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This Week in JAMA
JAMA. 2001;286:2507.
JAMA-EXPRESS
Inhalational Anthrax After Bioterrorism: Case Reports
Recent cases of inhalational anthrax following bioterrorism exposure to anthrax spores provide new information about the clinical presentation and course of this disease. In this issue of THE JOURNAL, Mayer and colleagues (SEE ARTICLE) present the cases of 2 patients with inhalational anthrax who continue in serious but stable condition, and Borio and colleagues (SEE ARTICLE) present the cases of 2 patients who died of inhalational anthrax. In an editorial, Lane and Fauci (SEE ARTICLE) stress the importance of obtaining an occupational and environmental history in cases of suspected inhalational anthrax and of rapid dissemination and sharing of epidemiologic, diagnostic, and treatment information.
Predictors of Outcomes of Antiretroviral Therapy
Initiation of antiretroviral therapy for patients with chronic, asymptomatic HIV infection is generally based on CD4 cell counts and plasma HIV RNA levels. Phillips and colleagues (SEE ARTICLE) analyzed data from therapy-naive patients starting antiretroviral therapy who participated in 3 large cohort studies and found that lower CD4 cell counts and higher viral load levels at baseline were not associated with poorer virological response to antiretroviral therapy. In a population-based study of therapy-naive patients starting antiretroviral therapy, Hogg and colleagues (SEE ARTICLE) found that risk of progression to AIDS and mortality was significantly higher among patients with baseline CD4 cell counts less than 200 cells/µL, but baseline plasma HIV RNA level was not an independent prognostic indicator. In an editorial, Pomerantz (SEE ARTICLE) discusses the implications of these findings for initiation of antiretroviral therapy.
Quality Improvement Strategies
A variety of approaches to improve the quality of medical care are currently available. Grol (SEE ARTICLE) summarizes the debate on methods for improving the quality of care and, in a review of articles on popular approaches for improving professional performance, observes that evidence regarding the impact and feasibility of the various approaches is mixed or lacking. In an editorial, Shaneyfelt (SEE ARTICLE) emphasizes the importance of quality improvement strategies that integrate quality improvement into daily clinical practice by providing patient-specific recommendations at the point of care.
A Piece of My Mind
"The paradox of the system of no-system is that it is becoming increasingly systematized." From "Within the System of No-System."
(SEE ARTICLE)
Contempo Updates
Gestational diabetes mellitus: screening, diagnosis, and management.
(SEE ARTICLE)
Medical News & Perspectives
Preliminary research findings suggest that a common medical practice can sometimes transform a Candida albicans infection into a life-threatening event.
(SEE ARTICLE)
A 28-Year-Old Man Addicted to Cocaine
Mr R has a 4-year history of cocaine addiction and, despite a recent hospitalization for cocaine-related chest pain, continues cocaine use. Hyman discusses the epidemiology of illicit drug use and dependence, risk factors for drug abuse and addiction, effects of cocaine and other addictive drugs on neural pathways, and addiction treatment.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about anthrax.
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