Complicated grief—persistent symptoms and impairment after a personal
loss through death—is difficult to treat and is estimated to affect
1 million persons annually. Shear and colleaguesArticle report
results of a randomized trial testing the efficacy of a novel complicated
grief treatment (CGT) strategy compared with standard interpersonal psychotherapy
for persons with complicated grief. They found that both CGT and interpersonal
psychotherapy achieved symptom improvement, but the therapeutic response was
greater and quicker for persons who received the CGT strategy. In an editorial,
GlassArticle discusses current perspectives on grief and unresolved
questions about complicated grief and its treatment.
Physician concerns about malpractice risk may influence patient care
and other professional decisions. Two articles in this issue of JAMA provide data on these issues. First,
Studdert and colleaguesArticle report results of a survey of Pennsylvania physicians representing
6 specialties at high risk of litigation for their practice of defensive medicine.
Of the physicians surveyed, 93% reported practicing defensive medicine, particularly
assurance behaviors such as ordering more tests, prescribing more medications,
and performing more procedures to confirm diagnoses. In the second article,
Kessler and colleaguesArticle report results of their analyses
of state-level data, which linked certain types of malpractice reforms with
an increase in supply of physicians in high-risk specialties. In an editorial,
Budetti discussesArticle the need for innovative approaches
to tort reform that combine evidence-based medicine with patient safety protections.
Trauma centers are not evenly distributed across the United States,
which may leave some patients without timely access to care. Branas and colleagues
reviewed national data on trauma centers, helipads, and block group population
to estimate the proportion of US residents living within 45 and 60 minutes
of a trauma center. They found that more than 80% of US residents have access
to a level I or II trauma center within an hour; however, 46.7 million, primarily
in rural areas, reside at even greater distance from trauma care.
In a randomized trial of 70 patients with symptomatic atrial fibrillation
(AF), Wazni and colleagues investigated the feasibility of pulmonary vein
isolation with radiofrequency ablation as a first-line and curative treatment
of AF. Compared with patients receiving antiarrhythmic and anticoagulation
drug treatment, patients who had radiofrequency ablation had fewer recurrences
of symptomatic AF and fewer hospitalizations during 1 year of follow-up.
Chlamydia pneumoniae infection has been associated
with initiation and progression of atherosclerosis, but results of clinical
trials of antichlamydial antibiotic therapy for patients with coronary artery
disease (CAD) have been inconsistent. In a meta-analysis of 11 prospective,
randomized, placebo-controlled trials of antichlamydial antibiotic therapy
for patients with CAD, Andraws and colleagues found that antibiotics had no
effect on all-cause mortality, rates of myocardial infarction, or a combined
end point of myocardial infarction and unstable angina.
Although safety concerns have recently emerged regarding some nonsteroidal
anti-inflammatory drugs (NSAIDs), particularly cyclo-oxygenase-2 inhibitors,
new research hints that some NSAIDs might have value in preventing and treating
Grand Rounds Erectile function often
returns within 2 years of radical prostatectomy; management strategies for
interim erectile dysfunction are discussed.
Legal and ethical risks when physicians have consulting relationships
with the investment industry.
Call for Papers
Authors are invited to submit manuscripts for a JAMA theme issue on women’s health.
For your patients: Information about grief.
NEXT WEEK Theme Issue on Tuberculosis
This Week in JAMA . JAMA. 2005;293(21):2565. doi:10.1001/jama.293.21.2565