Antibiotics for acute sinusitis are controversial and evidence regarding the use of topical steroids is equivocal. Williamson and colleaguesArticle report results of a clinical trial in which adult patients with acute maxillary sinusitis were randomly assigned to 1 of 4 treatment groups: antibiotic (amoxicillin, 500 mg 3 times a day for 7 days) and intranasal steroid (budesonide, 200 μg in each nostril, daily for 10 days); placebo antibiotic and steroid; antibiotic and placebo steroid; and placebo antibiotic and placebo steroid. The authors found that neither amoxicillin nor topical budesonide alone or in combination was superior to placebo in the treatment of acute sinusitis. In an editorial, LindbaekArticle discusses the implications of these findings for patient care.
In the prospective Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial, moderate-risk and high-risk patients with acute coronary syndromes undergoing early invasive management were randomly assigned to 1 of 3 pharmacological treatment regimens: heparin plus glycoprotein (GP) IIb/IIIa inhibitors, bivalirudin plus GP IIb/IIIa inhibitors, or bivalirudin monotherapy. Among the 30-day outcomes reported previously was that bivalirudin monotherapy was noninferior to heparin plus GP IIb/IIIa inhibitors in reducing ischemic events. In this issue, Stone and colleagues, writing for the ACUITY investigators, report that at 1 year, rates of composite ischemia or mortality did not differ significantly across pharmacotherapy treatment groups.
Sui and colleagues examined the independent and joint associations of cardiorespiratory fitness and adiposity with mortality in an analysis of data from adults 60 years and older at baseline who received periodic health examinations and counseling regarding diet, exercise, and other lifestyle factors at 1 preventive health clinic. During a mean 12-year follow-up, the authors found that low cardiorespiratory fitness at baseline was a significant predictor of all-cause mortality independent of overall or abdominal adiposity.
To examine the extent to which claims based on observational epidemiology and later contradicted by results of randomized trials persist in the literature, Tatsioni and colleagues performed a citation content analysis for 3 epidemiological associations relating vitamin E, beta carotene, and estrogen to lower risks of cardiovascular disease, cancer, and Alzheimer disease among women, respectively. In an examination of the literature published before, early, and late after publication of refuting evidence, the authors found that claims from highly cited observational studies persist and continue to be supported in the literature despite strong contradictory evidence from randomized trials.
Mr P, a 93-year-old man with end-stage dementia and recent hip fracture, can no longer orally maintain adequate hydration and nutrition. Mitchell discusses palliative care for patients with advanced dementia, treatment options for feeding problems, and ways to provide effective and caring decision support to the patient and family.
“Do you know the worst thing about living here? They don't see us anymore.” From “Words.”
Evidence of the effectiveness of medication coupled with brief behavioral interventions for alcohol use disorders is helping to shift treatment from inpatient specialist care to office-based general practices.
Global tobacco litigation
Disasters and mental health
Authors are invited to submit manuscripts for an upcoming JAMA theme issue.
How would you manage a 39-year-old man with erythema and swelling of a finger? Go to www.jama.com to read the case and submit your response. Your response may be selected for online publication. Submission deadline is December 26.
Join Dena Bravata, MD, MS, December 19 from 2 to 3 PM eastern time to discuss use of pedometers to increase physical activity. 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 acute sinusitis.
This Week in JAMA . JAMA. 2007;298(21):2451. doi:10.1001/jama.298.21.2451