Both cognitive-behavioral therapy (CBT) and fluoxetine have demonstrated
efficacy in adolescents with major depressive disorder; however, little is
known about the therapies' relative or combined effectiveness. Results from
the Treatment for Adolescents With Depression Study,Articlein which patients were randomized to 12 weeks of fluoxetine alone, CBT alone,
CBT and fluoxetine, or placebo, address these questions. The investigators
report that symptom reduction in the combined CBT and fluoxetine group was
significantly greater than with either treatment alone or placebo and that
fluoxetine alone was superior to CBT alone at 12 weeks. In an editorial,ArticleGlass discusses the contribution of these data to empirically
based treatment of adolescents with major depressive disorder.
A prior study documented that radiation combined with 3 years of androgen
suppression therapy (AST) improved survival in clinically localized prostate
cancer. However, long-term AST is associated with adverse effects. D'Amico
and colleaguesArticleassessed the survival benefit associated
with radiation therapy alone or in combination with 6 months of AST for men
with localized disease. After a median follow-up of 4.5 years, the authors
found statistically significant overall and disease-specific survival advantages
for patients receiving radiation and AST vs radiation therapy alone. In an
editorial,ArticleDeWeese discusses the importance of these
results for patients at high risk of disease recurrence.
Vitamin E supplementation has been shown to enhance the immune response
and reduce the incidence of self-reported infectious diseases in older persons.
In a randomized trial, Meydani and colleagues sought to determine the effect
of daily vitamin E supplementation vs placebo on the incidence of clinically
diagnosed respiratory tract infections in elderly nursing home residents.
They found no effect of vitamin E on the overall incidence or duration of
respiratory tract infections. However, significantly fewer residents receiving
vitamin E acquired 1 or more respiratory tract infections, and in a subgroup
analysis, residents receiving vitamin E had significantly fewer common colds.
After a hip fracture, a significant number of elderly patients do not
recover their prefracture ambulatory or functional status. In a group of community-dwelling
men and women who had a hip fracture and completed standard physical therapy,
Binder and colleagues investigated the effect of an additional 6 months of
supervised physical therapy and progressive resistance exercise training compared
with a flexibility-enhancing home exercise program on physical function and
disability. The authors found that patients randomized to the extended therapy
group had significantly improved physical performance, quality of life, and
functional status vs patients randomized to the home exercise program.
Surgical mortality rates are used as a measure of hospital quality,
but it is not clear that all hospitals have a sufficient volume of procedures
to identify quality deficiencies. Dimick and colleagues reviewed data from
a national hospital discharge database to determine the minimum number of
procedures needed to identify a poorly performing hospital for the 7 surgical
procedures for which mortality has been advocated as a quality indicator.
With the exception of coronary artery bypass graft surgery, the authors found
that the number of procedures and event rates were too low to allow adequate
assessment of hospital quality.
"As clinicians we are always creating environments that heal—in
a room, on a unit, throughout a building." From "Healing in Spaces."
Scientists are exploring the use of human embryonic stem cells in a
variety of medical applications.
Evidence for a role of small intestinal bacterial overgrowth in the
signs and symptoms of irritable bowel syndrome is reviewed.
From the Archives Journals
Characteristics of West Nile virus encephalomyelitis in organ transplant
recipients are reviewed.
For your patients: Information about irritable bowel syndrome.
This Week in JAMA. JAMA. 2004;292(7):773. doi:10.1001/jama.292.7.773