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This Week in JAMA
September 16, 1998

This Week in JAMA

JAMA. 1998;280(11):947. doi:10.1001/jama.280.11.947

Treatment Outcomes for Localized Prostate Cancer

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.

Illness Among Gulf War Veterans

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.

Test Scores Predict Clinical Practice Patterns

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 outcomes.

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Buckle Up in the Air

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.

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Quality of Care, Quality of Research

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.

The Cover

"Colors push, pull, shout, threaten . . . overwhelm." Joan Thorne, Naust, 1978, American.

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A Piece of My Mind

"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."

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Medical News & Perspectives

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.

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Contempo 1998

Recent advances in general psychiatry.

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Policy Perspectives

Estimating the inpatient hospital costs in teaching hospitals related to graduate medical education. Will future funding sources impose a new accountability?

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JAMA Patient Page

For your patients: Options for the treatment of prostate cancer.

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