001/jama.286.14.1677
Addiction Treatment and Primary Care

Addiction treatment is seldom coordinated with general medical care, despite the high prevalence of medical disorders among patients with substance abuse or dependence. Two randomized controlled trials reported in this issue of THE JOURNAL compare usual treatment of addiction disorders in specialized settings with treatment integrated with primary care or provided by primary care physicians. Weisner and colleaguesArticle found that abstinence outcomes in an integrated care group, in which primary care was included in the addiction treatment program, were similar to those in an independent care group, in which substance abuse treatment and primary care were provided separately. But among patients with substance abuse–related medical conditions, integrated care was associated with better abstinence outcomes and was cost-effective. Fiellin and colleaguesArticle, in a study of patients with opioid dependency stable on methadone maintenance, found that outcomes among those transferred to office-based methadone treatment provided by primary care physicians were generally comparable to those among patients who continued usual care in a narcotic treatment program. In an editorial, Stein and FriedmannArticle discuss generalist-specialist collaboration in the care of patients with addictive disorders and other chronic diseases.

Drug Coverage and Medication Use Among Elderly

Cost-sharing, which has been shown to influence the use of health care resources, varies among US prescription drug plans for elderly persons. In this analysis of data from the 1997 Medicare Current Beneficiary Survey, Federman and colleaguesArticle found that elderly Medicare beneficiaries with coronary heart disease who did not have drug coverage had larger out-of-pocket drug expenditures and lower use of statins compared with elderly Medicare patients with employer-sponsored drug coverage. In a commentary, BodenheimerArticle discusses factors that have contributed to the increase in pharmaceutical expenditures during the 1990s and proposes ways to make prescription drugs affordable for elderly persons.

IFN-γ Assay vs Tuberculin Skin Test to Detect Latent TB

Skin testing with purified protein derivative of tuberculin is widely used to detect latent Mycobacterium tuberculosis infection despite its known limitations as a diagnostic test. Mazurek and colleagues compared an interferon γ (IFN-γ) assay, an in vitro test that detects cell-mediated immunity to tuberculin, with tuberculin skin testing in a group of adults with varying risks of M tuberculosis infection or documented or suspected active tuberculosis (TB). The IFN-γ assay was comparable to tuberculin skin testing overall and specifically in its ability to detect latent M tuberculosis infection. It was less affected by prior BCG vaccination and discriminated responses due to nontuberculous mycobacteria.

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Misdiagnosis of Appendicitis Unchanged

Advanced diagnostic testing, including computed tomography, ultrasonography, and laparoscopy, has become increasingly available for the evaluation of patients with equivocal signs of appendicitis. In this analysis of data from Washington state, however, Flum and colleagues found that the frequency of misdiagnosis leading to unnecessary appendectomy did not change between 1987 and 1998.

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Contempo Updates

New models of the interaction between depression and other medical illnesses.

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Medical News & Perspectives

Recognition of the importance of design innovations and modifications on the delivery of health care and on individual well-being has resulted in improving living conditions for elderly people at home as well as making hospital stays more comfortable and resource-efficient.

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Serial SOFA Scores as Prognostic Indicator

A study among patients admitted to an intensive care unit indicates that repeated measurement of the Sequential Organ Failure Assessment (SOFA) score provides reliable prediction of mortality.

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Limitations of Early Pregnancy Testing

In this study of women planning to conceive, the estimated day of blastocyst implantation occurred after the first day of the next expected menses in 10% of pregnancies, and in these cases, pregnancy most likely would not be detected using human chorionic gonadotropin–based tests performed on the first day of the missed period.

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JAMA Patient Page

For your patients: Information about pregnancy testing.

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