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This Week in JAMA
JAMA. 1998;280:947.
Treatment Outcomes for Localized Prostate Cancer
Using an increase in posttreatment prostate-specific antigen levels to define treatment failure, D'Amico and coworkers (SEE ARTICLE) observed that radical prostatectomy, radiation therapy, and interstitial radiation therapy with or without androgen deprivation therapy were equivalent for the treatment of localized prostate cancer in low-risk patients; however, radical prostatectomy and radiation therapy were superior to treatment with interstitial radiation therapy for intermediate-risk and high-risk patients. Albertsen and colleagues (SEE ARTICLE) reviewed the records of more than 700 men who had initially untreated or conservatively treated localized prostate cancer. They found that men with well-differentiated tumors had a small risk of death from prostate cancer within 15 years of diagnosis; the prostate cancer–associated mortality increased as the degree of tumor differentiation decreased. In an editorial, Chodak (SEE ARTICLE) notes that these retrospective studies add useful information for the design and analysis of future controlled trials that are needed to determine the optimal management of patients with localized prostate cancer.
Illness Among Gulf War Veterans
Gulf War veterans were more likely than nondeployed personnel to meet the case definition of a chronic multisystem illness derived by Fukuda and colleagues (SEE ARTICLE) . No associations between this illness and specific clinical or laboratory findings or Gulf War exposures were detected, but Gulf War veterans who met the case definition had significantly diminished functioning and well-being. In their editorial, Lashof and Cassells (SEE ARTICLE) consider the implications of these findings and review the research concerning this controversial illness.
Test Scores Predict Clinical Practice Patterns
In a cohort of recently licensed family physicians in Québec, higher licensing examination scores were associated with higher consultation referral rates, higher rates of prescribing disease-specific medications relative to symptom-relief medications, lower rates of prescribing inappropriate drugs for elderly patients, and higher referral rates of women aged 50 to 69 years for screening mammography. Tamblyn and coinvestigators conclude that further research is needed to assess whether these differences in clinical practice persist over time and whether they are associated with differences in patient outcomes.
(SEE ARTICLE)
Buckle Up in the Air
The risk of death for pilots following crash landings of small general aviation aircraft was higher among pilots who did not wear lap or shoulder restraints and those who wore only lap restraints compared with pilots who wore both lap and shoulder restraints. Pilot death was also strongly associated with destruction of the airplane and with an airplane fire or explosion on the ground after the crash landing.
(SEE ARTICLE)
Quality of Care, Quality of Research
In a consensus statement, the National Roundtable on Health Care Quality (SEE ARTICLE) concludes that problems in the quality of health care (underuse, overuse, and misuse) occur in all regions of the United States, in communities of all sizes, and in all types of delivery systems. The statement emphasizes that rapid change in the delivery of health care is urgently needed. In a related commentary, Starfield (SEE ARTICLE) identifies ways to improve quality-of-care research.
The Cover
"Colors push, pull, shout, threaten . . . overwhelm." Joan Thorne, Naust, 1978, American.
(SEE ARTICLE)
A Piece of My Mind
"My goal is not to find balance, but to harmonize the worlds of work and family, without letting thoughts of one world unduly dominate the other." From "An Independent Scientist."
(SEE ARTICLE)
Medical News & Perspectives
At their first world meeting, experts on "the last taboo"—urinary incontinence—look at treatment advances and work to reclassify the condition as a World Health Organization–defined disease.
(SEE ARTICLE)
Contempo 1998
Recent advances in general psychiatry.
(SEE ARTICLE)
Policy Perspectives
Estimating the inpatient hospital costs in teaching hospitals related to graduate medical education. Will future funding sources impose a new accountability?
(SEE ARTICLE)
JAMA Patient Page
For your patients: Options for the treatment of prostate cancer.
(SEE ARTICLE)
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