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Timothy J. Daskivich, MD; Kang-Hsien Fan, MS; Tatsuki Koyama, PhD; Peter C. Albertsen, MD; Michael Goodman, MD, MPH; Ann S. Hamilton, PhD; Richard M. Hoffman, MD, MPH; Janet L. Stanford, PhD, MPH; Antoinette M. Stroup, PhD; Mark S. Litwin, MD, MPH; and David F. Penson, MD, MPH

Estimating risk for disease-specific and other-cause mortality can help to inform decisions on aggressive treatment of localized prostate cancer. This study examined the effect of age, comorbidity, and tumor risk on other-cause and prostate cancer–specific mortality in men with early-stage disease. It found that other-cause mortality risk increased with the number of major comorbid conditions, especially in older men, and prostate cancer mortality varied according to disease risk but not the number of comorbid conditions. These risk estimates may assist physicians and patients with decision making about prostate cancer management.

Topics: comorbidity, prostate cancer
William A. Bauman, MD; Ann M. Spungen, EdD; Joseph F. Collins, ScD; Dennis W. Raisch, RPH, PhD; Chester Ho, MD; George A. Deitrick, MD; Bernard A. Nemchausky, MD; Lance L. Goetz, MD; Jai S. Park, MD; Michael Schwartz, MD; John L. Merritt, MD; Vidya Jayawardena, MD; Paul Sandford, MD; Sunil Sabharwal, MD; Sally A. Holmes, MD; Fahima Nasar, MD; Roy Sasaki, MD; Vandana Punj, MD; Karin F. Zachow, MD; Walter C. Chua, MD; MaryKutty D. Thomas, MD; and Rose C. Trincher†, MD

Anabolic steroids have been reported to improve wound healing. This multicenter trial randomly assigned inpatient veterans with spinal cord injury and stage III or IV pressure ulcers to oxandrolone or placebo for 24 weeks or until the ulcers healed. In both groups, similar numbers of pressure ulcers healed and remained healed 8 weeks after treatment. The study was terminated after a futility analysis showed a low probability of detecting a significant difference between the groups. Oxandrolone did not improve healing of chronic pressure ulcers more than placebo.

Topics: decubitus ulcer, oxandrolone, spinal cord injuries
Mark A. Hlatky, MD; Derek B. Boothroyd, PhD; Laurence Baker, PhD; Dhruv S. Kazi, MD, MS; Matthew D. Solomon, MD, PhD; Tara I. Chang, MD, MS; David Shilane, PhD; and Alan S. Go, MD

This observational comparative effectiveness study using Medicare data found that coronary artery bypass grafting (CABG) was associated with a small mortality benefit compared with percutaneous coronary intervention (PCI). Patients with diabetes, a history of smoking, peripheral artery disease, and heart failure had a particular benefit with CABG, whereas those without any of these had slightly better survival with PCI. The findings suggest that individual patient characteristics should be considered in choosing CABG versus PCI.

Topics: percutaneous coronary intervention, coronary artery bypass surgery, comparative effectiveness research
David Kao, MD; Becki Bucher Bartelson, PhD; Vaishali Khatri, MPH; Richard Dart, MD; Philip S. Mehler, MD; David Katz, MD; and Mori J. Krantz, MD

Methadone is associated with QTc interval prolongation and torsade de pointes. This analysis of 1997–2011 data from the U.S. Food and Drug Administration Adverse Event Reporting System found that the number of reports of QTc prolongation and torsade de pointes associated with methadone was similar to that for other highly proarrhythmic drugs (such as dofetilide). The reports were especially common for patients taking antiretroviral drugs for HIV. The findings suggest that methadone-associated arrhythmia is more common than is often recognized and may pose special risk for patients with HIV receiving highly active antiretroviral therapy.

Topics: cardiac arrhythmia, torsades de pointes, methadone, qtc
Elizabeth O'Connor, PhD; Bradley N. Gaynes, MD, MPH; Brittany U. Burda, MPH; Clara Soh, MPA; and Evelyn P. Whitlock, MD, MPH
Includes: CME

This systematic review for the U.S. Preventive Services Task Force found little direct evidence about the benefits and harms of screening for suicide risk in primary care populations. Screening tools might help identify some adults at increased risk for suicide, but tools have limited ability to detect suicide risk in adolescents and older adults. Psychotherapy may reduce suicide attempts in some high-risk adults, but effective interventions for high-risk adolescents are not yet proven.

