This Week in JAMA FREE

Evidence does not support use of an implantable cardioverter-defibrillator (ICD) for primary prevention in patients with a recent myocardial infarction or coronary artery bypass grafting or for patients with a recent heart failure diagnosis or severe heart failure symptoms. In an analysis of cases submitted to a national registry of ICD implantations, Al-Khatib and colleagues Article found that 22.5% of implantations were not evidence-based and were associated with significantly higher risks of in-hospital death or postprocedure complications than evidence-based ICD implantations. In an editorial, Kadish and Goldberger Article discuss appropriate selection of patients for ICD implantation.

Gait speed or walking speed may be an indicator of well-being among older adults. In an analysis of data from 9 prospective cohort studies that involved community-dwelling older adults whose usual gait speed was assessed at baseline, Studenski and colleagues Article found that gait speed was associated with survival and that survival predictions based on age, sex, and gait speed were approximately similar to those derived with complex models that incorporate multiple health-related factors. In an editorial, Cesari Article discusses the role of gait speed in the clinical assessment of older patients.

Fabbri and colleagues Article analyzed blood samples from patients with untreated B-cell chronic lymphocytic leukemia (CLL) to investigate how specific chromosomal abnormalities may contribute to disease pathogenesis and influence patient outcomes. The authors identified a novel microRNA/tumor protein p53 (TP53) feedback circuitry that is perturbed at different levels by distinct CLL chromosomal abnormalities and likely contributes to the heterogeneous clinical course of CLL. In an editorial, Allendorf and Davis Article discuss the molecular pathogenesis of CLL.

Multinodular goiter is a common disorder that is sometimes seen in families; however, little is known about the underlying genetic susceptibility. In an analysis of lymphocytes and tissue samples obtained from 2 families with multinodular goiter and 3 families with multinodular goiter and ovarian Sertoli-Leydig cell tumors (a reported syndromic disease combination), Rio Frio and colleagues found that germline DICER1 gene mutations—causing dysregulation of microRNA expression patterns—are associated with autosomal dominant susceptibility to multinodular goiter with and without ovarian Sertoli-Leydig cell tumors.

Patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)—defined as urologic pain or pelvic discomfort with urinary symptoms with or without sexual dysfunction present for at least 3 of the previous 6 months—are treated with a wide variety of therapies despite little or conflicting evidence of therapeutic efficacy. In a systematic review and meta-analysis of data from 23 randomized clinical trials that evaluated drug treatments for CP/CPPS, Anothaisintawee and colleagues found that compared with placebo, α-blockers, antibiotics, and combinations of these were associated with greater improvement in clinical symptom scores.

“It struck me as I left home this morning that never in my life have I had another person's life totally dependent on my own survival.” From “Donor Diary.”

A new medication may be a useful alternative to warfarin for reducing stroke risk in patients with atrial fibrillation.

Novel approaches to regenerative medicine

AND AUTHOR INTERVIEW

New terminology for botulinum neurotoxins

Authors are invited to submit manuscripts for an upcoming JAMA theme issue.

Join Julia Howell Hayes, MD, Wednesday, January 19, 2011, from 2 to 3 PM eastern time to discuss active surveillance vs initial treatment for low-risk prostate cancer. To register, go to http://www.ihi.org/AuthorintheRoom.

Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

For your patients: Information about lymphocytic leukemia.

This article was corrected for errors on January 19, 2011.