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JAMA. 2005;293:1033.

Protecting the Distal Microcirculation During PCI
During percutaneous coronary intervention (PCI) in acute myocardial infarction, embolization of atheromatous and thrombotic debris is common and is thought to compromise patient outcomes. Stone and colleagues (SEE ARTICLE) report results of a clinical trial in which patients with ST-segment elevation myocardial infarction and eligible for PCI were randomly assigned to receive either PCI with a distal balloon occlusion and aspiration device to remove embolic debris or PCI without the aspiration device. The authors found the distal protection aspiration system effectively removed embolic debris but did not improve postprocedure coronary flow, time to ST-segment resolution, infarct size, or event-free survival. In an editorial, (SEE ARTICLE) Schömig and Kastrati discuss possible reasons use of the distal protection device failed to yield clinical benefit.

Age and Survival After Breast Cancer Chemotherapy
Adjuvant chemotherapy has improved survival in women 50 to 69 years of age with lymph node–positive breast cancer. However, whether women aged 70 years or older may experience similar benefit is not clear. Muss and colleagues (SEE ARTICLE) analyzed data from 4 treatment trials of adjuvant chemotherapy for node-positive disease and compared disease-free and overall survival and treatment-related mortality among women of different ages. They found chemotherapy reduced breast cancer mortality and recurrence for all women and found no association between age and disease-free survival. Non–breast cancer–related causes resulted in lower overall survival for women older than 65 years. Treatment-related deaths were few (0.5%) but increased with advancing age. In an editorial, (SEE ARTICLE) Gradishar and Kaklamani discuss factors to consider when treating elderly women with breast cancer.

Reducing Hip Fractures in Stroke Patients
Patients with a history of stroke are at increased risk of hip fracture and some studies have suggested an association of elevated homocysteine level and increased fracture risk. Sato and colleagues (SEE ARTICLE) investigated whether treatment with folate and vitamin B₁₂ would reduce the incidence of hip fractures in elderly Japanese patients with hemiplegia after ischemic stroke. Through 2 years of follow-up, they found a significant reduction in hip fractures in patients receiving folate and vitamin B₁₂ compared with those receiving placebo. In an editorial, (SEE ARTICLE) van Meurs and Uitterlinden discuss potential physiologic mechanisms for the treatment effect observed.

Treatment Preference and Clinical Trial Outcomes
Randomized clinical trial enrollment may be hampered when patient or physician preference for treatment leads to refusal of randomization. King and colleagues reviewed data from 32 randomized clinical trials to assess whether patient or physician preference affects trial recruitment or outcomes. They found that patient treatment preferences did lead to refusals of randomization, but there was scant evidence that treatment preference significantly affects the validity of trial outcomes.

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Learning Empathy
Evidence supports empathy as an important component of effective medical care, but empathic patient-physician relationships are not universal. In a discussion of empathy in clinical medicine, Larson and Yao equate empathy to "emotional labor" and propose the use of acting methods to help physicians learn and practice empathy.

(SEE ARTICLE)

Medical News & Perspectives
A new recipe for growing motor neurons from human embryonic stem cells is expected to help provide insights into such motor neuronal disorders as amyotrophic lateral sclerosis and clues to human stem cell development.

(Photo credit: Su-Chun Zhang/University of Wisconsin)

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CLINICIAN’S CORNER
A Woman With Kidney Stones
Clinical Crossroads
Ms P is a 44-year-old woman with morbid obesity who was recently diagnosed with kidney stones. Curhan discusses the pathophysiology, diagnosis, treatment, and prevention of kidney stones, including particular considerations in obese patients.

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JAMA Peer Reviewers
Sincere appreciation is extended to the peer reviewers for JAMA in 2004.

(SEE ARTICLE) and (SEE ARTICLE)

JAMA Patient Page
For your patients: Information about kidney stones.

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