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This Week in JAMA
April 14, 2004

This Week in JAMA

JAMA. 2004;291(14):1673. doi:10.1001/jama.291.14.1673

The benefits and risks of unopposed estrogen therapy for postmenopausal women with a prior hysterectomy are uncertain. The estrogen-alone component of the Women's Health Initiative (WHI)Articleassessed whether conjugated equine estrogen (CEE) therapy would reduce coronary heart disease incidence and the risk of stroke, fractures, and breast and colorectal cancers in women who participated in this randomized, placebo-controlled trial. After an average 6.8 years of follow-up, the trial was terminated when it was determined that CEE increased the risk of stroke and had no preventive effect on coronary heart disease events. However, women taking CEE had a reduced risk of fracture and demonstrated a trend toward a reduction in breast cancer vs women taking placebo. Yet a summary estimate of overall risks and benefits did not favor CEE therapy for postmenopausal women with hysterectomy. In an editorial, Hulley and GradyArticlereview the outcome data from the 3 major trials of hormone therapy for postmenopausal women and discuss the limited circumstances for which postmenopausal hormone use might be considered.

Accuracy of Computed Tomographic Colonography

The reported sensitivity of computed tomographic colonography (CTC) to detect clinically significant colonic lesions varies widely. Cotton and colleaguesArticlepresent results of a multicenter study to assess the accuracy of CTC among patients with clinical indications for colonoscopy who agreed to undergo CTC before conventional colonoscopy. The investigators found that CTC's sensitivity in detecting either clinically significant or any lesions was significantly less than that of conventional colonoscopy. In an editorial, RansohoffArticlediscusses the discrepant results in studies of CTC and the implications for its wide clinical use.

Atrial Fibrillation After Coronary Artery Surgery

A better understanding of the factors associated with atrial fibrillation after coronary artery bypass graft (CABG) surgery could improve identification of patients at greatest risk and enhance the use of preventive strategies. Mathew and colleagues reviewed data from patients undergoing CABG to assess the nature and consequences of new-onset atrial fibrillation and to develop and test a comprehensive risk index to identify patients at greatest risk of new-onset and recurrent atrial fibrillation. They identified a number of operative, comorbid, and medication-related factors predictive of new-onset and recurrent atrial fibrillation and pharmacologic therapies that may offer protection.

Adiponectin and Risk of Myocardial Infarction

Plasma levels of adiponectin, a newly described secretory product of adipocytes, are inversely associated with several cardiovascular risk factors and some studies suggest adiponectin may have antiatherogenic and anti-inflammatory properties. Pischon and colleagues assessed the association of plasma adiponectin level and risk of nonfatal or fatal myocardial infarction in men. In analyses that adjusted for traditional cardiovascular risk factors, they found that men with adiponectin levels in the highest quintile had a significantly decreased risk of myocardial infarction compared with men in the lowest quintile.

Medical News & Perspectives

Researchers and clinicians are becoming increasingly aware that as men age, they have a greater likelihood of passing along defective genes to their children.

Effects of Early Hip Fracture Repair

Surgical repair of hip fracture within 24 hours of hospital admission has no effect on mortality or function but results in shorter length of stay, less pain, and fewer postoperative complications compared with later surgery.

Enrollees Rate Medicare Plan Performance

Surveys of Medicare beneficiaries in fee-for-service (FFS) and managed care plans revealed that managed care plans scored higher for preventive care and customer service, but patients in FFS plans were more satisfied with access and their overall care.

Mechanically Ventilated Patients With Delirium

Mechanically ventilated patients with delirium have a higher risk of mortality, longer hospital stay, and increased cognitive impairment at discharge compared with ventilated patients without delirium.


Women's susceptibility to carcinogens in cigarette smoke, sex-associated differences in lung tumor biology, and estrogen effects on tumorigenesis are discussed in relation to the increasing incidence of lung cancer in women.

JAMA Patient Page

For your patients: Information about delirium.