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This Week in JAMA
November 2, 2011

This Week in JAMA

JAMA. 2011;306(17):1829. doi:10.1001/jama.2011.1608

In the Prostate, Lung, Colorectal and Ovarian cancer screening trial, 154 901 participants aged 55 through 74 years were randomly assigned to receive either annual chest radiographic screening or usual care for 4 years. Oken and colleagues assessed lung cancer mortality through 13 years of follow-up and report that undergoing chest radiographic screening for 4 consecutive years was not associated with a reduction in lung cancer mortality compared with usual care. In an editorial, Sox discusses the evidence that short-term lung cancer screening with chest radiography does not reduce mortality.

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A minimally toxic nonmyeloablative conditioning regimen is an option for older patients who are undergoing allogeneic hematopoietic cell transplantation (HCT) for advanced hematologic malignancies. Sorror and colleagues assessed long-term outcomes among 372 patients aged 60 to 75 years who were treated with a nonmyeloablative regimen before HCT at 18 collaborating institutions between 1998 and 2008. Among the authors' findings was that 5-year overall and progression-free survival were 35% and 32%, respectively. In an editorial, Mineishi discusses challenges associated with HCT in older patients.

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To examine the association between breast cancer and alcohol consumption during adult life, Chen and colleagues analyzed data from 105 986 Nurses' Health Study participants who completed 8 alcohol assessments between 1980 and 2008. The authors found that alcohol consumption both earlier and later in adult life and at levels as low as 3 to 6 drinks per week was associated with increased risks of invasive breast cancer. In an editorial, Narod discusses the relationship between alcohol consumption patterns and breast cancer risk.

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Recipients of solid organ transplants are at increased risk of cancer largely due to chronic immunosuppressive therapy. To characterize the cancer spectrum and risks among these patients, Engels and colleagues analyzed linked data from the US Scientific Registry of Transplant Recipients and 13 state and regional cancer registries. The analysis included 175 732 solid organ transplants. The authors found that compared with the general population, recipients of solid organ transplants were at increased risk for 32 different malignancies—both related and unrelated to known infectious etiologies.

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A 68-year-old woman scheduled to undergo elective knee replacement surgery is considering preoperative autologous blood donation. Uhl discusses patient blood management—an approach to care that includes preoperative patient assessment and blood management, and intraoperative and postoperative strategies to minimize the need for transfusion.

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How would you manage an 86-year-old woman with upper gastrointestinal bleeding who is anticoagulated and receiving antiplatelet therapy? Go to www.jama.com to read the case. Submit your response by December 4 for possible online posting.

“It is clear that something has to change to facilitate patient care and to address physicians' helplessness to perform our jobs to the best of our ability.” From “The Quiet Epidemic.”

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Scientists are working to understand and prevent an upsurge in cases of community-associated Clostridium difficile infections.

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Academic medical centers: organization and challenges

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Obstacles to personalized medicine

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A healthy mother delivered a term neonate who had meconium and underwent ventilation. The infant later developed thrombocytopenia and an indurated purplish plaque on her back. What would you do next?

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Join Steven Zweig, MD, MSPH, Wednesday, November 16, from 2 to 3 PM eastern time to discuss the physician's role in patients' nursing home care. To register, go to http://www.ihi.org/AuthorintheRoom.

For your patients: Information about plantar fasciitis.

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