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This Week in JAMA
JAMA. 2004;292:773.
JAMA-EXPRESS
Treating Adolescent Depression
Both cognitive-behavioral therapy (CBT) and fluoxetine have demonstrated efficacy in adolescents with major depressive disorder; however, little is known about the therapies' relative or combined effectiveness. Results from the Treatment for Adolescents With Depression Study, (SEE ARTICLE) in which patients were randomized to 12 weeks of fluoxetine alone, CBT alone, CBT and fluoxetine, or placebo, address these questions. The investigators report that symptom reduction in the combined CBT and fluoxetine group was significantly greater than with either treatment alone or placebo and that fluoxetine alone was superior to CBT alone at 12 weeks. In an editorial, (SEE ARTICLE) Glass discusses the contribution of these data to empirically based treatment of adolescents with major depressive disorder.
Radiation and Hormone Therapy for Prostate Cancer
A prior study documented that radiation combined with 3 years of androgen suppression therapy (AST) improved survival in clinically localized prostate cancer. However, long-term AST is associated with adverse effects. D'Amico and colleagues (SEE ARTICLE) assessed the survival benefit associated with radiation therapy alone or in combination with 6 months of AST for men with localized disease. After a median follow-up of 4.5 years, the authors found statistically significant overall and disease-specific survival advantages for patients receiving radiation and AST vs radiation therapy alone. In an editorial, (SEE ARTICLE) DeWeese discusses the importance of these results for patients at high risk of disease recurrence.
Vitamin E and Respiratory Infections in Elderly Persons
Vitamin E supplementation has been shown to enhance the immune response and reduce the incidence of self-reported infectious diseases in older persons. In a randomized trial, Meydani and colleagues sought to determine the effect of daily vitamin E supplementation vs placebo on the incidence of clinically diagnosed respiratory tract infections in elderly nursing home residents. They found no effect of vitamin E on the overall incidence or duration of respiratory tract infections. However, significantly fewer residents receiving vitamin E acquired 1 or more respiratory tract infections, and in a subgroup analysis, residents receiving vitamin E had significantly fewer common colds.
(SEE ARTICLE)
Outpatient Rehabilitation After Hip Fracture
After a hip fracture, a significant number of elderly patients do not recover their prefracture ambulatory or functional status. In a group of community-dwelling men and women who had a hip fracture and completed standard physical therapy, Binder and colleagues investigated the effect of an additional 6 months of supervised physical therapy and progressive resistance exercise training compared with a flexibility-enhancing home exercise program on physical function and disability. The authors found that patients randomized to the extended therapy group had significantly improved physical performance, quality of life, and functional status vs patients randomized to the home exercise program.
(SEE ARTICLE)
Surgical Mortality and Hospital Quality
Surgical mortality rates are used as a measure of hospital quality, but it is not clear that all hospitals have a sufficient volume of procedures to identify quality deficiencies. Dimick and colleagues reviewed data from a national hospital discharge database to determine the minimum number of procedures needed to identify a poorly performing hospital for the 7 surgical procedures for which mortality has been advocated as a quality indicator. With the exception of coronary artery bypass graft surgery, the authors found that the number of procedures and event rates were too low to allow adequate assessment of hospital quality.
(SEE ARTICLE)
A Piece of My Mind
"As clinicians we are always creating environments that heal—in a room, on a unit, throughout a building." From "Healing in Spaces."
(SEE ARTICLE)
Medical News & Perspectives
Scientists are exploring the use of human embryonic stem cells in a variety of medical applications.
(SEE ARTICLE)
CLINICIAN'S CORNER
Understanding Irritable Bowel Syndrome
Evidence for a role of small intestinal bacterial overgrowth in the signs and symptoms of irritable bowel syndrome is reviewed.
(SEE ARTICLE)
West Nile Virus in Transplant Recipients
From the Archives Journals
Characteristics of West Nile virus encephalomyelitis in organ transplant recipients are reviewed.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about irritable bowel syndrome.
(SEE ARTICLE)
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