This Week in JAMA FREE

Tamsulosin, an α_1a-adrenergic receptor blocker prescribed to treat benign prostatic hyperplasia (BPH), has been reported to increase the intraoperative difficulty of cataract surgery. Whether tamsulosin or other α-blocking drugs increase the risk of postoperative adverse ophthalmic events is not known. In a nested case-control study, Bell and colleagues Article found that retinal detachment, lost lens or lens fragment, and endophthalmitis after cataract surgery were significantly more common in men with recent tamsulosin exposure. No association was found for other α-blockers used to treat BPH. In an editorial, Friedman Article discusses the risks associated with α-adrenergic receptor blocking medications in patients undergoing cataract surgery.

Injection of bone marrow cells improves myocardial perfusion and left ventricular function in animal models of chronic myocardial ischemia. To assess whether patients would benefit from this treatment modality, van Ramshorst and colleagues conducted a randomized, double-blind, placebo-controlled trial of bone marrow cell therapy in patients with chronic myocardial ischemia refractory to medical therapy. The authors found that compared with placebo, intramyocardial bone marrow cell injection was associated with statistically significant but clinically modest improvements in myocardial perfusion and left ventricular function.

Cognitive behavioral therapy (CBT) and pharmacotherapy are each efficacious in the short-term treatment of insomnia. In a prospective randomized, 2-stage trial, Morin and colleagues evaluated the efficacy of combined therapy consisting of CBT plus zolpidem compared with CBT alone for acute treatment of persistent insomnia and evaluated the effects of maintenance therapy on long-term outcomes. The authors report that the combination of zolpidem and CBT was associated with a modest increase in total sleep time during the initial 6-week treatment period. At 6 months, patients who were randomly assigned to discontinue zolpidem after 6 weeks and continue CBT had higher rates of remission than did patients whose maintenance regimen consisted of CBT plus intermittent medication.

Persons with schizophrenia have been thought to have an increased risk of committing violent crime. In a longitudinal analysis of national data from Sweden, Fazel and colleagues assessed the risk of violent crime among patients diagnosed with schizophrenia and the role of substance abuse in mediating this risk. The authors found a substantially increased risk of violent crime among patients with schizophrenia and comorbid substance abuse. In contrast, the risk was only slightly increased among patients with schizophrenia without comorbid substance abuse.

In a systematic review and meta-analysis, Kodama and colleagues assessed the quantitative relationship between cardiorespiratory fitness and coronary heart disease (CHD) events, cardiovascular disease (CVD) events, and all-cause mortality in healthy adults. With cardiorespiratory fitness estimated as maximal aerobic capacity expressed in metabolic equivalent (MET) units, the authors found that individuals with a maximal aerobic capacity of 7.9 METs or higher had lower rates of CHD, CVD, and all-cause mortality than did individuals with a maximal aerobic capacity of less than 7.9 METs.

“At the end of the conversation my father's summary was ‘Young people might die, but old people have to.’” From “My Father's Voice.”

Although some researchers say that cardiac imaging has a role in assessing cardiovascular disease risk in asymptomatic patients, others counter that evidence showing these costly tools reduce morbidity or mortality is lacking.

Regulating the safety of pharmaceuticals

The patient-centered medical home

Successful homotransplantation of the human kidney between identical twins

Join Peter Hwang, MD, June 17, 2009, from 2 to 3 PM eastern time to discuss the diagnosis and treatment of rhinosinusitis. To register, go to http://www.ihi.org/AuthorintheRoom.

How would you manage a 64-year-old man with newly diagnosed prostate cancer? Go to www.jama.com to read the case and submit your response, which may be selected for online publication. Submission deadline is May 24.

For your patients: Information about cataracts