Two articles in this issue of JAMA report results of the Spine Patient Outcomes Research Trial (SPORT), a randomized trial that evaluated the efficacy of standard open diskectomy vs nonoperative (“usual care”) treatment for lumbar disk herniation. In the first article, Weinstein and colleaguesArticle report that intent-to-treat analyses demonstrated small but not statistically significant improvements in pain and function that favored diskectomy during the 2-year follow-up period. However, since large numbers of patients crossed over from their assigned treatment to the alternate treatment, the authors could not reach definitive conclusions regarding treatment superiority or equivalence. In the second article, the authorsArticle report results for patients who refused random assignment to operative or nonoperative treatment and were enrolled in a parallel observational cohort study. Among these patients, those who chose surgery reported greater improvement in pain and function compared with patients who chose nonoperative care. In an editorial, FlumArticle discusses the interpretation of trials with subjective outcomes and the potential value of sham-controlled surgical trials. In a second editorial, CarrageeArticle discusses lumbar disk herniation and factors that influence patients' treatment preference.
Segers and colleagues report results of a randomized trial that assessed the efficacy of perioperative oropharyngeal rinse and nasal ointment containing chlorhexidine gluconate vs placebo rinse and ointment to reduce nosocomial infections after cardiac surgery. The authors found that patients assigned to the chlorhexidine oropharyngeal rinse and nasal ointment had significantly lower rates of nosocomial infections—particularly of the lower respiratory tract and deep surgical sites—compared with patients assigned to placebo.
In an analysis of 2003-2004 survey data provided by US physicians engaged in direct patient care, Gruen and colleagues assessed physician participation in “public roles,” defined as community participation, political involvement, and collective advocacy. The authors found that 90% of respondents rated physicians' public roles as important and two thirds reported being actively involved in at least 1 of the defined activities in the previous 3 years. The authors also report the respondents' rankings of issues and sociodemographic and practice factors related to physicians' attitudes toward and assumption of a public role.
Chertow and colleagues investigated the clinical, epidemiologic, and laboratory features of 4 suspected cases of iatrogenic botulism. The authors found that clinical features of these cases were consistent with those seen in naturally occurring botulism. Their investigation revealed that the 4 patients had received facial area cosmetic injections with an unlicensed preparation of botulinum toxin A, which was highly concentrated and resulted in toxin levels 21 to 43 times the estimated human lethal dose.
“I realized . . . that I had been imprisoned my entire life by my society's expectations and cultural codes for the simple crime of having been born a girl.” From “Capturing Life.”
Researchers are learning how factors such as damage to the nervous system or a person’s genetics, emotions, and expectations can influence their perception of pain.
Identification of genes related to smoking may have limited value in public health prevention and cessation efforts.
Join Louise C. Walter on December 20, 2006, from 2 to 3 PM eastern time to discuss PSA screening among elderly men with limited life expectancy. To register, go to http://www.ihi.org/AuthorintheRoom.
Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.
For your patients: Information about herniated lumbar disks.
This Week in JAMA . JAMA. 2006;296(20):2411. doi:10.1001/jama.296.20.2411