Therapies commonly used for chronic neck pain have not been evaluated
in randomized studies. In this trial, Ylinen and colleagues randomly assigned
female office workers with chronic, nonspecific neck pain to a neck muscle
endurance training program, an intensive isometric neck strength training
program, or to a control group. After 1 year, neck pain and disability had
decreased significantly in both training groups compared with the control
Previous studies suggest that black patients hospitalized with heart
failure receive poorer quality of care and have worse outcomes than white
patients, but the evidence is inconsistent. In this analysis of data from
the National Heart Failure Project, an ongoing initiative to improve quality
of care for Medicare beneficiaries hospitalized with heart failure, Rathore
and colleagues found that black and white patients with Medicare had comparable
quality of care during hospitalization for heart failure. Black patients had
slightly higher readmission rates than white patients but lower mortality
rates up to 1 year after hospitalization.
Treatment with individual bone antiresorptive agents has been shown
to increase bone mineral density (BMD) and reduce fracture risk in women with
postmenopausal osteoporosis, but the effectiveness of combination antiresorptive
therapy is not known. Greenspan and colleagues conducted a placebo-controlled
randomized trial comparing hormone therapy combined with alendronate to each
therapy alone among community-dwelling women aged 65 to 90 years. After 3
years, increases in spine and total hip BMD were significantly greater in
the combination therapy group than in the monotherapy groups.
To synthesize evidence from the many clinical trials of antihypertensive
agents, Psaty and colleagues conducted a network meta-analysis that combined
direct within-trial between-drug comparisons of first-line antihypertensive
agents with indirect evidence that was derived from trials that had 1 treatment
in common. Low-dose diuretics were more effective for preventing cardiovascular
disease morbidity and mortality than the other first-line treatment strategies—β-blockers,
angiotensin-converting enzyme inhibitors, calcium channel blockers, α-blockers,
and angiotensin receptor blockers.
Evaluation and treatment of insomnia.
Researchers have discovered the cause of the premature aging that characterizes
a rare disorder called progeria—a finding that is also expected to provide
insight into the normal aging process.
The use of composite outcomes that combine multiple end points provides
efficiencies in the conduct of clinical trials as does the use of factorial
designs, but both require careful attention to appropriate analysis and reporting.
A practical guide to the new guidelines
for hypertension prevention and management from "The Seventh Report of the
Joint National Committee on Prevention, Detection, Evaluation, and Treatment
of High Blood Pressure" (JNC 7).
For your patients: Information about insomnia.
This Week in JAMA . JAMA. 2003;289(19):2459. doi:10.1001/jama.289.19.2459