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This Week in JAMA
JAMA. 2004;292:1925.
Association of Gastric Acid Suppression With Pneumonia
Gastric acidity is 1 defense against ingested pathogens, and there is some evidence that acid-suppressive therapy facilitates nosocomial infections. In a case-control study, Laheij and colleagues (SEE ARTICLE) investigated the association between acid-suppressive drugs and the occurrence of community-acquired pneumonia. They found that persons currently taking acid-suppressive drugs had an increased risk of developing pneumonia compared with never users and those who had stopped, and the risk was greater in users of proton pump inhibitors vs patients taking H2-receptor antagonists. In an editorial, Gregor (SEE ARTICLE) highlights the importance of these findings in light of increasing use of gastric acid–suppressing drugs.
Hospital Factors and PCI Outcomes
Developments in technique and adjunctive pharmacologic therapies have resulted in fewer patients needing emergency coronary artery bypass graft (CABG) surgery after percutaneous coronary interventions (PCIs). However, whether it is safe to perform PCI in hospitals without onsite CABG surgery programs is not clear. To address this question, Wennberg and colleagues (SEE ARTICLE) examined Medicare hospital data to compare in-hospital and 30-day mortality for patients having PCIs in hospitals with and without onsite CABG programs. They found that patients whose PCIs were nonemergent (not primary/rescue) and were performed in hospitals without onsite CABG surgery capabilities had higher mortality than similar patients who had PCIs in hospitals with CABG surgery programs. In an editorial, Weaver (SEE ARTICLE) discusses the need for more data to determine whether onsite surgical backup is needed in centers performing PCI.
Treating Pediatric Obsessive-Compulsive Disorder
Cognitive-behavior therapy (CBT) and medical management with a selective serotonin reuptake inhibitor (SSRI) are proven therapies for pediatric obsessive-compulsive disorder (OCD), but their relative and combined efficacy are not known. The Pediatric OCD Treatment Study was a randomized, 12-week trial designed to investigate the efficacy of CBT, medical management with sertraline, or the 2 combined vs placebo for initial treatment of OCD. The investigators found children and adolescents in the 3 treatment groups had greater symptom relief than patients taking placebo. Combined treatment was superior to either active treatment alone and remission was best achieved with combined treatment or CBT.
(SEE ARTICLE)
Appendiceal Rupture, Negative Appendectomy in Children
Rates of appendiceal rupture and negative appendectomy in children are high, but factors associated with these outcomes are not clear. Ponsky and colleagues analyzed hospital- and patient-level characteristics to identify factors related to these outcomes. They found the risk of rupture was higher in Asian and black children compared with whites and uninsured or Medicaid-insured children had a higher risk of rupture than children covered by private insurance. Race and insurance status were not associated with negative appendectomy; however, the negative appendectomy rate declined as hospital appendectomy volume increased.
(SEE ARTICLE)
Hormone Therapy: Promotion and Prescribing Patterns
In analyses of national data from 2001 through 2003, Majumdar and colleagues found significant declines in pharmaceutical industry promotion and physician prescribing of hormone therapy after publication of harmful outcomes and lack of net clinical benefit in the Women’s Health Initiative Estrogen Plus Progestin Trial.
(SEE ARTICLE)
Medical News & Perspectives
After more than a half century of pioneering work that helped to establish the concept of preventable and modifiable risk factors in cardiovascular disease, Jeremiah Stamler, MD, continues to elucidate how addressing such risk factors can improve human health.
(SEE ARTICLE)
CLINICIAN’S CORNER
Shoulder Instability
The Rational Clinical Examination
An evidence-based review of tests to diagnose shoulder instability and labral tears.
(SEE ARTICLE)
Health Reform: Present and Future
Budetti describes the deterioration of the US health care system in the decade since President Clinton’s Health Security Act failed to win congressional approval.
(SEE ARTICLE)
COMMENTARIES
Kerry, Bush Outline Health Plans
US presidential candidates Senator John Kerry (SEE ARTICLE) and President George W. Bush (SEE ARTICLE) outline their plans for improving healthcare access and controlling costs.
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Photo credit: Kerry-Edwards 2004, Inc; Photo credit: Bush-Cheney '04, Inc
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JAMA Patient Page
For your patients: Information about obsessive-compulsive disorder.
(SEE ARTICLE)
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