Approximately one-third of patients with peripheral artery disease (PAD) experience intermittent claudication and associated lifestyle limitations. In a randomized placebo-controlled trial involving 212 Australian patients with PAD, Ahimastos and colleagues found that compared with placebo, 24-week treatment with ramipril—an angiotensin-converting enzyme inhibitor—was associated with increased pain-free and maximum walking times during a standard treadmill exercise test and improvement in patient-perceived physical functioning. In an editorial, McDermott discusses medical therapy for PAD.
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To assess the efficacies of common treatments for chronic lateral epicondylalgia, Coombes and colleagues randomly assigned 165 patients to receive 1 of the following 4 treatments: corticosteroid injection, placebo injection, corticosteroid injection plus physiotherapy (PT), or placebo injection plus PT. The 2 primary trial outcomes were patient-reported complete recovery or much improvement assessed at 1 year and 1-year disease recurrence rates. The authors report that compared with placebo injection, corticosteroid injection resulted in lower rates of complete recovery/much improvement at 1 year, as well as greater recurrence. The PT and no-PT groups did not differ in 1-year ratings of complete recovery/much improvement or recurrence.
Teno and colleagues analyzed data from a random sample of 848 303 fee-for-service Medicare beneficiaries who died in 2000, 2005, or 2009 to examine changes in site of death, place of care, and health care transitions at the end of life. Among the authors' findings were that compared with 2000, hospice use increased and a lower proportion of individuals died in an acute care hospital in 2005 and 2009; however, intensive care unit use and number of health care transitions increased in the last month of life. In an editorial, Jenq and Tinetti discuss factors associated with changes in end-of-life care over the past decade.
Ms L is a 54-year-old biological male who self-identifies as a woman. She has received female hormone therapy to change her appearance and match her gender identity and is now considering feminizing surgical treatment. Spack discusses gender identity disorder, medical and surgical options for transgender individuals, research priorities, and health care system response.
Do the benefits of opioid analgesics outweigh the risks in patients with rheumatoid arthritis? In this JAMA Clinical Evidence Synopsis, Whittle and colleagues summarize the evidence from 11 randomized controlled trials (involving 672 patients and conducted in 1969-2006) that compared opioids with placebo or other analgesics. The authors conclude that weak opioids may be effective in the short term, but adverse effects are common.
Genetic studies are providing new insights into the biology of breast cancer and opening new avenues for diagnosis and treatment.
Tracking tissue for transplantation
FDA regulation of off-label drug promotion
European working time directive: effects on medical care and education
Improving population health in US cities
“[T]he homeless population is aging even more rapidly than the rest of the US population.” From “Falling Off the Edge.”
Restructuring of structured abstracts
Dr Bauchner summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl
Join Daniel S. Chertow, MD, MPH, February 20, 2013, from 2 to 3 PM eastern time to discuss bacterial coinfection in influenza. To register, go to http://www.ihi.org/AuthorintheRoom.
For your patients: Information about pulmonary embolism.
This Week in JAMA. JAMA. 2013;309(5):415. doi:10.1001/jama.2012.145196