Wik and colleaguesArticle conducted a randomized trial among patients with
out-of-hospital ventricular fibrillation to compare immediate defibrillation
(standard care) with 3 minutes of basic cardiopulmonary resuscitation (CPR)
prior to defibrillation. Survival to hospital discharge, rates of return of
spontaneous circulation (ROSC), 1-year survival, and neurological outcomes
were not significantly different in the 2 treatment groups overall or among
patients with ambulance response times of 5 minutes or less. Among patients
with ambulance response times longer than 5 minutes, however, rates of survival
to hospital discharge and at 1 year and of ROSC were higher in the CPR first
group. In an editorial, ValenzuelaArticle describes elements of research design to
include in future trials of CPR first.
Gulf war veterans' illnesses (GWVI) are multisymptom illnesses characterized
by persistent pain, fatigue, and cognitive symptoms. Donta and colleaguesArticle
conducted a randomized trial to compare the effectiveness of a 12-week program
of cognitive behavioral therapy (CBT), exercise, and a combination of both
for improving physical functioning and reducing symptoms of Gulf War veterans
with GWVI. At 12 months, the proportion of veterans with improvement in physical
functioning was greater among those who received CBT with or without exercise
than among those who received exercise alone or usual care. Compared with
usual care, fatigue, cognitive symptoms, distress, and mental health functioning
were improved in the exercise groups, and cognitive symptoms and mental health
functioning were improved in the CBT alone group. In an editorial, HotopfArticle
discusses the need to develop a model for the cognitive and behavioral factors
underlying the chronic symptoms of GWVI that would guide the CBT intervention.
To study the relationship between alcohol consumption and risk of dementia
in older adults, Mukamal and colleagues conducted a nested case-control study
of alcohol consumption and risk of incident dementia in the Cardiovascular
Health Study, a prospective, population-based cohort study of adults aged
65 years and older. Weekly alcohol consumption was categorized as none, less
than 1 drink, 1 to less than 7 drinks, 7 to less than 14 drinks, and 14 or
more drinks. The risk of incident dementia was lowest among older adults who
consumed 1 to less than 7 drinks per week.
Colorectal cancer screening has been shown in randomized trials to reduce
colorectal cancer mortality, but the benefit of prostate-specific antigen
(PSA) screening for prostate cancer has not yet been demonstrated in randomized
trials and its use is controversial. Nevertheless, in this analysis of data
from the 2001 Behavioral Risk Factor Surveillance System, Sirovich and colleagues
found that men aged 50 years or older were significantly more likely to report
undergoing PSA screening than colorectal cancer screening.
"My reluctance to return to the office generally is precipitated by
the fear of what I will find in my mailbox." From "Dumbing Down."
The use of tissue-type plasminogen activator is at the center of a debate
between proponents who say it's underused and emergency physicians faced with
treatment decisions in real-world settings.
The incidence of all breast cancers with a lobular component increased
from 19.8 per 100 000 in 1987 to 33.4 per 100 000 in 1999, a period
during which use of combined estrogen and progestin hormone replacement therapy
increased steadily, whereas the incidence of ductal carcinoma remained essentially
Epidemiological characteristics of cases of newborns killed or left
to die by a parent in North Carolina, 1985-2000.
Evaluation and management of headache.
JAMA and the BMJ Publishing Group announce
the Fifth International Congress on Peer Review and Biomedical Publication
to be held in September 2005. Deadline for submission of abstracts is January
15, 2005. See http://www.jama-peer.org.
For your patients: Information about headaches.
This Week in JAMA. JAMA. 2003;289(11):1343. doi:10.1001/jama.289.11.1343