Chronically ill, homebound older adults have a higher risk of depression,
but being diagnosed and receiving treatment may be less likely than among
socially integrated adults in the same age group. Ciechanowski and colleaguesArticlereport results of a randomized trial of a brief home-based
psychotherapy program to detect and treat minor depression and dysthymia in
low-income, homebound, chronically ill older adults. At a 12-month follow-up,
patients in the intervention group were more likely to have complete remission
from depression, experience a reduction in depressive symptoms by at least
50%, and report significantly improved functional and emotional well-being
compared with patients in the usual care group. In an editorial,ArticleLyness discusses the efficacy and challenges of depression treatment in later
Several studies have sought to determine whether sexual activity is
associated with prostate cancer risk with mixed results. Leitzmann and colleagues
compared data on ejaculation frequency during 2 decades of adulthood and in
the past year with incident prostate cancer to examine whether sexual activity
is related to prostate cancer risk. They found no association of ejaculation
frequency with subsequent risk of prostate cancer.
Guidelines for the treatment of pharyngitis vary in their recommendations
for throat cultures and prescription of antibiotics. McIsaac and colleagues
compared several alternative strategies for the diagnosis and treatment of
acute sore throat and assessed diagnostic sensitivity and specificity, the
total and unnecessary antibiotics prescribed, and the treatment of group A
streptococcus pharyngitis at the initial visit. They found that strategies
including throat cultures had the highest sensitivity and specificity; in
adults, a clinical prediction rule to select patients for throat cultures
had high sensitivity and specificity. Unnecessary antibiotic use was minimized
when prescription followed a positive rapid antigen test or throat culture
Elderly individuals may have episodes when they need assistance in accomplishing
basic activities of daily living (ADLs), but information on the likelihood
and time course of recovering independence is lacking. Hardy and Gill report
results of a prospective study of initially ADL-independent older adults of
whom slightly more than half experienced disability during the study and in
whom the time course of recovery and recovery-related factors were assessed.
Among those who became newly disabled, 81% recovered their independence within
a year and the majority remained independent for at least 6 months. Three
or more months of disability, cognitive impairment, frailty, and disability
in 3 or 4 ADLs were associated with a diminished likelihood of recovery.
Inhaled nitric oxide improves oxygenation in patients with acute lung
injury, but whether it benefits longer-term clinical outcomes has not been
clearly demonstrated. Taylor and colleaguesArticle report
results of a randomized trial of low-dose inhaled nitric oxide compared with
nitrogen gas administered to patients with moderately severe acute lung injury
and without sepsis or nonpulmonary organ dysfunction. The study failed to
document a beneficial effect of nitric oxide on any of the outcome variables
including days alive and eligible for extubation, mortality, or adverse events.
In an editorial,Article Adhikari and Granton discuss
why nitric oxide is unlikely to improve long-term clinical outcomes in patients
with acute lung injury or acute respiratory distress syndrome.
"Had Mr B had a stroke? Was he competent—and so can legally refuse
all procedures as he is doing? Or was he incompetent—and can't consent
to any procedure?" From "Name Brand Medically Necessary: Do Not Substitute."
Advocates of stenting to treat carotid artery stenosis are clashing
with those who say that endarterectomy should remain the standard of care.
Scientific Review/Clinical Applications The
efficacy and adverse event profiles of 2 estrogens commonly prescribed to
treat postmenopausal hot flashes are reviewed in Part 1Articleof this article. Part 2Articlediscusses initiating estrogen
therapy for a perimenopausal woman with symptoms and discontinuing treatment
for a long-term user.
Relating basic science to benefit for individual patients.
For your patients: Information about sore throat.
This Week in JAMA. JAMA. 2004;291(13):1535. doi:10.1001/jama.291.13.1535