Topics: primary health care, psychotherapy, suicide attempt, suicide, elderly, feeling suicidal, self-injurious behavior, ...
Jennifer R. Eads, MD; Neal J. Meropol, MD; and Jerry L. Spivak, MD

This Update summarizes studies published in 2012 that the authors consider highly relevant to the practice of hematology and oncology.

Topics: mutation, cancer, medical oncology, hematology, ponatinib, protein-tyrosine kinase inhibitor, thrombocytopenia
Amir Qaseem, MD, PhD, MHA; Michael J. Barry, MD; Thomas D. Denberg, MD, PhD; Douglas K. Owens, MD, MS; Paul Shekelle, MD, PhD, for the Clinical Guidelines Committee of the American College of Physicians*

The Clinical Guidelines Committee of the American College of Physicians (ACP) searched for and evaluated U.S.-based guidelines on prostate cancer screening registered in the National Guidelines Clearinghouse. Guidelines were identified from the U.S. Preventive Services Task Force (2012), American Cancer Society (2010), American Urological Association (2009), and American College of Preventive Medicine (2008). In this guidance statement, ACP provides clinical guidance in light of these differing recommendations from other organizations.

Topics: prostate cancer, prostate specific antigen measurement, prostate cancer screening, clinical practice guideline ...

Australia and the United States share many characteristics, but with respect to gun violence, the 2 countries differ dramatically. The United States has 13.7 times Australia's population but 134 times its total firearm-related deaths. This commentary describes the event that spurred changes in Australian gun control, the circumstances that made change possible, and the evidence that the changes are responsible for the reduction in gun-related deaths. The authors speculate about whether interventions similar to those that successfully reduced the toll of guns on the lives of Australians may, perhaps, take hold in the United States.

Topics: australia, firearms, violence
Lazzaro Repetto, MD; Angela Marie Abbatecola, MD, PhD; and Giuseppe Paolisso, MD

In this issue, Daskivich and colleagues investigated the effect of age, tumor risk, and comorbidity on survival in a large population-based cohort of men older than 60 years with prostate cancer. Their findings suggest that the number of comorbid conditions is effective in predicting mortality across age groups. The editorialists discuss the study and its findings, concluding that consideration of these factors may help to identify certain older men who are unlikely to benefit from aggressive therapy.

Topics: prostate cancer
George A. Sarosi, MD
Includes: Audio/Video

When I was in medical school during the early 1960s, there was no talk about health care costs, length of stay, or diagnosis-related groups. We lived in blissful ignorance of the entire issue of who was paying for the care of our patients.

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Gottfried Hirnschall, MD, MPH; and Cornelis de Joncheere, PharmD, MSc, MBA
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Rochelle P. Walensky, MD, MPH; A. David Paltiel, MBA, PhD; and Bruce R. Schackman, MBA, PhD
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Michel Labrecque, MD, PhD; and Armen Aprikian, MD
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Roman Gulati, MS; and Ruth Etzioni, PhD
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Jason D. Eubanks, MD
Includes: Audio/Video
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Topics: heart failure
Topics: carvedilol, heart failure, systole
Topics: diabetes mellitus, type 2, life style, overweight, disease remission
Topics: chronic obstructive airway disease, dietary supplements, patient-important outcome
Topics: fatty acids, omega-6, saturated fatty acids, diet
Topics: glucocorticoids, sciatica, mineralocorticoids, lower limb pain, disability
Topics: glucocorticoids, tennis elbow, mineralocorticoids
Topics: renal function, chlorambucil, glomerulonephritis, membranous, prednisolone, cyclosporine
Topics: antibiotics, diarrhea, probiotics, clostridium difficile (bacteria), diarrhea, clostridium difficile
Topics: urinary tract infection
Topics: ischemic stroke, alteplase
Topics: blood transfusion
Topics: comorbidity, prostate cancer
Topics: decubitus ulcer, oxandrolone
Topics: coronary arteriosclerosis, catheter device, coronary artery bypass surgery, percutaneous coronary intervention
Topics: prostate-specific antigen, prostate cancer, prostate cancer screening
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