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This Week in JAMA
February 20, 2002

This Week in JAMA

JAMA. 2002;287(7):809. doi:10.1001/jama.287.7.809
Raloxifene Therapy and Risk of Cardiovascular Events

In recent studies, hormone replacement therapy has been associated with an early increase in risk of cardiovascular events in postmenopausal women with cardiovascular disease. Raloxifene, a selective estrogen receptor modulator, has been shown to have favorable effects on known cardiovascular risk factors, but its effect on the risk of arterial cardiovascular events is not known. In this secondary analysis of data from the MORE trial, a placebo-controlled study of the effects of raloxifene on bone mineral density and vertebral fractures in postmenopausal women with osteoporosis, Barrett-Connor and colleagues found no early increase in coronary or cerebrovascular events associated with raloxifene therapy, either 60 or 120 mg/d. Overall, the risk of cardiovascular events was not significantly different in the raloxifene groups compared with the placebo group during 4 years of therapy. Among women with increased cardiovascular risk at study entry, however, those in the raloxifene groups had a significantly reduced risk of cardiovascular events compared with those in the placebo group.

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Bioterrorism-Related Anthrax Infection: Reports of 3 Cases Without Direct Occupational Exposure

In this issue of THE JOURNAL, 3 articles describe recent cases of bioterrorism-related anthrax infection that were not directly linked to occupational exposure. In the 2 adult cases with fatal inhalational anthrax, reported by Mina and colleaguesArticle and by Barakat and colleaguesArticle, the source of anthrax exposure has not been identified despite epidemiologic investigation. The third case, cutaneous anthrax in a 7-month-old infant reported by Freedman and colleaguesArticle, was complicated by severe microangiopathic hemolytic anemia. The source of infection is thought to be the workplace of the infant's mother, which the infant visited the day before the onset of symptoms. In an editorial, Gerberding and coauthorsArticle discuss the critical role of clinicians in all phases of bioterrorism preparedness response programs and the importance of ongoing collaboration between clinicians and public health agencies.

Palliative Care in US Hospitals

Reverend J, a 75-year-old man with widely metastatic adenocarcinoma, was admitted to an acute palliative care unit in a teaching hospital where he died 5 days after admission. von Gunten discusses the use of clinical palliative care services in hospitals, illustrated by excerpts from interviews with Mrs J and members of the palliative care team conducted after Reverend J's death.

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Medical News & Perspectives

The discovery of a genetic mutation apparently linked to one of the most aggressive types of prostate cancer may point toward a new approach to screening for this disease.

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CLINICIAN'S CORNER

In part 1Article, the scientific basis for the use of β-blocker therapy in heart failure is reviewed. Part 2Article presents selected cases of patients with heart failure to illustrate nuances of β-blocker therapy and provides clinical tools to assist use of β-blockers in practice.

Thank You to Authors and Peer Reviewers

JAMA acknowledgesArticle with gratitude the authors of the 4189 manuscripts received in 2001 and extends sincere thanks to the 3483 peer reviewersArticle for their scholarly contributions.

JAMA Patient Page

For your patients: Information about palliative care.

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