The benefits of statin drugs to reduce lipoprotein levels and cardiovascular
morbidity and mortality are well established, but the optimal intensity of
therapy is not known. Nissen and colleaguesArticlereport results
from a multicenter randomized trial examining the progression of atherosclerosis
in a target vessel in patients randomly assigned to receive either a moderate
lipid-lowering regimen of 40 mg/d of pravastatin or an intensive regimen of
80 mg/d of atorvastatin. At the 18-month follow-up, patients receiving atorvastatin
had significantly less increase in atheroma volume in the target vessel and
significantly greater reductions in low-density lipoprotein cholesterol and
C-reactive protein levels compared with patients receiving pravastatin. In
an editorial,ArticleSacks discusses the implications of these
results for clinical practice.
See online video
Suicide rates are highest in the elderly, and many individuals who attempt
suicide have seen a primary care physician in the preceding months. Bruce
and colleagues report results of a primary care practice–based randomized
trial to improve depression treatment and decrease suicide risk in older patients.
Intervention practices used a clinical algorithm to guide treatment decision
making and nonphysician, master's-level depression care managers to provide
much of the patient follow-up. Physicians in control practices were educated
about depression treatment guidelines but otherwise followed usual patterns
of care. Patients in the intervention practices experienced a more rapid decline
in suicidal ideation and faster resolution of depressive symptoms compared
with patients in the control practices.
In a randomized trial assessing pain relief after neurolytic celiac
plexus block (NCPB) plus systemic analgesics compared with systemic analgesia
alone in patients with inoperable pancreatic cancer, Wong and colleagues found
that patients receiving NCPB had greater pain relief but not improved quality
of life or survival.
Canada's Medicare system prohibits parallel private insurance for any
publicly insured service and may keep individuals of higher socioeconomic
status (SES) within the public system. Whether the expectations of higher
SES patients influence the level of care for all patients is not known. Alter
and colleagues surveyed patients discharged from Ontario hospitals after a
myocardial infarction to assess the relationship of SES to use of services
and satisfaction with care. They found that compared with patients of lower
SES, patients of higher SES were more likely to see a cardiologist and to
receive cardiac catheterization and cardiac rehabilitation within 30 days
of discharge; in adjusted analyses, higher education and not higher income
was a better predictor of receiving specialty care and greater dissatisfaction
with care received.
"She came to me as a patient when I first entered practice and was just
about as green as a gourd." From "The Bless Cloth."
Researchers are using imaging techniques to dissect neurobiological
factors that underlie alcohol disorders.
Low levels of a serum protein involved in bone turnover predict a high
risk of nontraumatic fracture.
The addition of formaldehyde to maternal blood samples enhances recovery
of fetal DNA.
A proposal to foster the transfer of research results to clinical practice.
The contribution of microchimerism to autoimmunity and host tolerance
of transplanted tissues.
For your patients: Information about suicide in older persons.
This Week in JAMA. JAMA. 2004;291(9):1033. doi:10.1001/jama.291.9.1033