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This Week in JAMA
JAMA. 2000;283:3037.
Cognitive Rehabilitation After Traumatic Brain Injury
A variety of cognitive rehabilitation interventions are used for the treatment of traumatic brain injury (TBI), but most of these interventions have not been rigorously assessed. Salazar and colleagues (SEE ARTICLE) compared comprehensive interdisciplinary in-hospital rehabilitation to limited home rehabilitation by randomly assigning active-duty military personnel who had sustained moderate-to-severe closed head injury to one of these treatment strategies. One year after treatment, the percentage of patients who had returned to gainful employment and who were considered fit for military duty was similar in the 2 groups. Among patients unconscious for more than 1 hour after head injury, the rate of fitness for duty was higher in the hospital rehabilitation group. In an editorial, Jordan (SEE ARTICLE) discusses factors to consider when assessing the efficacy of cognitive rehabilitation for TBI.
Venlafaxine XR for Generalized Anxiety Disorder
Treatment of generalized anxiety disorder with venlafaxine extended release (XR) has been shown to be efficacious in short-term trials. In this 6-month controlled trial to assess the long-term efficacy and safety of venlafaxine XR, Gelenberg and colleagues found that adults with generalized anxiety disorder without coexisting major depressive disorder randomized to receive venlafaxine XR had higher response rates to treatment than those in the placebo group. Adverse events in the venlafaxine XR group tended to decrease with continued use.
(SEE ARTICLE)
Infant Hib Vaccine and H influenzae in Older Individuals
After a statewide Haemophilus influenzae type b (Hib) infant vaccination program was initiated in Alaska in 1991, the annual incidence of Hib disease in Alaskan children younger than 5 years markedly declined. To determine the effect of the vaccination program on unimmunized Alaskans aged 10 years and older, Perdue and colleagues compared the incidence of invasive H influenzae disease in this older Alaskan population in the period before introduction of the Hib vaccination program (1980-1990) with the incidence after the program was introduced (1991-1996). The overall incidence of H influenzae disease in Alaskans aged 10 years and older declined 33% after introduction of the Hib vaccination program. The incidence of Hib disease decreased 80%, whereas incidence of invasive disease from other H influenzae serotypes and nontypeable strains increased.
(SEE ARTICLE)
Exercise Training in Chronic CHF and LV Function
Endurance exercise training programs improve functional work capacity in patients with chronic congestive heart failure (CHF) by enhancing endothelial function and aerobic metabolism in skeletal muscle. To determine the effect of long-term exercise training on left ventricular (LV) function and peripheral resistance, Hambrecht and colleagues randomly assigned patients with stable chronic CHF to 2 weeks of in-hospital ergometer exercise followed by 6 months of home-based ergometer exercise training or to no intervention. After 6 months, patients in the exercise training group had a significant reduction in total peripheral resistance at rest and during peak exercise compared with the control group, a significant increase in stroke volume at rest and at peak exercise, and a small but significant reduction in left ventricular end diastolic and end systolic diameters.
(SEE ARTICLE)
Recommendations for Primary Stroke Centers
Recent studies suggest that many hospitals do not have the necessary organizational features or expertise to rapidly identify patients with acute stroke or provide optimal treatment. Based on review of the published literature since 1996 and expert opinion, Alberts and colleagues (SEE ARTICLE) developed recommendations for the formation and operation of primary stroke centers. These centers would stabilize and provide emergency treatment for patients with acute stroke and provide referral for further care. In an editorial, Barnett and Buchan (SEE ARTICLE) describe community-wide reorganization strategies and resources necessary to develop primary stroke centers.
A Piece of My Mind
"I had always preached to friends that life is too precious, too short, and too uncertain. Don't wait to say the things you want to say to those you love. Make each day count." From "Blood Lines."
(SEE ARTICLE)
Medical News & Perspectives
People exposed to pesticides in the home or garden may have a significantly higher risk of Parkinson disease, according to a new study. Previously, only occupational exposure had been studied and found relevant.
(SEE ARTICLE)
The Rational Clinical Examination
A systematic review of the accuracy of history and physical examination for the diagnosis of carpal tunnel syndrome.
(SEE ARTICLE)
Public Health Law
Part III: Evaluation of Public Health Law
Justification for public health regulation and proposed systematic evaluation to assess whether a public health regulation is warranted.
(SEE ARTICLE)
JAMA Patient Page
For your patients: A primer on generalized anxiety disorder.
(SEE ARTICLE)
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