Information on patterns of motor development of children with cerebral
palsy is necessary for prognostic counseling, planning interventions, and
judging progress over time, but such information has been limited. Rosenbaum
and colleaguesArticle used longitudinal observations of children aged 1 to 13 years
with cerebral palsy to create motor development curves that chart the rates
and limits of gross motor function by severity of motor impairment. In an
editorial, KinsmanArticle discusses how to use this prognostic information when communicating
with families of children with cerebral palsy.
Many types of treatment are advocated for plantar fasciitis despite
limited evidence to support the use of these treatments. Buchbinder and colleagues
conducted a randomized controlled trial among patients with ultrasound-proven
plantar fasciitis to assess whether ultrasound-guided extracorporeal shock
wave therapy given weekly for 3 weeks would reduce pain and improve function
6 and 12 weeks after completion of therapy. Pain and function improved in
both the active treatment and placebo groups at 6 and 12 weeks. The degree
of improvement was not statistically significantly different between treatment
groups for any measured outcome.
Evidence from prior trials suggests that continuous labor support during
childbirth is associated with improved outcomes, including reduction in the
likelihood of cesarean delivery. In this randomized trial, however, Hodnett
and colleagues found that the rate of cesarean delivery among women who received
continuous labor support by a trained labor support nurse was not statistically
significantly different from that among women who received usual care by a
nurse who had not received labor support training. Differences in other medical
and psychosocial outcomes during labor and delivery, immediately postpartum,
and 6 to 8 weeks after childbirth were also not significant.
In part 1Article of this article, recent evidence on the effectiveness of interventions
for primary and secondary stroke prevention is systematically reviewed. Two
clinical situations presented in part 2Article illustrate how to apply evidence to
individual patients in a process of shared decision making for stroke prevention.
Current guidelines for treatment of depression recommend continuing
antidepressant therapy for at least 4 to 9 months, but many patients receiving
antidepressants discontinue medication within 3 months after the start of
therapy. Bull and colleagues conducted surveys of patients with depression
who recently began taking a selective serotonin reuptake inhibitor and of
their prescribing physicians. Most physicians reported usually asking patients
to continue using antidepressants for at least 6 months, but only about one
third of patients reported being told to use antidepressants for this duration.
Patients who reported discussing adverse effects with their physicians and
patients with 3 or more follow-up visits were less likely to discontinue taking
the initially prescribed antidepressant medication.
"While my boss was staying up late trying to perfect a lecture, returning
patients' calls, or writing up the latest results of one of his studies, he
had been neglecting his administrative chores." From "The Three-Legged Stool."
Contention over whether simian virus 40 causes cancer in humans—and
whether humans can transmit it to each other—may veer in a new direction
after a reported finding of the virus in sewage samples.
Kassirer and Cecil examine inconsistencies in evidentiary standards
for medical testimony and discuss ways in which the medical community can
participate in strengthening the presentation of medical testimony in court.
Original research on depression, including randomized trials of treatment
interventions and studies of epidemiologic, biological, psychosocial, and
health services aspects of depression, are invited for a JAMA theme issue
scheduled for June 2003.
For your patients: Information about birth labor.
This Week in JAMA. JAMA. 2002;288(11):1319. doi:10.1001/jama.288.11.1319