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This Week in JAMA
JAMA. 2005;293:2565.
Treatment of Complicated Grief
Complicated grief—persistent symptoms and impairment after a personal loss through death—is difficult to treat and is estimated to affect 1 million persons annually. Shear and colleagues (SEE ARTICLE) report results of a randomized trial testing the efficacy of a novel complicated grief treatment (CGT) strategy compared with standard interpersonal psychotherapy for persons with complicated grief. They found that both CGT and interpersonal psychotherapy achieved symptom improvement, but the therapeutic response was greater and quicker for persons who received the CGT strategy. In an editorial, Glass (SEE ARTICLE) discusses current perspectives on grief and unresolved questions about complicated grief and its treatment.
Defensive Medicine and Malpractice Reform
Physician concerns about malpractice risk may influence patient care and other professional decisions. Two articles in this issue of JAMA provide data on these issues. First, Studdert and colleagues (SEE ARTICLE) report results of a survey of Pennsylvania physicians representing 6 specialties at high risk of litigation for their practice of defensive medicine. Of the physicians surveyed, 93% reported practicing defensive medicine, particularly assurance behaviors such as ordering more tests, prescribing more medications, and performing more procedures to confirm diagnoses. In the second article, Kessler and colleagues (SEE ARTICLE) report results of their analyses of state-level data, which linked certain types of malpractice reforms with an increase in supply of physicians in high-risk specialties. In an editorial, Budetti discusses (SEE ARTICLE) the need for innovative approaches to tort reform that combine evidence-based medicine with patient safety protections.
Access to Trauma Centers
Trauma centers are not evenly distributed across the United States, which may leave some patients without timely access to care. Branas and colleagues reviewed national data on trauma centers, helipads, and block group population to estimate the proportion of US residents living within 45 and 60 minutes of a trauma center. They found that more than 80% of US residents have access to a level I or II trauma center within an hour; however, 46.7 million, primarily in rural areas, reside at even greater distance from trauma care.
(SEE ARTICLE)
Radiofrequency Ablation to Treat Atrial Fibrillation
In a randomized trial of 70 patients with symptomatic atrial fibrillation (AF), Wazni and colleagues investigated the feasibility of pulmonary vein isolation with radiofrequency ablation as a first-line and curative treatment of AF. Compared with patients receiving antiarrhythmic and anticoagulation drug treatment, patients who had radiofrequency ablation had fewer recurrences of symptomatic AF and fewer hospitalizations during 1 year of follow-up.
(SEE ARTICLE)
Antibiotic Therapy and CAD Outcomes
Chlamydia pneumoniae infection has been associated with initiation and progression of atherosclerosis, but results of clinical trials of antichlamydial antibiotic therapy for patients with coronary artery disease (CAD) have been inconsistent. In a meta-analysis of 11 prospective, randomized, placebo-controlled trials of antichlamydial antibiotic therapy for patients with CAD, Andraws and colleagues found that antibiotics had no effect on all-cause mortality, rates of myocardial infarction, or a combined end point of myocardial infarction and unstable angina.
(SEE ARTICLE)
Medical News & Perspectives
Although safety concerns have recently emerged regarding some nonsteroidal anti-inflammatory drugs (NSAIDs), particularly cyclo-oxygenase-2 inhibitors, new research hints that some NSAIDs might have value in preventing and treating various cancers.
(SEE ARTICLE)
CLINICIAN’S CORNER
Erectile Dysfunction After Prostatectomy
Grand Rounds
Erectile function often returns within 2 years of radical prostatectomy; management strategies for interim erectile dysfunction are discussed.
(SEE ARTICLE)
Physicians and the Investment Industry
Legal and ethical risks when physicians have consulting relationships with the investment industry.
(SEE ARTICLE)
Women’s Health
Call for Papers
Authors are invited to submit manuscripts for a JAMA theme issue on women’s health.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about grief.
(SEE ARTICLE)
NEXT WEEK
Theme Issue on Tuberculosis
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