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This Week in JAMA
JAMA. 1998;280:1727.
Cancer Surgery Mortality and Hospital Volume
In a retrospective analysis of data from the linked Surveillance, Epidemiology, and End Results (SEER)–Medicare database, Begg and colleagues (SEE ARTICLE) found that the 30-day mortality after complex surgical oncology procedures was significantly lower at hospitals with high volumes of these cases. In a related editorial, Hillner and Smith (SEE ARTICLE) suggest that high-risk oncologic surgery should be concentrated in designated high-volume centers to improve patient outcomes.
Sertraline Improves Symptoms of OCD in Children
Few trials of medications for the treatment of obsessive-compulsive disorder (OCD) have been conducted in children and adolescents, even though this population constitutes about half of all patients with OCD. In this 12-week multicenter trial, March and colleagues (SEE ARTICLE) found that children and adolescents treated with sertraline had significant symptomatic improvement compared with those who received placebo. In a related editorial, Rapoport (SEE ARTICLE) discusses the importance of further research on the neurobiology and pharmacotherapy of OCD in children.
Cost-effectiveness of Screening for Type 2 Diabetes
Type 2 diabetes is often undetected until after the development of microvascular complications. The CDC Diabetes Cost-Effectiveness Study Group developed a computer simulation model to estimate the cost-effectiveness of early diagnosis and treatment of type 2 diabetes. They found that a 1-time population-based screening program of individuals aged 25 years and older would be most cost-effective in younger individuals and those at high risk of developing major complications.
(SEE ARTICLE)
Dialysis Dose Inadequate Predictor of Survival
In a retrospective analysis of data from more than 18,000 patients with end-stage renal disease receiving hemodialysis, Owen and colleagues found that the association between the urea reduction ratio (the usual measure of dialysis dose) and survival varied according to race and sex subgroups. In white women, mortality risk increased steeply as the urea reduction ratio decreased below 60%, but this association was weak among black men.
(SEE ARTICLE)
Cardiac Arrhythmias With Erythromycin
The risk of torsades de pointes arrhythmias with antiarrhythmic drugs is greater in women than men, but this association has not been studied in other drug classes. In this 2-part study, Drici and colleagues found that voluntary reports of cardiac arrhythmias associated with erythromycin submitted to the FDA MEDWATCH Spontaneous Reporting System were more frequent for women than men. In studies of isolated rabbit hearts perfused with erythromycin, QT-prolongation was significantly greater in female than in male rabbit hearts.
(SEE ARTICLE)
Equivocal Efficacy of Tacrine in Alzheimer Disease
In a meta-analysis of data from 1984 patients in 12 trials of tacrine for the treatment of Alzheimer disease, Qizilbash and colleagues found that patients treated with tacrine had a slower rate of cognitive decline at 12 weeks than patients who received placebo. Improvements in behavioral disturbance in patients treated with tacrine were of uncertain clinical significance and there were no significant effects on functional autonomy.
(SEE ARTICLE)
The Cover
George Caleb Bingham, The Verdict of the People, c 1854-1855, American.
(SEE ARTICLE)
Medical News & Perspectives
Two new drugs—still in trials—hold the first real promise for treating influenza.
(SEE ARTICLE)
Contempo 1998
Changes in the health care system are shaping interactions between managed care plans and public health agencies.
(SEE ARTICLE)
Call for Papers: Medical Education
Original research, reviews, and commentaries are invited for the annual JAMA theme issue on medical education scheduled for September 1999.
(SEE ARTICLE)
Policy Perspectives
Access to care for poor children is improved by Medicaid coverage, but it is still inferior to that of nonpoor children with private health insurance.
(SEE ARTICLE)
From the JAMA Web Sites
Determining criteria for the selective screening of asymptomatic young women for Chlamydia trachomatis infection.
(SEE ARTICLE)
JAMA Patient Page
For your patients: A guide to obsessive-compulsive disorder.
(SEE ARTICLE)
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