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This Week in JAMA
January 18, 2006

This Week in JAMA

JAMA. 2006;295(3):249. doi:10.1001/jama.295.3.249
Watchful Waiting vs Prompt Repair of Inguinal Hernia

Men with inguinal hernia may have few symptoms, and it is not known whether surgical repair can be deferred until symptoms develop. Fitzgibbons and colleaguesArticle report results of a randomized trial involving men with minimally symptomatic inguinal hernia who were assigned to treatments of watchful waiting or standard open tension-free surgical repair. Comparing the 2 groups of patients, the authors found similar proportions who reported pain or discomfort that interfered with usual activities and comparable physical function scores during 2 years of follow-up. In an editorial, FlumArticle discusses the implications of the trial findings for patients with asymptomatic or minimally symptomatic inguinal hernia.

Thromboembolic Events and Recombinant Factor VIIa

Recombinant human coagulation factor VIIa (rFVIIa) is licensed for use by patients with hemophilia and inhibitors to factors VIII or IX, but it is increasingly used by patients without hemophilia. O’Connell and colleagues reviewed 168 thromboembolic adverse event reports in the US Food and Drug Administration Adverse Event Reporting System associated with use of rFVIIa. The authors found that use of rFVIIa for unlabeled indications preceded 151 of these events and report event specifics, such as source and reason for rFVIIa use, thromboembolic site, morbidity and mortality, timing of rFVIIa administration, and concomitant medications.

Surveillance for Recurrent Bladder Cancer

Recurrences of bladder cancer are common and current surveillance methods miss some cancers. In a cohort of 668 patients having cystoscopy and urine cytology, Grossman and colleagues investigated whether adding a point-of-care proteomic assay for the nuclear matrix protein NMP22 in voided urine to cystoscopy improves detection of bladder cancer recurrences. The authors found that cystoscopy plus the NMP22 assay detected significantly more bladder cancers compared with cystoscopy alone or cystoscopy with urine cytology.

Aspirin and Prevention of CVD Events by Sex

Aspirin is often prescribed for primary prevention of cardiovascular disease (CVD), but it is not clear whether women derive the same benefit as men. To address this question, Berger and colleagues conducted a sex-specific meta-analysis of data from randomized trials of aspirin for primary prevention of CVD. They found a beneficial effect of aspirin on a composite outcome of nonfatal myocardial infarction (MI), nonfatal stroke, and cardiovascular mortality in both women and men. In sex-specific analyses of each outcome separately, aspirin therapy was associated with a significant reduction in stroke, with no effect on MI or cardiovascular mortality in women, and a significant reduction in MI, with no effect on stroke or cardiovascular mortality in men.

Peer Reviewers Suggested by Authors or by Editors

Some journals allow authors to suggest peer reviewers for their manuscripts. Whether review quality and publication recommendations differ with author- vs editor-suggested reviewers is not known. Schroter and colleagues conducted an observational study of peer review at 10 biomedical journals and compared review quality and publication recommendations from reviewers who were suggested either by authors or by editors. The authors found no difference in review quality by reviewer type. However, reviewers suggested by authors were more likely to make favorable recommendations for publication.

Medical News & Perspectives

Many thousands of survivors of Hurricane Katrina who remained in affected areas or relocated elsewhere throughout the United States are expected to require mental health services for conditions such as posttraumatic stress disorder and depression.


Clinical Crossroads

Ms A is a 60-year-old women who has had depression for much of her adult life. Salzman reviews the causes and management of treatment-resistant depression and the contribution of comorbid personality disorder.

100 000 Lives Campaign

Berwick and colleagues describe the 100 000 Lives Campaign, an initiative of the Institute for Healthcare Improvement, and discuss the 6 hospital interventions they believe could result in 100 000 patient lives saved.

Medical Education Call for Papers

Authors are invited to submit manuscripts for the annual JAMA theme issue on medical education scheduled for September 2006.

Author in the Room

Join Olga Jonasson, MD, in a teleconference on February 15, 2006, to discuss a randomized trial comparing watchful waiting vs standard open tension-free surgical repair for treating inguinal hernia.

For more information and to register for “Author in the Room,” please visit http://www.ihi.org/authorintheroom.

JAMA Patient Page

For your patients: Information about depression.