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This Week in JAMA |

This Week in JAMA FREE

JAMA. 2004;291(1):9. doi:10.1001/jama.291.1.9.
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IMPACT OF CLINICAL TRIAL RESULTS ON PRESCRIBING PATTERNS

Two articles in this issue of THE JOURNAL examine how publication of clinical trial results influence physician prescribing practices. In an analysis of national trends in hormone therapy use from January 1995 through July 2003, Hersh and colleaguesArticlefound that hormone therapy prescriptions increased from 1995 to 1999, remained stable through June 2002, then declined rapidly following publication of 2 trials in July 2002 that demonstrated increased risk of cardiovascular disease and other adverse effects with oral estrogen plus progestin therapy. Stafford and colleaguesArticleexamined national use of α-blockers for hypertension treatment before and after publication of a clinical trial of antihypertensive therapy in which the α-blocker doxazosin arm was terminated early because of unfavorable results compared with diuretics. Use of doxazosin and other α-blockers increased steadily from 1996 through 1999, but then declined modestly after publication of the early trial results. In an editorial,ArticleNaylor discusses the complex interplay of factors that influence physician prescribing behavior.

INTRATHECAL ZICONOTIDE FOR TREATMENT OF REFRACTORY PAIN

Ziconotide blocks neurotransmission from primary nociceptive afferents by selectively binding to N-type voltage-sensitive calcium channels on neurons. Staats and colleagues conducted a randomized trial to test the effectiveness of intrathecal ziconotide for treatment of pain refractory to conventional treatment in patients with AIDS or end-stage cancer. Improvement in pain intensity scores from baseline to the end of the initial 5- to 6-day titration phase was significantly greater in the ziconotide group than in the placebo group.

PUBLIC ENTHUSIASM FOR CANCER SCREENING IN THE US

Cancer screening has been widely promoted in the United States despite evidence of potential harm associated with screening, such as false-positive results and treatment for slow-growing cancers that would not cause problems in a person's lifetime even if untreated. Schwartz and colleagues conducted a national telephone survey of adults without a history of cancer to determine the public's general beliefs about cancer screening and early cancer detection. Most survey participants responded that routine cancer screening is almost always a good idea and that finding cancer early saves lives. Among respondents who had experienced a false-positive screening test result, more than 40% described that experience as very scary, but almost all were glad they had had the initial test. Two thirds of respondents stated they would want to be tested for a cancer even if nothing could be done.

PERIOPERATIVE HYPEROXIA AND SURGICAL SITE INFECTION

The use of high fractional inspired concentration of oxygen (FIO2) in the perioperative period has been reported to reduce surgical site infection in selected patients. In this randomized trial in a heterogeneous general surgery patient population, Pryor and colleagues found that the incidence of surgical site infection in the first 14 days after surgery was significantly higher in the group that received FIO2 of 0.80 during surgery and for the first 2 hours after surgery than in the group that received FIO2of 0.35.

QUALITY OF END-OF-LIFE CARE AND LAST PLACE OF CARE

Over the past century, nursing homes and hospitals have increasingly become the site of death. Teno and colleagues conducted a mortality follow-back survey of family members of decedents to examine whether family members' perceptions of the quality of end-of-life care differed by the last place of care. Overall, family members reported high rates of unmet needs for symptom management, physician communication, emotional support, and being treated with respect. Family members of decedents who received care at home with hospice services reported greater satisfaction with overall quality of care and fewer unmet needs than did family members of decedents whose last setting of care was a hospital, nursing home, or home with home nursing services.

A PIECE OF MY MIND

"When the trial started on June 23, 2003, I was nervous but confident." From "Winners and Losers."

See Article

MEDICAL NEWS & PERSPECTIVES

At a first of its kind summit, federal officials unveiled a plan to discover the causes of autism and to develop treatments for the increasingly diagnosed disorder within 10 years.

See Article

PHYSICIAN-CITIZENS

Defining the professional obligations and public roles of physicians.

CLINICIAN'S CORNER

Effects of climate change on health.

INFORMATION FOR JAMA AUTHORS—2004

Information for authors interested in submitting manuscripts for consideration for publication in JAMA and updated instructions for manuscript preparation and submission.

JAMA EDITORIAL GOVERNANCE PLAN

Clarification of the reporting relationships between the editor-in-chief of JAMA, the Journal Oversight Committee, and the AMA for editorial governance of JAMA.

STUDENTJAMA

Ethical issues in methods of medical student education.

JAMA PATIENT PAGE

For your patients: Information about prenatal care.

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