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Estrogen alone or in combination with progestin (E+P) has been prescribed
to treat urinary incontinence in menopausal women, but there is little objective
evidence of its efficacy. Hendrix and colleaguesArticle used
data from the Women’s Health Initiative trials to assess the effects
of estrogen alone or E+P on the 1-year incidence and severity of symptoms
of stress, urge, and mixed incontinence in healthy postmenopausal women. They
found that both hormone regimens increased the incidence of all types of incontinence
and were associated with worsening of symptoms. In an editorial, DuBeauArticle discusses physiologic effects of estrogen on the urinary tract and its possible role in urinary incontinence.Article
Empirical treatment of acute cystitis in women is complicated by a high
prevalence of antibiotic resistance among uropathogenic strains of Escherichia coli. Hooton and colleagues investigated the efficacy of
a 3-day regimen of amoxicillin-clavulanate vs a 3-day regimen of ciprofloxacin
in women with acute uncomplicated cystitis. They found that ciprofloxacin
was superior to amoxicillin-clavulanate in achieving a clinical cure. At a
2-week follow-up, significantly more women who received ciprofloxacin had
both microbiological cure and eradication of vaginal E coli.
Screening for depression is common in primary care settings, but little
attention has been paid to assessing for a history of hypomania or mania suggestive
of bipolar disorder. Das and colleagues screened for bipolar disorder in an
urban adult primary care clinic and examined demographic, clinical, and treatment
characteristics of patients with a positive screening test result. In this
urban and largely poor patient population, the prevalence of having a positive
screening for lifetime bipolar disorder was 9.8%, which was consistent across
demographic variables. Bipolar disorder was often underrecognized and appropriate
medication not prescribed.
The prevalence of 2 breast cancer susceptibility genes,
BRCA1 and BRCA2, in
invasive breast cancer is well described, but it is not known whether these
mutations are associated with ductal carcinoma in situ (DCIS). Claus and colleagues
used data from a case-control study of women with DCIS to estimate the prevalence
of these mutations. They found disease-associated BRCA1 and
BRCA2 mutations in 0.8% and 2.4% of DCIS
cases, respectively, which is similar to the prevalence reported in invasive
Randomized clinical trials (RCTs) often compare an innovative or an
experimental therapy with standard treatment. Soares and colleaguesArticle
were interested in assessing the probability that the innovative treatment
would be superior to the standard treatment, accounting for factors that can
affect the outcome of RCTs. They reviewed 59 high-quality, phase 3 RCTs conducted
by the Radiation Therapy Oncology Group from 1968 to 2002. They found no evidence
that innovative are superior to standard treatments. In the studies reviewed,
standard treatment was preferred to innovative treatment in 71% of the trials.
Innovations offered no survival advantage and were somewhat more likely to
result in treatment-related mortality. In an editorial, Grann and GrannArticle
discuss the importance of clinical trials to ensure treatment is evidence-based.
Over a 74-year career, Michael E. DeBakey, MD, has published more than
1600 scientific articles, performed more than 60 000 surgeries, and conducted
research that was key to important innovations in cardiovascular surgery.
Many consider him to be the greatest surgeon ever.
Current options for reperfusion therapy, in particular, pharmacological
facilitation of primary percutaneous coronary intervention (PCI), are reviewed
by Gersh and colleagues.
Influenza cannot be confirmed or excluded based on clinical findings
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This Week in JAMA . JAMA. 2005;293(8):899. doi:10.1001/jama.293.8.899