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.
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.
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 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.
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.
Incidence, predictors, and clinical outcomes 9 months after implantation
of drug-eluting stents.
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).
Clinical ReviewRoutine episiotomy offers
neither short-term nor long-term benefits.
For your patients: Information about childbirth.
This Week in JAMA . JAMA. 2005;293(17):2061. doi:10.1001/jama.293.17.2061