Urinary incontinence is a significant morbidity that can persist for years following radical prostatectomy. In a randomized trial that enrolled men with postprostatectomy incontinence of at least 1 year's duration, Goode and colleagues Article found that 8 weeks of behavioral therapy—consisting of pelvic floor muscle training, bladder control strategies, fluid management, and self-monitoring with a bladder diary—was associated with a significant reduction in incontinence episodes compared with delayed treatment (control), with no additional benefit from biofeedback and pelvic floor electrical stimulation. In an editorial, Article Penson discusses the prevention and treatment of postprostatectomy urinary incontinence.
The herpes zoster vaccine has demonstrated efficacy in clinical trials; however, evidence that it benefits patients in general practice settings is limited. In a retrospective cohort study that involved community-dwelling and immunocompetent adults aged 60 years or older, Tseng and colleagues found that receipt of the herpes zoster vaccine was associated with a lower incidence of herpes zoster across all age strata and among persons with chronic diseases.
In coronary artery bypass grafting (CABG), the observation of improved long-term patency of internal mammary artery grafts has prompted exploration of the use of other arterial grafts. Goldman and colleagues report results of a randomized trial, predominantly in men who were undergoing first-time elective CABG and received a left internal mammary artery graft to the left anterior descending coronary artery (whenever possible), and the best remaining recipient vessel was randomized to either a radial artery or saphenous vein graft. The authors found that use of a radial artery graft compared with a saphenous vein graft did not result in improved angiographic graft patency 1 year after CABG.
Angiotensin II receptor blockers (ARBs) are associated with reduced mortality and hospitalization among patients with heart failure and reduced left ventricular ejection fraction; however, different ARBs have not been compared head to head and may have varying clinical effects. In an analysis of data from the Swedish Heart Failure Registry, Eklind-Cervenka and colleagues found that all-cause mortality was lower at 1 year and 5 years among patients who received candesartan compared with those who received losartan.
Idiopathic inflammatory myopathies or myositis syndromes are systemic autoimmune diseases defined by combinations of clinical and laboratory features. Rider and Miller describe the clinical course of a patient with dermatomyositis who presented with photosensitive rashes and later developed widespread skin disease and generalized lipodystrophy that represents a newly recognized phenotype defined by anti-p155 autoantibodies. The authors discuss clinical and immune response features that define myositis syndrome phenotypes and their importance for predicting clinical signs and symptoms, genetic and environmental risk factors, response to therapy, and prognosis.
“I came to regard my donor kidney, whichever one it would be, as not mine but the recipient’s. I was its custodian, responsible to preserve its health.” From “The Gift: Hy’shqe Siam.”
Recently released guidelines will help physicians determine which patients with heart disease who take antiplatelet drugs will benefit most from a proton pump inhibitor to reduce the risk of gastrointestinal bleeding.
Ethical allocation of preexposure HIV prophylaxis
Physical examination of obese patients
Physician and hospital choice: an essential benefit?
Call for Papers
Authors are invited to submit manuscripts for an upcoming JAMA theme issue.
Join Julia Howell Hayes, MD, Wednesday, January 19, 2011, from 2 to 3 PM eastern time to discuss active surveillance vs initial treatment for low-risk prostate cancer. 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 shingles.
This Week in JAMA . JAMA. 2011;305(2):123. doi:10.1001/jama.2010.1985