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- ArticleHodis HN.JAMA. 1990 Jul 11;264(2):181.
- ArticleFarr B, Torner J.JAMA. 1990 Jul 11;264(2):185.
- ArticleNightingale SL.JAMA. 1990 Jul 11;264(2):168.
- ArticleTuteur PG.JAMA. 1990 Jul 11;264(2):175.
- ArticleMarwick C.JAMA. 1990 Jul 11;264(2):166.
- ArticleLitvinas L.JAMA. 1990 Jul 11;264(2):203.
- ArticleMarwick C.JAMA. 1990 Jul 11;264(2):164.
- ArticleGoldsmith MF.JAMA. 1990 Jul 11;264(2):161, 164.
- ArticleBanta HD, Thacker SB.JAMA. 1990 Jul 11;264(2):235-40.Assessment of health care technologies should be an iterative process, not a single event. In the United States there are an increasing number of organized attempts at reassessment of technologies by the health industry, professional societies, and national government agencies, such as the Medical Necessity Project of Blue Cross/Blue Shield, the Clinical Efficacy Assessment Project of the American College of Physicians, and the work of the US Preventive Services Task Force. We examine four clinical practices--electronic fetal monitoring, episiotomy, electroencephalography, and hysterectomy--to illustrate the need to continuously reassess existing technologies and to challenge our current inertia in this critical arena of health practice.
- ArticleBreo DL.JAMA. 1990 Jul 11;264(2):257-8.
- ArticleSlutsker L, Hoesly FC, Miller L, Williams LP, Watson JC, Fleming DW.JAMA. 1990 Jul 11;264(2):213-7.Although eosinophilia-myalgia syndrome has been linked to use of tryptophan, it has been unclear whether tryptophan itself or a contaminant causes illness. In Oregon, we compared the brand and source of tryptophan used by 58 patients with eosinophilia-myalgia syndrome with the brand and source of tryptophan used by 30 asymptomatic controls identified through a random telephone survey and 63 asymptomatic controls who contacted the Oregon Health Division voluntarily. Although a single brand/retail lot of tryptophan was statistically associated with the development of eosinophilia-myalgia syndrome, there was no common importer, wholesaler, tablet maker, encapsulator, or distributor. However, 45 (98%) of 46 cases had taken a product made by one manufacturer, compared with three (30%) of 10 telephone survey controls and 15 (48%) of 31 volunteer controls. Retail lots of tryptophan from this manufacturer that were associated with cases were significantly more likely to have been produced from January through June 1989 than lots from this manufacturer that were taken by controls. These findings indicate that the recent epidemic of eosinophilia-myalgia syndrome was caused by a contaminant or an alteration in a subset of tryptophan manufactured by a single company in Japan shortly before the outbreak began.
- ArticleGoldsmith MF.JAMA. 1990 Jul 11;264(2):165-6.
- ArticleJAMA. 1990 Jul 11;264(2):173-4.
- ArticleJAMA. 1990 Jul 11;264(2):171-3.
- ArticleChu SY, Buehler JW, Berkelman RL.JAMA. 1990 Jul 11;264(2):225-9.To assess the effect of the human immunodeficiency virus (HIV) on mortality in US women 15 to 44 years of age and to identify associated causes of death, we examined final (1980 through 1987) and provisional (1988) national mortality statistics. Between 1985 and 1988, the death rate for HIV/acquired immunodeficiency syndrome (AIDS) quadrupled (0.6 per 100,000 to 2.5 per 100,000), and by 1987, HIV/AIDS had become one of the 10 leading causes of death. In 1988, the death rate for black women (10.3 per 100,000) was nine times the rate for white women (1.2 per 100,000). The majority of deaths in both black and white women occurred in women 25 to 34 years of age, for whom HIV-related deaths accounted for 11% and 3% of all deaths in 1988, respectively. Among 1157 death certificates that included any mention of HIV/AIDS in 1987, other leading diagnoses included drug abuse (27%), Pneumocystis carinii pneumonia (20%), other pneumonias (14%), septicemia (10%), other infections not in the AIDS surveillance definition (7%), nephritis (6%), liver diseases (4%), and anemias (4%). If current mortality trends continue, HIV/AIDS can be expected to become one of the five leading causes of death by 1991 in women of reproductive age. Because women infected with HIV are the major source of infection for infants, these trends in AIDS mortality in women forecast the impact of HIV on mortality in children as well.
- ArticleWiström J, Settergren B, Gustafsson A, Juto P, Norrby RS.JAMA. 1990 Jul 11;264(2):181-2.
- ArticleHenkin Y, Johnson KC, Segrest JP.JAMA. 1990 Jul 11;264(2):241-3.Niacin (nicotinic acid) is available in several forms, including crystalline preparations and various types of sustained-release preparations. Evidence exists that sustained-release niacin, with respect to both dosage and severity, is more hepatotoxic than crystalline niacin. Three patients who developed hepatitis during treatment with sustained-release niacin were rechallenged with equivalent or higher doses of crystalline niacin, with no evidence of recurring hepatocellular damage. Although the mechanism for niacin-induced hepatitis is unknown, these cases support previous observations that crystalline niacin may be less hepatotoxic than sustained-release preparations in certain patients.
- ArticleRoss LS.JAMA. 1990 Jul 11;264(2):184-5.
- ArticleTobin MJ.JAMA. 1990 Jul 11;264(2):244-51.
- ArticleJAMA. 1990 Jul 11;264(2):182-4.