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This Week in JAMA
JAMA. 2005;293:899.
Estrogen and Progression of Urinary Incontinence
Estrogen alone or in combination with progestin (E+P) has been prescribed to treat urinary incontinence in menopausal women, but there is little objective evidence of its efficacy. Hendrix and colleagues (SEE ARTICLE) used data from the Women’s Health Initiative trials to assess the effects of estrogen alone or E+P on the 1-year incidence and severity of symptoms of stress, urge, and mixed incontinence in healthy postmenopausal women. They found that both hormone regimens increased the incidence of all types of incontinence and were associated with worsening of symptoms. In an editorial, DuBeau (SEE ARTICLE) discusses physiologic effects of estrogen on the urinary tract and its possible role in urinary incontinence. (SEE ARTICLE)
Antibiotic Regimens for Uncomplicated Cystitis
Empirical treatment of acute cystitis in women is complicated by a high prevalence of antibiotic resistance among uropathogenic strains of Escherichia coli. Hooton and colleagues investigated the efficacy of a 3-day regimen of amoxicillin-clavulanate vs a 3-day regimen of ciprofloxacin in women with acute uncomplicated cystitis. They found that ciprofloxacin was superior to amoxicillin-clavulanate in achieving a clinical cure. At a 2-week follow-up, significantly more women who received ciprofloxacin had both microbiological cure and eradication of vaginal E coli.
(SEE ARTICLE)
Primary Care Screening for Bipolar Disorder
Screening for depression is common in primary care settings, but little attention has been paid to assessing for a history of hypomania or mania suggestive of bipolar disorder. Das and colleagues screened for bipolar disorder in an urban adult primary care clinic and examined demographic, clinical, and treatment characteristics of patients with a positive screening test result. In this urban and largely poor patient population, the prevalence of having a positive screening for lifetime bipolar disorder was 9.8%, which was consistent across demographic variables. Bipolar disorder was often underrecognized and appropriate medication not prescribed.
(SEE ARTICLE)
BRCA Mutations in Ductal Carcinoma In Situ
The prevalence of 2 breast cancer susceptibility genes, BRCA1 and BRCA2, in invasive breast cancer is well described, but it is not known whether these mutations are associated with ductal carcinoma in situ (DCIS). Claus and colleagues used data from a case-control study of women with DCIS to estimate the prevalence of these mutations. They found disease-associated BRCA1 and BRCA2 mutations in 0.8% and 2.4% of DCIS cases, respectively, which is similar to the prevalence reported in invasive breast cancer.
(SEE ARTICLE)
Radiation Oncology Treatment Comparisons
Randomized clinical trials (RCTs) often compare an innovative or an experimental therapy with standard treatment. Soares and colleagues (SEE ARTICLE) were interested in assessing the probability that the innovative treatment would be superior to the standard treatment, accounting for factors that can affect the outcome of RCTs. They reviewed 59 high-quality, phase 3 RCTs conducted by the Radiation Therapy Oncology Group from 1968 to 2002. They found no evidence that innovative are superior to standard treatments. In the studies reviewed, standard treatment was preferred to innovative treatment in 71% of the trials. Innovations offered no survival advantage and were somewhat more likely to result in treatment-related mortality. In an editorial, Grann and Grann (SEE ARTICLE) discuss the importance of clinical trials to ensure treatment is evidence-based.
Medical News & Perspectives
Over a 74-year career, Michael E. DeBakey, MD, has published more than 1600 scientific articles, performed more than 60 000 surgeries, and conducted research that was key to important innovations in cardiovascular surgery. Many consider him to be the greatest surgeon ever.
(SEE ARTICLE)
Facilitated PCI
Current options for reperfusion therapy, in particular, pharmacological facilitation of primary percutaneous coronary intervention (PCI), are reviewed by Gersh and colleagues.
(SEE ARTICLE)
CLINICIAN’S CORNER
Influenza
The Rational Clinical Examination
Influenza cannot be confirmed or excluded based on clinical findings alone.
(SEE ARTICLE)
Author in the Room
Translate clinical research findings "from page to patient" with JAMA’s new interactive teleconferences.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about influenza.
(SEE ARTICLE)
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