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This Week in JAMA
JAMA. 1998;279:1417.
Effects of Raloxifene in Postmenopausal Women
Many postmenopausal women are undecided about hormone replacement therapy (HRT) because of the potential breast cancer risk. Raloxifene is an estrogen analog that, like tamoxifen, has estrogenic activity in certain tissues and antiestrogenic activity in others. In this randomized trial, Dr Walsh and colleagues demonstrated that raloxifene and HRT both lowered low-density lipoprotein cholesterol equivalently, but HRT was more effective in raising high-density lipoprotein cholesterol and lowering lipoprotein(a).
(SEE ARTICLE) and related editorial (SEE ARTICLE)
Stabilizing Patients With Pneumonia
Community-acquired pneumonia (CAP) accounts for a large number of hospital admissions, but length of stay varies substantially. The Pneumonia Patient Outcomes Research Team studied a large cohort of patients with CAP to determine how quickly key clinical indicators resolve. Clinical stability was achieved in a median of 3 to 7 days, but the change to oral antibiotics and discharge from hospital took longer in the majority of patients.
(SEE ARTICLE)
Lipid-Lowering Treatment: Do Patients Stay With It?
Lipid-lowering therapy has been shown to reduce cardiac morbidity and mortality, but it is not known how well patients tolerate long-term treatment outside the context of clinical trials. Dr Avorn and colleagues assess persistence of use of lipid-lowering therapy in patients older than 65 years. On average, participants filled only enough medication for 60% of the year, and after 5 years of follow-up, only half of surviving patients were still taking lipid-lowering medication.
(SEE ARTICLE)
Caring for Crowds
Providing medical care for mass gatherings creates challenges for physicians, other health care professionals, and event organizers. Dr Wetterhall and colleagues characterize the care provided to spectators, volunteers, and athletes at the 1996 Summer Olympics. These unique data, along with the public health response for the Olympic Games described in the accompanying article by Dr Meehan and colleagues, should help in planning the medical response for future mass gatherings.
(SEE ARTICLE) and related article (SEE ARTICLE)
Influence of a Child's Sex on Medulloblastoma Outcome
Medulloblastoma is the most common brain tumor in children. Traditionally, age at presentation, presence of metastases, and extent of resection have helped predict outcome. Dr Weil and colleagues found that sex of the child also correlated with outcome, with girls doing much better than boys.
(SEE ARTICLE)
Inflammatory Mediators and Coronary Heart Disease
Epidemiologic studies have suggested a link between "inflammatory" factors, such as fibrinogen, C-reactive protein, albumin, and leukocyte count, and the risk of coronary heart disease. In this meta-analysis, Dr Danesh and colleagues demonstrate that for each of these factors, the published data show a consistent and significant association with coronary heart disease risk.
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The Cover
"Things speak sometimes in a thousand voices, not one of them the voice we thought we knew." Karl Schmidt-Rottluff, Rising Moon, 1912, German.
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Medical News & Perspectives
An FDA advisory committee approves plans for a study in which volunteers will be infected with live typhoid bacillus as a first step toward developing new vaccine for the disease.
(SEE ARTICLE)
Contempo 1998
The management of osteoporosis and asthma is changing, but continuity of care continues to be better care. Is hepatitis C infection an emerging threat? Prescribe St John's wort? An update in family medicine this week in Contempo.
(SEE ARTICLE)
A Piece of My Mind
"The only thing I have to offer is my compassion. . . . It's all so overwhelming. I'm not sure I can keep doing this." From "Regaining Compassion."
(SEE ARTICLE)
Controversies
Many journals have adopted the CONSORT statement as a way to improve reporting for clinical trials. Dr Meinert suggests that this approach may be missing the mark; Mr Moher maintains that it is on target to achieve its intended purpose.
(SEE ARTICLE)
JAMA Patient Page
For your patients—information about osteoporosis.
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