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This Week in JAMA
JAMA. 2001;285:2049.
Combination Therapy and Vertical Transmission of HIV
Zidovudine monotherapy became the standard of care for reduction of maternal-infant transmission of human immunodeficiency virus (HIV) when its efficacy was demonstrated in 1994. Mandelbrot and colleagues (SEE ARTICLE) report that the transmission rate in a prospective cohort of women and their newborns who received lamivudine in addition to standard zidovudine prophylaxis was 1.6% compared with a transmission rate of 6.8% in a historical cohort who received zidovudine monotherapy. Combination prophylaxis, however, was associated with resistance to lamivudine and the occurrence of neutropenia and anemia, but the frequency of moderate-to-severe hematologic toxicity was not significantly different from that in the historical comparison group. In an editorial, Shaffer (SEE ARTICLE) discusses possible prophylactic strategies suggested by these findings to reduce vertical HIV transmission in both developed and developing countries.
Bullying Among US Schoolchildren
In this analysis of data from a survey of US youth in grades 6 through 10, Nansel and colleagues (SEE ARTICLE) found that 29.9% of the sample reported moderate or frequent involvement in bullying as a bully, being bullied, or both. Children involved in bullying demonstrated poorer psychosocial adjustment than children who did not report involvement with bullying. In an editorial, Spivak and Prothrow-Stith (SEE ARTICLE) consider the possible relationship of bullying to youth violence and discuss approaches to prevention and intervention.
Cardiac Procedures and Outcomes After Acute MI
To determine whether differences in invasive procedure rates alone account for observed outcome differences in patients with acute myocardial infarction (MI) admitted to hospitals with or without on-site revascularization facilities, Alter and colleagues evaluated outcomes of patients hospitalized with acute MI, controlling for other hospital characteristics and also for patient and physician characteristics. Patients admitted to hospitals with on-site revascularization facilities were much more likely to undergo revascularization. Five-year mortality rates were similar in the 2 groups, but nonfatal 5-year cardiac event rates were significantly lower among patients admitted to hospitals with on-site revascularization facilities. Differences in nonfatal outcomes were explained primarily by hospital teaching status and not by differences in cardiac intervention rates.
(SEE ARTICLE)
Fasting and Postload Glucose and Incidence of Diabetes
The risk of type 2 diabetes mellitus (DM) is increased among individuals with impaired glucose tolerance, but the risk of developing diabetes among persons with normal or impaired fasting glucose levels is not known. The Hoorn Study is a population-based cohort study on glucose intolerance in a general Dutch elderly population that began in 1989. de Vegt and colleagues report that over a period of 6 years, the cumulative incidence of type 2 diabetes was higher among individuals with impaired fasting glucose and impaired glucose tolerance at baseline than among individuals with a normal fasting glucose level, and highest among those with both impaired fasting glucose and impaired glucose tolerance.
(SEE ARTICLE)
Medication Errors and ADEs Among Pediatric Inpatients
To determine the rate of medication errors in pediatric inpatient settings, Kaushal and colleagues reviewed 10 778 medication orders for 1120 patients admitted to 2 pediatric academic institutions during a 6-week period. The investigators identified 616 (5.7%) medication errors, 115 (1.1%) potential adverse drug events (ADEs), and 26 (0.24%) ADEs, 5 of which were preventable. Most potential ADEs occurred at the stage of drug ordering. Physician reviewers and ward-based clinical pharmacologists estimated that computerized physician order entry could potentially have prevented 93% to 94% of potential ADEs.
(SEE ARTICLE)
Contempo Updates
New research on the nitric oxide pathway and regulation of vasomotor tone is elucidating potential novel antihypertensive drug targets.
(SEE ARTICLE)
Medical News & Perspectives
Pediatric dermatology is a growing subspecialty that focuses on many disorders unique to children. New approaches to the management of dermatologic problems in children were presented at the annual meeting of the American Academy of Dermatology.
(SEE ARTICLE)
A 45-Year-Old Woman With OCD
Mrs T describes symptoms of obsessive-compulsive disorder (OCD) beginning in early childhood. She has also experienced episodes of severe depression requiring hospitalization. Jenike discusses diagnostic criteria for OCD, pathophysiology, and treatment.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about bullying.
(SEE ARTICLE)
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