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Using an increase in posttreatment prostate-specific antigen levels
to define treatment failure, D'Amico and coworkersArticle observed that radical prostatectomy,
radiation therapy, and interstitial radiation therapy with or without androgen
deprivation therapy were equivalent for the treatment of localized prostate
cancer in low-risk patients; however, radical prostatectomy and radiation
therapy were superior to treatment with interstitial radiation therapy for
intermediate-risk and high-risk patients. Albertsen and colleaguesArticle reviewed
the records of more than 700 men who had initially untreated or conservatively
treated localized prostate cancer. They found that men with well-differentiated
tumors had a small risk of death from prostate cancer within 15 years of diagnosis;
the prostate cancer–associated mortality increased as the degree of
tumor differentiation decreased. In an editorial, ChodakArticle notes that these
retrospective studies add useful information for the design and analysis of
future controlled trials that are needed to determine the optimal management
of patients with localized prostate cancer.
Gulf War veterans were more likely than nondeployed personnel to meet
the case definition of a chronic multisystem illness derived by Fukuda and
colleaguesArticle. No associations between this illness and specific clinical or
laboratory findings or Gulf War exposures were detected, but Gulf War veterans
who met the case definition had significantly diminished functioning and well-being.
In their editorial, Lashof and CassellsArticle consider the implications of these
findings and review the research concerning this controversial illness.
In a cohort of recently licensed family physicians in Québec,
higher licensing examination scores were associated with higher consultation
referral rates, higher rates of prescribing disease-specific medications relative
to symptom-relief medications, lower rates of prescribing inappropriate drugs
for elderly patients, and higher referral rates of women aged 50 to 69 years
for screening mammography. Tamblyn and coinvestigators conclude that further
research is needed to assess whether these differences in clinical practice
persist over time and whether they are associated with differences in patient
The risk of death for pilots following crash landings of small general
aviation aircraft was higher among pilots who did not wear lap or shoulder
restraints and those who wore only lap restraints compared with pilots who
wore both lap and shoulder restraints. Pilot death was also strongly associated
with destruction of the airplane and with an airplane fire or explosion on
the ground after the crash landing.
In a consensus statement, the National Roundtable on Health Care QualityArticle concludes that problems in the quality of health care (underuse, overuse,
and misuse) occur in all regions of the United States, in communities of all
sizes, and in all types of delivery systems. The statement emphasizes that
rapid change in the delivery of health care is urgently needed. In a related
commentary, StarfieldArticle identifies ways to improve quality-of-care research.
"Colors push, pull, shout, threaten . . . overwhelm." Joan Thorne, Naust, 1978, American.
"My goal is not to find balance, but to harmonize the worlds of work
and family, without letting thoughts of one world unduly dominate the other."
From "An Independent Scientist."
At their first world meeting, experts on "the last taboo"—urinary
incontinence—look at treatment advances and work to reclassify the condition
as a World Health Organization–defined disease.
Recent advances in general psychiatry.
Estimating the inpatient hospital costs in teaching hospitals related
to graduate medical education. Will future funding sources impose a new accountability?
For your patients: Options for the treatment of prostate cancer.
This Week in JAMA. JAMA. 1998;280(11):947. doi:10.1001/jama.280.11.947