Urinary incontinence in older patients is a prevalent condition
associated with substantial psychosocial morbidity. In a randomized
trial, Burgio and colleagues compared the effectiveness of
biofeedback-assisted behavioral treatment, low-dose oxybutynin, and
placebo for the treatment of urge or mixed urge and stress urinary
incontinence in women aged 55 to 92 years. Both treatments were more
effective than placebo, and patient satisfaction was highest in
patients treated with behavioral therapy. In a related editorial,
Resnick encourages physicians to be proactive in identifying and
treating patients with incontinence.
See Article and editorial Article
In a 4-year follow-up of 35 patients with moderate to severe coronary
heart disease who had previously participated in a 1-year trial of
intensive lifestyle and dietary change, Ornish and colleagues found
that patients in the experimental group had continued reduction in
coronary artery percent diameter stenosis. In contrast, patients who
received usual care had continued progression of coronary
atherosclerosis and an increased risk of cardiac events.
In a survey of a sample of US colleges and universities,
Hennessey and coworkers found that most had a tuberculosis (TB)
screening program but that screening practices were often inadequate
and inefficient. In schools that accepted only Mantoux tests, a
positive skin test result was reported in 2.1% of students at schools
that screened all new students and in 22.9% of students at schools
that screened only international students. The estimated rate of TB
cases identified by required screening was less than 5 per
100,000 students screened, but the case rate among international
students was about 30 times higher than that among US residents.
To assess the relationship between the use of total parenteral
nutrition (TPN) in critically ill patients and mortality and morbidity
outcomes, Heyland and colleagues conducted a meta-analysis of 26
randomized clinical trials. They found no overall effect of TPN on
mortality rates in critically ill and surgical patients. In subgroup
analyses, complication rates were significantly lower in patients
treated with TPN in studies that included only malnourished patients
and in those that did not use lipids. Studies that included only
critically ill patients demonstrated a significant increase in
mortality and complication rates associated with TPN compared with
studies of surgical patients.
In a systematic review, Solomon and colleagues incorporated behavioral
criteria in the methodologic assessment of 49 studies of interventions
designed to influence the diagnostic testing behavior of physicians.
They found that methodologic quality was generally low, but the success
rate of interventions that targeted more than 1 behavioral factor was
higher than that of interventions targeting a single behavioral factor.
van Walraven and colleagues conducted a time-series analysis of claims
submitted for laboratory tests and found that revision of requisition
forms, funding policy changes, and guideline dissemination
significantly improved the utilization of specific laboratory tests. In
a related editorial, Lundberg outlines an approach to improve physician
use of diagnostic tests.
See Article and Article and
editorial on Article
François Boucher, Allegory of Music, 1752, French.
European neurologists focus their attention on the ills expected to
beset a growing population of aging persons.
Natriuretic peptides may provide a new approach for the detection and
treatment of certain cardiovascular conditions.
"I realized, for the first time, that I was seeing the forest for the
trees." From "First Attending Rounds."
Web resources for practicing clinicians on HIV/AIDS.
Complexities of caring for colleagues.
For your patients: Causes and treatment of urinary incontinence.
This Week in JAMA. JAMA. 1998;280(23):1971. doi:10.1001/jama.280.23.1971