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JAMA. 1998;279(19):1507. doi:10.1001/jama.279.19.1507.
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SAFER SEX OR ABSTINENCE?

Given current high levels of sexual activity among youth and the increasing risks of sexually transmitted diseases, the question has become not whether to provide sex education but how. In a randomized trial, Dr Jemmott and colleaguesArticle compare 2 sexual risk-reduction intervention strategies and an active control intervention. The results, based on self-reported behavior, appear to favor safer sex interventions over abstinence, although both had some short-term effect.

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TREATING INFECTION ASSOCIATED WITH ORTHOPEDIC IMPLANTS

Clinicians often can't cure infection associated with orthopedic fixation devices and prosthetic joints without removing the foreign body. Dr Zimmerli and colleaguesArticle conducted a randomized controlled trial of antimicrobial therapy for staphylococcal infections involving orthopedic devices and found that rifampin plus a companion drug was superior to placebo plus companion in eradicating infection.

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IMPROVING SPECIFICITY OF PROSTATE CANCER DETECTION

Prostate specific antigen (PSA) elevations predict the presence of prostate cancer, but test specificity is poor when the PSA is 4 to10 ng/mL. The proportion of PSA that is free in the serum is lower in prostate cancer than in benign disease, leading some to suggest that measuring free PSA would enhance diagnostic utility. In this study of men with PSA 4 to 10 ng/mL, Dr Catalona and colleagues use a 25% cutoff value for free PSA, which still detected 92% of the cancers (98% in younger men), and improved the test's overall specificity to 20%.

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WHY PATIENTS USE ALTERNATIVE MEDICINE

Many reasons have been offered to explain why patients seek alternatives to the traditional medical care most physicians provide. In this nationally representative survey, Dr Astin finds that alternative medicine is used by up to 40% of individuals in a given year for a wide range of health problems and across a wide range of modalities; few individuals rely primarily on alternative therapies, and dissatisfaction with traditional medicine did not predict use of alternative care.

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GENETIC CHANGES IN HIV-RELATED LUNG CANCER

Genetic variation known as microsatellite alteration (in which the size of a single allele is altered) occurs in a variety of sporadic cancers, including lung cancer. Dr Wistuba and colleagues find the frequency of microsatellite alteration was substantially greater in HIV-associated tumors, suggesting that genomic instability may be the responsible molecular mechanism.

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REORGANIZING THE INPATIENT ACADEMIC MEDICAL SERVICE

In this innovative experiment, Dr Wachter and colleagues find a reorganized inpatient medical service, led by faculty members who became involved early and more intensively in clinical decisions and served as attending physicians more often, resulted in similar clinical outcomes but significant resource savings and decreased length of stay compared with the traditional medical service.

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THE COVER

"The artist who attends to an object so closely that he can put its spirit on canvas is no less a creator." Pieter Claesz, Still Life, 1643, Dutch.

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MEDICAL NEWS & PERSPECTIVES

Some experts bet advances in materials and design will give artificial hearts the edge over xenotransplants in the race for an acceptable alternative to human donor hearts.

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A PIECE OF MY MIND

"[T]o hold the living heart of another human being is among the rarest of privileges. Those so favored should never lose sight of the inherent mystery and wonder of the experience." From "Holding the Heart."

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CONTEMPO 1998

Changing societal attitudes and legal and medical opinion are defining the approach to palliative care for patients who are terminally or incurably ill. Dr Pellegrino examines the ethical context of this fundamental medical practice.

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JAMA NETSIGHT

Web sites that can provide useful information for parents of pediatric patients. In our guide to interactive medicine.

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THE JAMA PATIENT PAGE

For your patients—information about preventing HIV infection.

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