This Week in JAMA FREE

Adefovir dipivoxil is an antiretroviral drug in a new drug class, nucleotide analog reverse transcriptase inhibitors. In this study of patients infected with human immunodeficiency virus (HIV) who had plasma HIV RNA levels greater than 2500 copies/mL despite at least 8 weeks of antiretroviral therapy, Kahn and colleagues found that in the group that received added adefovir (120 mg/d), plasma HIV RNA levels after 24 weeks had decreased significantly from baseline, but were unchanged in the placebo group. CD4⁺ cell counts did not change from baseline in either group. Several adverse effects were associated with adefovir, including delayed onset of mild nephrotoxicity. In an editorial, Mellors comments on the recent recommendation by an advisory committee of the US Food and Drug Administration not to approve adefovir for patients infected with HIV who are failing antiretroviral therapy.

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In this audiotape analysis of 1057 patient-physician encounters that contained 3552 clinical decisions, Braddock and colleagues found that only 9% of decisions included all 7 elements of informed decision making. Discussion of the nature of the intervention occurred most frequently and assessment of patient understanding occurred least frequently. In an editorial, Barry explores reasons why physicians may not involve patients in shared decision making in clinical practice.

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The W strain of Mycobacterium tuberculosis is a multidrug-resistant clone associated with high mortality. Using a combination of molecular typing techniques and surveillance data to investigate the spread of the W family of M tuberculosis in New Jersey during 1996-1998, Bifani and colleagues identified an outbreak that was not detected by conventional contact tracing methods. Of the 1575 culture-positive tuberculosis cases, 1207 isolates were genotyped, and 68 belonged to the W family. Forty-three of these 68 isolates were closely related variants with similar, although not identical, fingerprint patterns, and these cases were clustered geographically and shared demographic features, which is characteristic of outbreak strain transmission. In contrast, the other 25 W family isolates were heterogeneous strains from cases that were dispersed geographically and without demographic uniformity.

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The use of full face protection by ice hockey players has been controversial because of concern that full face shields may increase risk of concussion and neck injuries. In this prospective study of 642 intercollegiate ice hockey players, Benson and colleagues found that risk of sustaining a facial laceration and dental injury and time lost from participation because of concussion were significantly lower among hockey players who wore full face shields compared with those who wore half face shields, while the risk of neck injuries, concussion, or other injuries was similar in the 2 groups.

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Ms B has endometriosis with moderate dysmenorrhea and a history of recurrent endometriomas. She has been unable to become pregnant and has undergone 2 unsuccessful cycles of in vitro fertilization. Adamson discusses the diagnosis and natural history of endometriosis and medical and surgical management options for treatment of associated chronic pain and infertility.

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A critique of current management and return-to-play guidelines for athletes with sports-related concussion and recommendations for clinical assessment.

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Directors of the National Institutes of Health gaze into their crystal balls and tell what they foresee happening in their fields during the first fifth of the new century.

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Factors associated with cardiopulmonary resuscitation (CPR) attempts among seriously ill hospitalized adults who experienced cardiopulmonary arrest.

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Results of this meta-analysis suggest that in women and individuals aged 65 years or older, the risk reduction for major coronary events associated with statin drug therapy is similar to that in middle-aged men.

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Demonstration of an approach to systematically compare the relative effectiveness of health interventions for individuals and populations.

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For your patients: Communicating with your doctor.

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