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This Week in JAMA
June 1, 2005

This Week in JAMA

JAMA. 2005;293(21):2565. doi:10.1001/jama.293.21.2565
Treatment of Complicated Grief

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.

Defensive Medicine and Malpractice Reform

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.

Access to Trauma Centers

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.

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Radiofrequency Ablation to Treat Atrial Fibrillation

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.

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Antibiotic Therapy and CAD Outcomes

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.

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Medical News & Perspectives

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 various cancers.

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CLINICIAN’S CORNER

Grand Rounds
Erectile function often returns within 2 years of radical prostatectomy; management strategies for interim erectile dysfunction are discussed.

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Physicians and the Investment Industry

Legal and ethical risks when physicians have consulting relationships with the investment industry.

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Women’s Health

Call for Papers

Authors are invited to submit manuscripts for a JAMA theme issue on women’s health.

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JAMA Patient Page

For your patients: Information about grief.

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