New findings from the Women‘s Health Initiative (WHI) challenge
previous evidence that suggested that estrogen-containing hormone therapy
has a protective effect on the brain in postmenopausal women. In the estrogen
plus progestin component of the WHI Memory Study (WHIMS), which included women
aged 65 years or older enrolled in the WHI trial,
Shumaker and colleaguesArticle found that the risk of probable dementia in the estrogen
plus progestin group was twice that in the placebo group during a mean follow-up
of 4 years. Rapp and colleaguesArticle also report
that although most women in WHIMS did not experience a clinically important
decline in global cognitive function, more women in the estrogen plus progestin
group than in the placebo group had a substantial decline in cognitive function.
Wassertheil-Smoller and colleaguesArticle, in additional
analyses of data from the WHI trial, found that the risk of stroke, particularly
ischemic stroke, was significantly increased in the estrogen plus progestin
group overall and in a number of subgroups of women. In an editorial, YaffeArticle considers possible explanations for the discrepancies
between results of observational studies of hormone therapy and those of the
WHI randomized trial.
The most common modes of death for patients with heart failure are sudden
cardiac death from ventricular arrhythmias and progressive heart failure.
Young and colleaguesArticle conducted a randomized
trial among patients with moderate-to-severe heart failure and wide QRS interval
to evaluate combining an implantable cardioverter defibrillator (ICD) with
cardiac resynchronization therapy (CRT), which would provide both defibrillation
and resynchronization capabilities. All patients underwent implantation with
a combined defibrillation-resynchronization device and had the cardioverter-defibrillator
function activated throughout the trial. Improvements in quality of life,
functional class, and exercise capacity were significantly greater among patients
who had active CRT and ICD than among those with active ICD alone. CRT did
not interfere with cardioverter-defibrillator function. In an editorial,
BradleyArticle points out several caveats to consider when applying
the results of this study to patients who may be candidates for combined resynchronization-defibrillation
Many prostate cancers detected using serum prostate-specific antigen
(PSA) screening are clinically insignificant, and it is not clear whether
early detection of prostate cancer using PSA screening reduces prostate cancer
mortality. Eastham and colleagues conducted PSA testing on consecutive annual
blood samples from an unscreened cohort of men participating in the Polyp
Prevention Trial. Among men with an abnormal PSA test result, 40% to 55%,
depending on the cutoff level for an abnormal PSA result, had a normal PSA
finding at 1 or more subsequent visits during 4 years of follow-up.
Mrs W visited a physician after 1 day of cold symptoms, concerned about
spreading her illness to family members. The physician diagnosed viral acute
respiratory infection but prescribed an antibiotic at the patient's insistence.
Gonzales discusses the evaluation and treatment of acute respiratory infections
and risks of unnecessary antibiotic use.
"That smart funny quirky slightly crazy brilliant light has been snuffed
out, destroyed, lost forever, and nothing will ever be the same again." From
"What I Have Seen."
A novel program in North Carolina using HIV RNA screening to detect
acute HIV infections could help health officials identify early clusters and
Major challenges in writing about race and ethnicity in biomedical publications
and recommendations to address them.
For your patients: Information about the common cold.
This Week in JAMA . JAMA. 2003;289(20):2611. doi:10.1001/jama.289.20.2611