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This Week in JAMA
August 24/31, 2005

This Week in JAMA

JAMA. 2005;294(8):875. doi:10.1001/jama.294.8.875
Anesthesia-Assisted Heroin Detoxification

Anesthesia-assisted opioid detoxification with rapid antagonist induction has been publicized as a fast and painless way to achieve opioid withdrawal, but its efficacy and safety have not been rigorously assessed. Collins and colleaguesArticle randomly assigned treatment-seeking heroin-dependent patients to anesthesia-assisted rapid detoxification with naltrexone induction, buprenorphine-assisted rapid detoxification with naltrexone induction, or clonidine-assisted opioid detoxification with delayed naltrexone induction. The authors found that withdrawal severity, treatment completion and retention, and proportions of opioid-positive urine specimens during 12 weeks of outpatient treatment were comparable across the 3 methods of detoxification. Anesthesia-assisted withdrawal was associated with 3 potentially life-threatening adverse events. In an editorial, O’ConnorArticle discusses methods of opioid detoxification and the need for effective relapse prevention strategies.

Aspirin, NSAIDs, and Risk of Colorectal Cancer

Short-term aspirin use prevents recurrent colorectal adenoma, but whether regular use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) could offer primary prevention of colorectal cancer is not clear. Chan and colleagues investigated this question using prospectively collected medication and disease data from a large cohort of women. They observed a significantly lower risk of colon but not rectal cancer among women taking 2 or more aspirin or NSAIDs per week (regular users) compared with nonregular users. The greatest risk reduction was found among women who reported an aspirin intake of more than 14 tablets per week for 10 or more years.

Screening Healthy Infants for Iron Deficiency

Iron deficiency without anemia has been associated with neurocognitive impairment in infants, but hemoglobin level, the current standard for diagnosing iron deficiency, fails to identify infants who are deficient in iron but not yet anemic. Ullrich and colleagues assessed reticulocyte hemoglobin content (CHr) and hemoglobin values in healthy 9- to 12-month-old infants to determine an optimal CHr threshold for iron deficiency without anemia and to compare the usefulness of the 2 parameters for detecting iron deficiency. They suggest an optimal CHr cutoff for iron deficiency of 27.5 pg, which was more accurate than hemoglobin for detecting iron deficiency in the infants studied.

Endoscopic Ultrasound in Lung Cancer Staging

Imperfect preoperative staging of patients with non–small cell lung cancer results in an estimated 40% unnecessary thoracotomies. Annema and colleagues investigated the utility of adding transesophageal ultrasound–guided fine-needle aspiration to mediastinoscopy compared with mediastinoscopy alone for preoperative determination of mediastinal tumor invasion and lymph node metastases. They found that preoperative staging with the combined modes identified more patients who were not suitable candidates for surgical resection.

Race, Genetics, and Health

Race is often considered in analyses of genetic contributions to health risks. Bamshad discusses the limitations of using race as a predictor of genetic similarity and reviews evidence suggesting that geographic ancestry is superior to race in predicting genetic components of disease risk or treatment response.

Medical News & Perspectives

A landmark trial published in JAMA 40 years ago helped establish methadone maintenance as a standard therapy for opioid addiction. The study, and its outspoken authors, had a lasting impact on the field of addiction treatment.

Clinician's corner

Pain perception is unlikely prior to 29 or 30 weeks’ gestation.

See Article

Implantable Cardioverter-Defibrillators

Measures to enhance the safety and monitoring of implantable medical devices and improved identification of patients at risk of sudden cardiac death who might benefit from prophylactic placement of an implantable cardioverter-defibrillator are discussed in 2 commentaries.

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JAMA Patient Page

For your patients: Information about lung cancer.

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Author in the Room

“Impact of Varicella Vaccination on Health Care Utilization, 1994-2002,” published in the August 17, 2005, issue of JAMA, will be discussed for Author in the Room on September 21, 2005. Register for the conference and learn more at http://www.ihi.org/IHI/Programs/ConferencesAndTraining/Author+in+the+Room.htm.