Two articles in this issue of JAMA describe interventions to improve cervical cancer prevention in women at high risk. First, Denny and colleaguesArticle assessed the safety and efficacy of 2 screen-and-treat approaches among women in South Africa who were randomly assigned to human papillomavirus (HPV) DNA testing, visual inspection with acetic acid (VIA), or delayed evaluation. Women with positive test results were treated with cryotherapy within several days of screening. At 6- and 12-month follow-up visits, the prevalence of cervical intraepithelial neoplasia grade 2+ was significantly lower in the 2 screen-and-treat groups compared with women in the delayed evaluation group. In a second article, Brewster and colleaguesArticle report results of a randomized trial comparing diagnosis and treatment of severely abnormal Papanicolaou test results in a single visit vs usual care. Single-visit diagnosis and treatment was completed in a mean of 2.8 hours with high patient acceptability and was associated with a higher rate of follow-up than usual care. In an editorial, Blumenthal and GaffikinArticle discuss strategies to improve cervical cancer prevention.
Annual influenza vaccination is recommended for children with certain chronic medical conditions, but whether these conditions are associated with serious influenza-associated complications is not clear. In a review of 745 pediatric hospitalizations for influenza, Keren and colleagues determined that children with neurological or neuromuscular diseases—a disease category recently added to the list of persons for whom annual influenza vaccination is recommended—were at highest risk of influenza-related respiratory failure.
“Family G,” a family with a high incidence of cancers of the colon, rectum, stomach, and endometrium, now called Lynch syndrome, was first described more than 100 years ago and was last reviewed by Lynch in 1971. In this issue of JAMA, Douglas and colleagues update and summarize the history and genetics of Lynch syndrome in family G. Specifically, among 929 known descendents of the original progenitor, 74 have been diagnosed as having 1 or more Lynch syndrome–associated cancers. Among 40 family members who were tested, 5 carry the MSH2 T to G mutation, and 97 living members were excluded as mutation carriers.
Randomized clinical trials (RCTs) are sometimes stopped earlier than planned when interim data analyses reveal significant benefit from the intervention. However, little is known about the characteristics of these truncated trials. In a systematic review of RCTs stopped early for benefit, Montori and colleaguesArticle found that truncated trials are becoming more common. Published reports of the trial results often fail to provide information about the decision to stop early, and the treatment effects are often implausibly large. In an editorial, PocockArticle discusses circumstances that may or may not justify early trial termination.
“I was not motivated by concern for the ill person before me or by a genuine curiosity and desire to identify and treat his disease. I was motivated by the need to pass an examination upon which my career depended.” From “Playing Doctor.”
Safety experts hope adoption of new guidelines and other measures will reduce hazards of magnetic resonance imaging, such as failure of implantable devices, burns, and injury from projectiles drawn by the device’s powerful magnet.
Sawaya reviews cervical cancer screening in his discussion of Ms G, a 21-year-old woman with results from 2 consecutive Papanicolaou tests showing atypical squamous cells of undetermined significance (ASC-US).
Urban academic medical centers are expected to meet the immediate health care needs of proximate community residents as well as the specialized and complex needs of patients across the region.
Findings from genomics and brain imaging will transform psychiatry as a clinical neuroscience and lead to treatment of mental disorders as disorders of the brain.
For your patients: Information about randomized controlled trials.
This Week in JAMA . JAMA. 2005;294(17):2131. doi:10.1001/jama.294.17.2131