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This Week in JAMA
JAMA. 2000;284:1891.
Early Therapy for Parkinson Disease
Dopamine-receptor agonists have been proposed as an alternative to levodopa for the treatment of Parkinson disease to reduce the risk of motor adverse effects associated with levodopa therapy. In this 2-year trial comparing pramipexole, a dopamine-receptor agonist, with levodopa for the initial treatment of patients with early Parkinson disease, the Parkinson Study Group (SEE ARTICLE) found that the proportion of patients who developed dopaminergic motor complications was significantly less in the pramipexole group than in the levodopa group. Parkinsonian features, however, improved more in the levodopa group than in the pramipexole group, and somnolence, hallucinations, and edema were more frequent in the pramipexole group. In an editorial, Tanner (SEE ARTICLE) weighs the benefits and risks of these drugs.
Brain Volumes, Cognitive Outcomes of Preterm Infants
Preterm infants often experience long-term neurodevelopmental difficulties. To examine whether regional brain volumes are associated with cognitive outcomes in prematurely born children, Peterson and colleagues (SEE ARTICLE) used structural magnetic resonance imaging to measure regional brain volumes of 25 prematurely born 8-year-old children and 39 matched term controls. Volumes of specific cerebral regions were significantly reduced in the preterm children compared with the term children, and these abnormalities correlated with poorer scores on measures of cognitive function. In an editorial, Hack and Taylor (SEE ARTICLE) discuss possible mechanisms of perinatal brain injury.
Timing of Misoprostol for Early Medical Abortion
For medical abortions, the conventional timing for misoprostol administration is 48 hours after mifepristone. Schaff and colleagues conducted a trial to determine whether a more flexible schedule for misoprostol administration would be as effective and safe as the 2-day protocol for women seeking early abortion. Among women with gestations no more than 56 days, complete medical abortion rates and adverse effects were comparable for self-administration of vaginal misoprostol at 1, 2, or 3 days after mifepristone.
(SEE ARTICLE)
Cost-effectiveness of Screening for Colorectal Cancer
Screening for colorectal cancer has been shown to reduce colorectal cancer mortality through early detection and treatment. Using a Markov model with a hypothetical cohort of 50-year-old white men at average risk for colorectal cancer, Frazier and colleagues compared the cost-effectiveness of 22 screening strategies for colorectal cancer, including those recommended by expert panels. With screening compliance assumed to be 60%, the most effective screening strategy was annual rehydrated fecal occult blood testing plus sigmoidoscopy every 5 years (with colonoscopy if either a low- or high-risk polyp was found) from age 50 to 85 years, which reduced colorectal cancer incidence by 60% and colorectal cancer mortality by 80% compared with no screening. The most effective 1-time screening strategy was colonoscopy at age 55 years, which reduced colorectal cancer mortality by 31%.
(SEE ARTICLE)
Patients' Use of the Web for Medical Information
In 1998, an estimated 60 million persons in the United States searched for health information on the Web. To determine the use of the Web for health information specifically in a clinical population, O'Connor and Johanson surveyed patients attending gastroenterology outpatient clinics in August 1999. Fifty percent of patients reported having access to the Web and about one quarter of all respondents reported having obtained medical information from the Web within the previous year.
(SEE ARTICLE)
A Piece of My Mind
"When a man feels his ability to help the tribe has expired, he chants a prayer and, dressed in his finest skins, bids farewell to his family and walks over the frozen Arctic Ocean, never to return." From "Five Miles From Tomorrow."
(SEE ARTICLE)
Medical News & Perspectives
A look at this year's winners of the Lasker Medical Research Awards.
(SEE ARTICLE)
Clinicians Infected With Blood-Borne Pathogens
Should current US policy that requires health care workers infected with a blood-borne pathogen to disclose their infection status to patients be reformed?
(SEE ARTICLE) and (SEE ARTICLE)
Controversies
Petty (SEE ARTICLE) outlines why screening for detection of early-stage lung cancer should be beneficial, but Frame (SEE ARTICLE) points out that there is no evidence that screening reduces lung cancer mortality.
JAMA Patient Page
For your patients: A primer on Parkinson disease.
(SEE ARTICLE)
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