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This Week in JAMA
September 21, 2011

This Week in JAMA

JAMA. 2011;306(11):1169. doi:10.1001/jama.2011.1347

Validated tools to enable personalized prediction of sexual function after prostate cancer treatment are limited. In analyses of pretreatment and 2-year follow-up data from a multicenter cohort of 1027 men with early-stage prostate cancer treated with radical prostatectomy, external radiotherapy, or brachytherapy, Alemozaffar and colleagues Article developed models to predict preservation of erectile function. The models, which include pretreatment sexual function, patient characteristics, and treatment factors, were validated in a cohort of 1655 patients. In an editorial, Barry Article discusses how predictive models and patient decision aids can support shared decision making.

In a prospective, observational study of 1789 patients with acute coronary syndromes who underwent percutaneous coronary intervention and whose antithrombotic treatment was adjusted according to results of platelet function tests, Parodi and colleagues Article found that patients with high residual platelet reactivity after receiving a loading dose of the antiplatelet agent clopidogrel were at increased risk of an ischemic event during 2 years of follow-up. In an editorial, Angiolillo Article discusses uncertainties surrounding the use of platelet function testing in routine clinical care.

Among pediatric patients with obsessive-compulsive disorder (OCD), partial response to serotonin reuptake inhibitors (SRIs) is the norm. In a 12-week randomized trial that involved 124 pediatric patients with primary OCD and a partial response to SRI therapy, Franklin and colleagues examined the effects of combining pharmacotherapy with cognitive behavior therapy (CBT). The authors found that CBT plus medication management was associated with greater reduction in OCD symptoms than was achieved with medication management alone, or when brief instruction in CBT principles and skills was delivered by the psychiatrist in the context of medication management.

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Early effects of preterm birth on morbidity and mortality are well documented, but less is known about longer-term outcomes. Crump and colleagues examined the association between gestational age at birth and all-cause and cause-specific mortality in young adulthood in a cohort of 674 820 Swedish individuals who were born as singletons in 1973-1979. The cohort was followed up through 2008, and the authors found that compared with term births, low gestational age at birth was independently associated with increased mortality in early childhood and young adulthood.

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Data suggest that depression is associated with an increased risk of stroke. To evaluate the association, Pan and colleagues conducted a systematic literature review and identified 28 prospective cohort studies that assessed the association between depression and risk of stroke. In a meta-analysis of the pooled data (encompassing 317 540 individuals and 8478 incident stroke events), the authors found that depression was associated with a significantly increased risk of stroke morbidity and mortality.

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A 5-year-old boy has a 3-month history of a progressive and erythematous periocular rash that did not respond to treatment for eczema. What would you do next?

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“My children had heard about many of my patients over the years, yet they had rarely met any.” From “Yitgadal.”

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Academic detailing, noncommercial educational outreach that is intended to provide clinicians with evidence-based information about drugs and devices, has elicited criticism from the pharmaceutical industry and others.

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FDA—a misunderstood agency

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Perspectives on pharmacogenomics

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Advancing the research infrastructure

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Reproductive health and health reform

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

Join Michael Paasche-Orlow, MD, MA, MPH, Wednesday, October 19, from 2 to 3 PM eastern time to discuss caring for patients with limited health literacy. To register, go to http://www.ihi.org/AuthorintheRoom.

Ms J, a 46-year-old woman with a history of iron deficiency anemia and 3 miscarriages, was recently diagnosed with celiac disease. How would you treat her illness, and what follow-up would you recommend for Ms J and her family? Go to www.jama.com to read the case. Submit your response by October 9 for possible online posting.

For your patients: Information about stroke imaging.

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