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JAMA. 2005;294:153.

Symptoms After Discontinuing Estrogen Plus Progestin
Current recommendations for menopausal symptom management with hormone therapy encourage prescription of the lowest effective dosage for the shortest duration possible. However, few data exist regarding symptoms experienced when hormone therapy is discontinued. Ockene and colleagues (SEE ARTICLE) report results of a survey completed by 8405 women (89.9% of those eligible) who were still taking their study medication (combined conjugated equine estrogens plus medroxyprogesterone acetate [CEE + MPA] or placebo) when the Women’s Health Initiative trial was stopped. Among their findings were that women formerly taking CEE + MPA reported more symptoms than women formerly taking placebo and that the presence of symptoms at baseline was associated with increased symptom reports after stopping either CEE + MPA or placebo. In an editorial, Petitti (SEE ARTICLE) discusses symptoms of menopause, aging, and treatment options.

Hepatitis A Vaccination Outcomes
Incidence of hepatitis A following implementation of wide-scale vaccination programs is reported in 2 articles in this issue of JAMA. First, Wasley and colleagues (SEE ARTICLE) compared the incidence of hepatitis A in the United States from 1990 to 1997—a period preceding recommendations for targeted vaccination of children and adults at risk—to that in 2003. They found a 76% decline of hepatitis A from the 1990-1997 rates to the 2003 rates. In the second article, Dagan and colleagues (SEE ARTICLE) report hepatitis A incidence in Israel before and after a national immunization program for children 18 to 24 months of age. They found a more than 95% decline in overall hepatitis A incidence compared with rates before establishing the immunization program. In an editorial, Van Damme and Van Herck (SEE ARTICLE) discuss the contributions of national immunization programs and herd immunity to reductions in hepatitis A incidence.

Use of Hospice Services in Nursing Homes
Hospice care may improve the quality of end-of-life care for nursing home residents, but data suggest that hospice is underused. Casarett and colleagues conducted a randomized trial to determine whether a simple communication to the responsible physician could increase hospice use and improve care among patients whose care goals and needs were appropriate for hospice care. Residents in the intervention group, whose physician received a fax requesting authorization of a hospice informational visit, were more likely to enroll in hospice and had fewer acute care admissions and their family or surrogate rated their care more favorably than residents in the control group whose physicians were not informed of their suitability for hospice.

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Prone Positioning in Pediatric Acute Lung Injury
In uncontrolled studies of pediatric acute lung injury, prone positioning appeared to improve oxygenation, but its effects on ventilator-free days or clinical outcomes are not known. Curley and colleagues (SEE ARTICLE) randomly assigned infants and children with acute lung injury to supine or prone positioning and assessed outcomes through 28 days. The trial was stopped when an interim analysis confirmed improved oxygenation but revealed no difference in ventilator-free days or clinical outcomes in children being placed in the prone position compared with those placed in the supine position. In an editorial, Kavanagh (SEE ARTICLE) discusses implications of the trial outcomes for clinical practice and future investigations.

Medical News & Perspectives
Scientists report that live vaccines targeting Ebola and Marburg viruses have successfully protected monkeys from infection, findings seen as an advance toward the development of effective human vaccines.

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Contradictions in Research Results
In subsequent well-designed investigations of clinical questions initially explored in highly cited research studies, contradictory results or effect sizes of smaller magnitude are not uncommon.

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CLINICIAN’S CORNER
Androgen Deprivation in Prostate Cancer
Clinical Review
Risks and benefits of androgen deprivation therapy and treatment of adverse effects.

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JAMA Patient Page
For your patients: Information about hepatitis A.

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