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This Week in JAMA
JAMA. 2003;289:2611.
JAMA-EXPRESS
Dementia and Stroke Outcomes of Hormone Therapy
New findings from the Women‘s Health Initiative (WHI) challenge previous evidence that suggested that estrogen-containing hormone therapy has a protective effect on the brain in postmenopausal women. In the estrogen plus progestin component of the WHI Memory Study (WHIMS), which included women aged 65 years or older enrolled in the WHI trial, Shumaker and colleagues (SEE ARTICLE) found that the risk of probable dementia in the estrogen plus progestin group was twice that in the placebo group during a mean follow-up of 4 years. Rapp and colleagues (SEE ARTICLE) also report that although most women in WHIMS did not experience a clinically important decline in global cognitive function, more women in the estrogen plus progestin group than in the placebo group had a substantial decline in cognitive function. Wassertheil-Smoller and colleagues (SEE ARTICLE) , in additional analyses of data from the WHI trial, found that the risk of stroke, particularly ischemic stroke, was significantly increased in the estrogen plus progestin group overall and in a number of subgroups of women. In an editorial, Yaffe (SEE ARTICLE) considers possible explanations for the discrepancies between results of observational studies of hormone therapy and those of the WHI randomized trial.
Combined Cardiac Resynchronization and Defibrillation
The most common modes of death for patients with heart failure are sudden cardiac death from ventricular arrhythmias and progressive heart failure. Young and colleagues (SEE ARTICLE) conducted a randomized trial among patients with moderate-to-severe heart failure and wide QRS interval to evaluate combining an implantable cardioverter defibrillator (ICD) with cardiac resynchronization therapy (CRT), which would provide both defibrillation and resynchronization capabilities. All patients underwent implantation with a combined defibrillation-resynchronization device and had the cardioverter-defibrillator function activated throughout the trial. Improvements in quality of life, functional class, and exercise capacity were significantly greater among patients who had active CRT and ICD than among those with active ICD alone. CRT did not interfere with cardioverter-defibrillator function. In an editorial, Bradley (SEE ARTICLE) points out several caveats to consider when applying the results of this study to patients who may be candidates for combined resynchronization-defibrillation therapy.
Fluctuations in Serum Prostate-Specific Antigen Levels
Many prostate cancers detected using serum prostate-specific antigen (PSA) screening are clinically insignificant, and it is not clear whether early detection of prostate cancer using PSA screening reduces prostate cancer mortality. Eastham and colleagues conducted PSA testing on consecutive annual blood samples from an unscreened cohort of men participating in the Polyp Prevention Trial. Among men with an abnormal PSA test result, 40% to 55%, depending on the cutoff level for an abnormal PSA result, had a normal PSA finding at 1 or more subsequent visits during 4 years of follow-up.
(SEE ARTICLE)
CLINICIAN'S CORNER
A 65-Year-Old Woman With Acute Cough
Clinical Crossroads
Mrs W visited a physician after 1 day of cold symptoms, concerned about spreading her illness to family members. The physician diagnosed viral acute respiratory infection but prescribed an antibiotic at the patient's insistence. Gonzales discusses the evaluation and treatment of acute respiratory infections and risks of unnecessary antibiotic use.
(SEE ARTICLE)
A Piece of My Mind
"That smart funny quirky slightly crazy brilliant light has been snuffed out, destroyed, lost forever, and nothing will ever be the same again." From "What I Have Seen."
(SEE ARTICLE)
Medical News & Perspectives
A novel program in North Carolina using HIV RNA screening to detect acute HIV infections could help health officials identify early clusters and target interventions.
(SEE ARTICLE)
Use of Race, Ethnicity in Biomedical Publications
Major challenges in writing about race and ethnicity in biomedical publications and recommendations to address them.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about the common cold.
(SEE ARTICLE)
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