The optimal adjuvant treatment for stage I endometrial carcinoma is not established and whether adjuvant radiation therapy (RT) is beneficial is controversial. Lee and colleagues conducted a retrospective analysis of national data, collected from 1988 through 2001 for 21 249 patients with stage IA-C node-negative endometrial adenocarcinoma, to evaluate the frequency and effect of adjuvant RT on overall and relative survival. The authors found that 19.2% of the women in this cohort received adjuvant RT. Adjuvant RT improved overall and relative survival of women with stage IC disease (grades 1 and 3-4) but not among women with tumors of other stage or grade combinations.
Myocardial injury is a frequent consequence of moderate to severe carbon monoxide (CO) poisoning. Although in-hospital mortality is low, long-term outcomes have received little attention. Henry and colleagues assessed the association between myocardial injury and long-term mortality in a prospective cohort study of 230 adults who were treated for moderate to severe CO poisoning and followed up for a median of 7.6 years. Thirty-seven percent of patients in the cohort had documented myocardial injury. The authors found that patients with myocardial injury had a significantly increased risk of long-term mortality compared with the patients without myocardial injury.
Consumption of omega-3 fatty acid–containing dietary supplements has been purported to reduce cancer risk, but whether this is a valid claim is not known. MacLean and colleagues reviewed published and unpublished clinical studies that have evaluated the effect of omega-3 fatty acid on cancer incidence. The studies reviewed were highly heterogeneous, conducted in 7 countries, used different methods to determine exposure, and assessed effects on 10 different types of cancer. Among 63 estimates of effect reported, only 8 were statistically significant. Overall, the authors found no evidence to suggest a significant association between omega-3 fatty acid consumption and cancer incidence.
Physicians' commitments to patient welfare and scientific integrity often conflict with the market forces that compel the pharmaceutical and medical device industries to seek profit. Furthermore, these conflicts of interest pose challenges to medical professionalism and patient trust. Brennan and colleagues reviewed current guidelines intended to regulate relations between physicians and industry and social science research on gift receipt behavior and suggest that these guidelines inadequately protect physician integrity and patient welfare. The authors propose a policy that would have academic medical centers take the lead in eliminating conflicts of interest between physicians and the health care industry.
“I want to put the pieces together—the endless lectures, the physical examination skills, the challenge of taking a history that means something—into a completed puzzle that resembles the image of the physician I am determined to become.” From “Jigsaw.”
The emergence of resistance mutations to imatinib, a drug that targets the molecular flaw underlying chronic myeloid leukemia, can lead to relapse. Now, new findings suggest the next generation of similarly targeted drugs may help patients with relapsed disease.
The accuracy and precision of bedside clinical maneuvers for diagnosing hearing impairment.
“Eminent domain,” a federal governmental right to assume control of public property in the name of public good, could limit biomedical patent protections in the interests of public health.
The aftermath of Hurricane Katrina highlights the need for a national approach to emergency health care coverage in times of crisis.
Authors are invited to submit manuscripts for a JAMA theme issue on men's health.
For your patients: Information about audiometry.
This Week in JAMA . JAMA. 2006;295(4):355. doi:10.1001/jama.295.4.355