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This Week in JAMA
May 4, 2005

This Week in JAMA

JAMA. 2005;293(17):2061. doi:10.1001/jama.293.17.2061
Conservative Management of Prostate Cancer

Understanding the natural history of localized prostate tumors is important to support treatment recommendations. In this issue of JAMA, Albertsen and colleaguesArticle report 20-year mortality outcomes for men with localized disease who were treated with observation or androgen withdrawal therapy. In analyses stratified for age and tumor grade, the authors found a minimal risk of prostate cancer death in men with low-grade tumors (Gleason score 2-4), a high risk in men with high-grade tumors (Gleason score 8-10), and an intermediate risk in men with tumors of Gleason score 5 or 6. In an editorial,Article Gann and Han discuss the relevance of these data for contemporary prostate cancer patients.

Race, BMD, and Risk of Nonspinal Fractures

Bone mineral density (BMD) predicts fracture risk in white women, but whether the relationship is similarly applicable to black women is not clear. Cauley and colleaguesArticle examined the association of BMD with risk of nonspinal fractures in white and black women in a large prospective cohort study. In age-adjusted models, they found that black women have a lower risk of fracture than white women at every level of BMD. In multivariable analyses, the lower risk of fracture in black vs white women was independent of BMD and other factors commonly associated with bone health. In an editorial,Article Acheson discusses the limitations of race-based norms for BMD, factors that may explain differences in fracture risk, and the importance of individual clinical assessment.

Drug-Eluting vs Bare-Metal Stents for STEMI

Sirolimus-eluting stents are associated with better outcomes than bare-metal stents after primary coronary intervention, but there are few data on their efficacy for patients with acute myocardial infarction. Valgimigli and colleaguesArticle evaluated clinical outcomes in patients with acute ST-segment elevation myocardial infarction (STEMI) who were randomly assigned to receive either single high-dose bolus tirofiban-supported sirolimus-eluted stent implantation or abciximab pretreatment and bare-metal stent placement. Patients in the tirofiban plus sirolimus-eluting stent group were significantly less likely to experience death, nonfatal myocardial infarction, stroke, or binary restenosis at 8 months compared with patients in the abciximab plus bare-metal stent group. In an editorial,Article Cohen and Ohman review the extant data on drug-eluting stents in the setting of acute myocardial infarction.

Acupuncture for Migraine Headaches

Acupuncture is used to prevent migraine attacks, but data on its effectiveness are scarce. Linde and colleagues randomly assigned patients with migraine headaches to 8 weeks of acupuncture or sham acupuncture treatments or to a waiting list (control) and assessed the number of days with moderate or severe headache reported in headache diaries for the 4 weeks before vs 9 to 12 weeks after randomization and treatment. They found that days with headache declined significantly and similarly for patients receiving actual or sham acupuncture compared with control patients.

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Medical News & Perspectives

State-of-the-art patient care and laboratory facilities in the newly opened $596 million Mark O. Hatfield Clinical Research Center at the National Institutes of Health will help researchers conduct clinical trials and transform laboratory research into clinical advances.

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Thrombosis of Drug-Eluting Stents

Incidence, predictors, and clinical outcomes 9 months after implantation of drug-eluting stents.

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Postmarketing Surveillance for ADRs

Structure, operation, and early results of a multidisciplinary, clinically based, postmarketing surveillance and information dissemination system for serious and previously unrecognized adverse drug reactions (ADRs).

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CLINICIAN’S CORNER

Clinical Review
Routine episiotomy offers neither short-term nor long-term benefits.

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JAMA Patient Page

For your patients: Information about childbirth.

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