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This Week in JAMA
JAMA. 2008;300(14):1621.
Ultrasound Diagnosis of Deep Vein Thrombosis
Patients with suspected deep vein thrombosis (DVT) of the lower extremities may be evaluated with either proximal vein 2-point ultrasonography or whole-leg ultrasonography. To assess whether the 2 strategies are equivalent, Bernardi and colleagues (SEE ARTICLE) randomly assigned 2098 consecutive outpatients with symptoms of a first-episode lower-extremity DVT to undergo either 2-point ultrasonography (plus D-dimer testing) or whole-leg color-coded Doppler ultrasonography. Patients with normal findings were followed up for 3 months. The authors report the 2 diagnostic strategies were equivalent for the detection of symptomatic venous thromboembolism. In an editorial, Landefeld (SEE ARTICLE) discusses the diagnosis of DVT.
Hip Fracture and 5- Reductase Inhibitors
Pharmacological treatment of benign prostatic hyperplasia includes 5- reductase inhibitors (eg, finasteride), which block the conversion of testosterone to dihydrotestosterone. Whether 5- reductase inhibitors adversely affect bone health is not clear. In a case-control study involving patients with a diagnosis of benign prostatic hyperplasia, Jacobsen and colleagues assessed the association between use of 5- reductase inhibitors and incident hip fracture. The authors found no association of exposure to 5- reductase inhibitors with increased risk of hip fracture.
(SEE ARTICLE)
Talking About Death, Medical Care, and Mental Health
Patients and physicians are encouraged to engage in conversations about end-of-life goals and expectations for medical care. However, it is not known whether these discussions are associated with less aggressive care or with increased or decreased patient and caregiver psychological distress. Wright and colleagues analyzed data from a multisite prospective cohort study of 332 patients with advanced cancer and their informal caregivers. The authors found that end-of-life discussions with physicians were associated with less aggressive medical care in the final week of life and earlier referrals to hospice. End-of-life discussions were not associated with more worry or higher rates of depression among patients, nor were they associated with worse bereavement adjustment among caregivers.
(SEE ARTICLE)
Circumcision and Sexually Transmitted Infections
Data suggest that male circumcision reduces men's risk of contracting human immunodeficiency virus (HIV) during heterosexual intercourse. Whether circumcision is associated with reduced risks of HIV infection among men who have sex with men is not certain. Millett and colleagues (SEE ARTICLE) pooled data from 15 observational studies that involved 53 567 men who have sex with men to assess the association between male circumcision and HIV and other sexually transmitted infections (STIs). The authors conclude there is insufficient evidence that male circumcision protects against HIV or other STIs among men who have sex with men. In an editorial, Vermund and Qian (SEE ARTICLE) discuss the implications of this finding for future research and HIV risk-reduction strategies.
CLINICIAN'S CORNER
Mobilizing Patients in the Intensive Care Unit
Mr E, a 56-year-old man with severe chronic obstructive pulmonary disease, had acute renal and respiratory failure that resulted in a 2-month medical intensive care unit stay complicated by aspiration, sepsis, and significant weight loss. Needham discusses the evidence supporting the safety, feasibility, and potential benefits of early mobilization of patients receiving mechanical ventilation.
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A Piece of My Mind
"Surgeons often have to judge the benefits of waiting, to prepare a patient for an operation . . . but not in this case." From "Saturday."
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Medical News & Perspectives
Some scientists say information provided by genome-wide prenatal tests is often ambiguous and may confuse parents.
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Commentaries
Patient care, square-rigger sailing, and safety
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Disclosing genetic research results after pediatric deaths
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Author in the Room Teleconference
Join Ingrid Nygaard, MD, MS, October 15 from 2 to 3 pm eastern time to discuss symptomatic pelvic floor disorders in women. To register, go to http://www.ihi.org/AuthorintheRoom.
Audio Commentary
Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl
Readers Respond
How would you manage an 82-year-old woman with hypertension and renal artery stenosis? Go to www.jama.com, read the case, and submit your response, which may be selected for online publication. Submission deadline is October 29.
JAMA Patient Page
For your patients: Information about thrombophlebitis.
(SEE ARTICLE)
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