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This Week in JAMA
JAMA. 2004;291:1293.
Radiotherapy for Recurrent Prostate Cancer
Men with a local recurrence of prostate cancer after a radical prostatectomy may benefit from radiotherapy, but the factors associated with a positive response are not well defined. Stephenson and colleagues (SEE ARTICLE) report the results of a retrospective analysis of patient outcomes after salvage radiotherapy. Predictors of progression-free survival at 4 years included a low preradiotherapy prostate-specific antigen (PSA) level and a PSA doubling time of longer than 10 months, early initiation of radiotherapy, lower Gleason score, positive surgical margins, and no seminal vesicle invasion. In an editorial, (SEE ARTICLE) Anscher emphasizes the benefits of early salvage treatment for all prostate cancer recurrences and the advantages of adjuvant therapy for some patients.
Transdermal Fentanyl for Postoperative Pain
Transdermal, patient-controlled analgesia (PCA) is convenient and eliminates the need for venous access required for intravenous PCA; however, its efficacy for postoperative pain is not established. Viscusi and colleagues report the results of a randomized trial comparing the safety and efficacy of an iontophoretic transdermal system using fentanyl hydrochloride with standard PCA using morphine and an electronic pump in adult patients who underwent major surgical procedures and who were randomized in the recovery room. Assessments of pain control and pain intensity 24 hours after randomization were similar in the 2 groups, implying therapeutic equivalence.
(SEE ARTICLE)
Prognosis in Patients With Uncontrolled Hypertension
The precision and reproducibility of office-based blood pressure measurements have been challenged because of significant intraobserver and interobserver variability, leading to the recommendation of home monitoring. Bobrie and colleagues report results of a prospective observational study of elderly patients with hypertension whose blood pressure control was assessed at office visits and at home. They found an increase in cardiovascular events for each 10-mm Hg systolic and 5-mm Hg diastolic increase above predefined thresholds for blood pressure control recorded at home. However, patients in the normotensive group with similarly increased elevations during clinical assessments compared with home measurement experienced no increase in events, suggesting superior prognostic accuracy for home-based blood pressure monitoring.
(SEE ARTICLE)
Hypertonic Saline in Brain Trauma Resuscitation
Studies document increased survival in patients with hypotension and severe traumatic brain injury who are treated with hypertonic saline (HTS) in the acute resuscitation phase, but whether HTS improves outcomes is unknown. Cooper and colleagues (SEE ARTICLE) compared HTS plus standard intravenous fluids with standard resuscitation fluids alone in the prehospital setting by assessing neurological outcomes at 3 and 6 months after injury. They found equivalent survival rates and long-term neurological status in both groups of patients. In an editorial, (SEE ARTICLE) Lewis discusses the importance of systematic evaluations of prehospital interventions and recommends that future studies continue to explore potential benefits of HTS resuscitation protocols.
Reducing Hospital Readmission Rates
Congestive heart failure is the leading reason for hospital readmission of elderly patients in the United States. Readmissions have been blamed on poor discharge planning and postdischarge care. Phillips and colleagues report results of a systematic review examining the efficacy of comprehensive discharge planning with postdischarge support vs usual care to reduce readmissions and to improve health outcomes. Their review showed fewer readmissions and higher scores on measures of health and quality of life in patients assigned to the comprehensive care interventions vs those receiving usual care.
(SEE ARTICLE)
Medical News & Perspectives
Researchers hope that targeting molecules that promote the growth of abnormal blood vessels will prove useful in treating degenerative eye disorders, such as diabetic retinopathy and age-related macular degeneration.
(SEE ARTICLE)
CLINICIAN'S CORNER
The Rational Clinical Examination
Vaginal complaints are common, but the symptoms, signs, and microscopy findings may not identify their cause.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about vaginal symptoms.
(SEE ARTICLE)
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