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 colleagues Article found 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 colleagues Article examined 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, Article Naylor discusses the complex interplay of factors that influence physician prescribing behavior.
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.
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.
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.
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.
"When the trial started on June 23, 2003, I was nervous but confident." From "Winners and Losers."
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