Many postmenopausal women are undecided about hormone replacement therapy
(HRT) because of the potential breast cancer risk. Raloxifene is an estrogen
analog that, like tamoxifen, has estrogenic activity in certain tissues and
antiestrogenic activity in others. In this randomized trial, Dr Walsh and
colleagues demonstrated that raloxifene and HRT both lowered low-density lipoprotein
cholesterol equivalently, but HRT was more effective in raising high-density
lipoprotein cholesterol and lowering lipoprotein(a).
See Article and related editorial Article
Community-acquired pneumonia (CAP) accounts for a large number of hospital
admissions, but length of stay varies substantially. The Pneumonia Patient
Outcomes Research Team studied a large cohort of patients with CAP to determine
how quickly key clinical indicators resolve. Clinical stability was achieved
in a median of 3 to 7 days, but the change to oral antibiotics and discharge
from hospital took longer in the majority of patients.
Lipid-lowering therapy has been shown to reduce cardiac morbidity and
mortality, but it is not known how well patients tolerate long-term treatment
outside the context of clinical trials. Dr Avorn and colleagues assess persistence
of use of lipid-lowering therapy in patients older than 65 years. On average,
participants filled only enough medication for 60% of the year, and after
5 years of follow-up, only half of surviving patients were still taking lipid-lowering
Providing medical care for mass gatherings creates challenges for physicians,
other health care professionals, and event organizers. Dr Wetterhall and colleagues
characterize the care provided to spectators, volunteers, and athletes at
the 1996 Summer Olympics. These unique data, along with the public health
response for the Olympic Games described in the accompanying article by Dr
Meehan and colleagues, should help in planning the medical response for future
See Article and related article Article
Medulloblastoma is the most common brain tumor in children. Traditionally,
age at presentation, presence of metastases, and extent of resection have
helped predict outcome. Dr Weil and colleagues found that sex of the child
also correlated with outcome, with girls doing much better than boys.
Epidemiologic studies have suggested a link between "inflammatory" factors,
such as fibrinogen, C-reactive protein, albumin, and leukocyte count, and
the risk of coronary heart disease. In this meta-analysis, Dr Danesh and colleagues
demonstrate that for each of these factors, the published data show a consistent
and significant association with coronary heart disease risk.
"Things speak sometimes in a thousand voices, not one of them the voice
we thought we knew." Karl Schmidt-Rottluff, Rising Moon, 1912, German.
An FDA advisory committee approves plans for a study in which volunteers
will be infected with live typhoid bacillus as a first step toward developing
new vaccine for the disease.
The management of osteoporosis and asthma is changing, but continuity
of care continues to be better care. Is hepatitis C infection an emerging
threat? Prescribe St John's wort? An update in family medicine this week in
"The only thing I have to offer is my compassion.
. . . It's all so overwhelming. I'm not sure I can keep doing this." From
Many journals have adopted the CONSORT statement as a way to improve
reporting for clinical trials. Dr Meinert suggests that this approach may
be missing the mark; Mr Moher maintains that it is on target to achieve its
For your patients—information about osteoporosis.
This Week in JAMA. JAMA. 1998;279(18):1417. doi:10.1001/jama.279.18.1417