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This Week in JAMA
JAMA. 1999;281:399.
Treatment of Diabetes-Related Erectile Dysfunction
Erectile dysfunction is a frequent complication in men with diabetes mellitus. In this trial by Rendell and colleagues, men with erectile dysfunction and type 1 or type 2 diabetes mellitus were randomly assigned to receive a flexible dose of oral sildenafil or placebo for 12 weeks. Improvement in erectile function was significantly greater in the sildenafil group than in the placebo group. Cardiovascular adverse events were uncommon and were similar in the 2 groups. In a commentary, Lipshultz and Kim discuss treatment strategies for erectile dysfunction in men with diabetes.
(SEE ARTICLE) and commentary (SEE ARTICLE)
Antibiotic Use and Risk of Acute MI
If bacterial infections increase the risk of acute myocardial infarction (MI), then antibiotic use for any reason might decrease the risk of acute MI. In this large case-control study, Meier and colleagues found that individuals with a first MI were much less likely to have used tetracycline antibiotics or quinolones in the previous 3 years than were matched controls. In an editorial, Folsom emphasizes that evidence supporting an infectious etiology of atherosclerotic vascular disease is inconclusive and not sufficient to warrant the addition of antibiotics to established interventions for the prevention or treatment of MI.
(SEE ARTICLE) and editorial (SEE ARTICLE)
Managed Care Influences Fee-for-Service Expenditures
By altering the availability of medical services and physician practice patterns, managed care may have system-wide effects that influence the care of patients whether or not they are enrolled in a managed care plan. Using regression models to test this hypothesis, Baker found that increased market share of health maintenance organizations was associated with decreased expenditures for the care of patients in traditional Medicare fee-for-service plans. In an editorial, Reinhardt discusses models of physician behavior that might explain Baker's findings.
(SEE ARTICLE) and editorial (SEE ARTICLE)
Blood Pressure and Cognitive Function in the Elderly
Previous studies have suggested an association between blood pressure and cognitive function in the elderly. In this longitudinal study of elderly individuals, Glynn and coworkers examined the relationship between blood pressure and performance on 2 brief tests of cognition and memory. In general, blood pressure measurements at baseline or 9 years prior to baseline were not predictive of a change in cognitive function. Slightly increased error rates on 1 of the tests during 6 years of follow-up, however, were observed in individuals with elevated or low blood pressure at baseline or 9 years before baseline relative to those with normal blood pressure.
(SEE ARTICLE)
Grand Rounds: An Adult With Prolonged Fever
In this Grand Rounds at The Johns Hopkins Hospital, Auwaerter discusses the case of a previously healthy 42-year-old man who presented with fever, gastrointestinal symptoms, and fatigue. A prolonged febrile illness followed with pneumonia, hepatitis, and eventually pharyngitis. Test results for hepatitis A, B, and C were negative. White blood cell counts were normal, but inspection of a peripheral blood smear in the fourth week of illness provided diagnostic clues.
(SEE ARTICLE)
A Piece of My Mind
"The presence of a want does not equate with the existence of a need." From "A Vision of Health Care in the Next Millennium."
(SEE ARTICLE)
Medical News & Perspectives
George D. Lundberg ousted as editor.
(SEE ARTICLE)
Health care policy experts tell what to expect in the quality arena this year, including federal legislation, private initiatives, and national guidelines.
(SEE ARTICLE)
Special Communication
Is there a point at which continued growth in medical care is likely to produce harm? An examination of how more medical care may lead to unintended harm and how to avoid harmful practices.
(SEE ARTICLE)
Editorial
JAMA and editorial independence.
(SEE ARTICLE)
MSJAMA
Revisiting the history and traditions underlying medicine's symbols: the white coat, serpents, staffs, and Aesculapius.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Basics of high blood pressure.
(SEE ARTICLE)
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