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This Week in JAMA
March 3, 2004

This Week in JAMA

JAMA. 2004;291(9):1033. doi:10.1001/jama.291.9.1033

Lipid Lowering and Progression of Atherosclerosis

The benefits of statin drugs to reduce lipoprotein levels and cardiovascular morbidity and mortality are well established, but the optimal intensity of therapy is not known. Nissen and colleaguesArticlereport results from a multicenter randomized trial examining the progression of atherosclerosis in a target vessel in patients randomly assigned to receive either a moderate lipid-lowering regimen of 40 mg/d of pravastatin or an intensive regimen of 80 mg/d of atorvastatin. At the 18-month follow-up, patients receiving atorvastatin had significantly less increase in atheroma volume in the target vessel and significantly greater reductions in low-density lipoprotein cholesterol and C-reactive protein levels compared with patients receiving pravastatin. In an editorial,ArticleSacks discusses the implications of these results for clinical practice.

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Suicidal Ideation and Depression in the Elderly

Suicide rates are highest in the elderly, and many individuals who attempt suicide have seen a primary care physician in the preceding months. Bruce and colleagues report results of a primary care practice–based randomized trial to improve depression treatment and decrease suicide risk in older patients. Intervention practices used a clinical algorithm to guide treatment decision making and nonphysician, master's-level depression care managers to provide much of the patient follow-up. Physicians in control practices were educated about depression treatment guidelines but otherwise followed usual patterns of care. Patients in the intervention practices experienced a more rapid decline in suicidal ideation and faster resolution of depressive symptoms compared with patients in the control practices.


Alleviating Pancreatic Cancer Pain

In a randomized trial assessing pain relief after neurolytic celiac plexus block (NCPB) plus systemic analgesics compared with systemic analgesia alone in patients with inoperable pancreatic cancer, Wong and colleagues found that patients receiving NCPB had greater pain relief but not improved quality of life or survival.


Patient Perceptions of Cardiac Care in Canada

Canada's Medicare system prohibits parallel private insurance for any publicly insured service and may keep individuals of higher socioeconomic status (SES) within the public system. Whether the expectations of higher SES patients influence the level of care for all patients is not known. Alter and colleagues surveyed patients discharged from Ontario hospitals after a myocardial infarction to assess the relationship of SES to use of services and satisfaction with care. They found that compared with patients of lower SES, patients of higher SES were more likely to see a cardiologist and to receive cardiac catheterization and cardiac rehabilitation within 30 days of discharge; in adjusted analyses, higher education and not higher income was a better predictor of receiving specialty care and greater dissatisfaction with care received.


A Piece of My Mind

"She came to me as a patient when I first entered practice and was just about as green as a gourd." From "The Bless Cloth."


Medical News & Perspectives

Researchers are using imaging techniques to dissect neurobiological factors that underlie alcohol disorders.


Fracture Risk Marker

Low levels of a serum protein involved in bone turnover predict a high risk of nontraumatic fracture.


Recovering Fetal DNA From Maternal Blood

The addition of formaldehyde to maternal blood samples enhances recovery of fetal DNA.


Public-Private Partners in Research

A proposal to foster the transfer of research results to clinical practice.


Clinician's corner

The contribution of microchimerism to autoimmunity and host tolerance of transplanted tissues.


JAMA Patient Page

For your patients: Information about suicide in older persons.