The Women’s Health Initiative (WHI) hormone therapy trials—which involved 27 347 postmenopausal women who were randomly assigned either to receive conjugated equine estrogen (CEE) plus medroxyprogesterone acetate (MPA) or placebo for a median of 5.6 years or to receive CEE alone (among women with hysterectomy) or placebo for a median of 7.2 years—investigated the benefits and risks of menopausal hormone therapy for chronic disease prevention. In this article, Manson and colleagues present a comprehensive overview of health outcomes during the cumulative 13-year (median) intervention and postintervention phases of the 2 trials. The authors report a complex pattern of risks and benefits associated with menopausal hormone therapy, which do not support its use for chronic disease prevention. Hormone therapy may be appropriate for menopausal symptom management in some women. In an Editorial, Nable discusses menopausal hormone therapy and women’s health in the post-WHI era.
Author Video Interview
Obesity may be associated with chronic musculoskeletal pain and some patients report improvement in pain after bariatric surgery. In a retrospective cohort study involving 11 719 adults undergoing bariatric surgery, Raebel and colleagues compared opioid use in the year before surgery and for up to 3 years after and found that among patients who took opioid long-term preoperatively (n=933), opioid use increased in the years after surgery. In an Editorial, Alford discusses barriers to effective management of chronic pain.
Wissenberg and colleagues analyzed data from the Danish Cardiac Arrest Registry—representing 19 468 patients with out-of-hospital cardiac arrest in 2001 to 2010—to assess temporal changes in bystander cardiopulmonary resuscitation (CPR) attempts and patient survival. The authors found that survival following out-of-hospital cardiac arrest increased between 2001 and 2010 and was significantly associated with a concomitant increase in bystander CPR.
Recent data have challenged traditional thinking about axillary surgery in patients with breast cancer. Rao and colleagues reviewed the literature on surgical and nonsurgical axillary interventions in breast cancer to examine the association of these interventions with recurrent axillary node metastases, mortality, and morbidity. The authors report that the available evidence suggests that compared with sentinel node biopsy alone, complete axillary node dissection is associated with more harm than benefit in women undergoing breast-conserving therapy who do not have palpable lymph nodes suspicious for metastases, whose tumors measure 3.0 cm or smaller, and who have 3 or fewer positive nodes on sentinel node biopsy.
Continuing Medical Education
Cranberry products—particularly cranberry juice—are widely used as a nonpharmacologic approach to prevention and treatment of urinary tract infections (UTIs). However, it is not clear that—when systematically compared with placebo or other treatments—cranberry products actually prevent UTIs. In this JAMA Clinical Evidence Synopsis, Jepson and colleagues summarize the results of a systematic review and analysis of data from 24 clinical trials (4473 patients) that compared cranberry juice or cranberry products with placebo, no treatment, or another treatment on the incidence of UTIs. The authors found that cranberry products are not associated with prevention of UTIs. However, the lack of an association may be related to poor adherence to therapy, insufficient active ingredient in the cranberry product tested, or lack of statistical power in the studies analyzed.
Highlights. JAMA. 2013;310(13):1307-1309. doi:10.1001/jama.2013.5338