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This Week in JAMA
December 7, 2011

This Week in JAMA

JAMA. 2011;306(21):2293. doi:10.1001/jama.2011.1787

Several studies have reported serious infections in patients taking tumor necrosis factor (TNF)-α antagonists. Grijalva and colleagues analyzed retrospective data from 16 022 patients with autoimmune diseases to assess whether initiation of TNF-α antagonists compared with nonbiologic therapies was associated with an increased risk of serious infections requiring hospitalization. In their analyses of disease-specific and propensity score–matched patient cohorts the authors found that initiation of TNF-α antagonists was not associated with an increased risk of hospitalization for serious infections. In an editorial, Dixon and Felson discuss the safety of anti-TNF therapy.

To investigate factors associated with response to etanercept, a TNF-α antagonist, in juvenile idiopathic arthritis (JIA), Otten and colleagues analyzed data from 262 patients with JIA who had initiated etanercept treatment. The authors report that 15 months after starting etanercept, 85 patients had achieved an excellent response, which was associated with low baseline disability scores, low prior use of disease-modifying antirheumatic drugs, and younger age at disease onset. Poor treatment response (in 85 patients) was associated with systemic JIA and female sex.

Corticosteroids administered to women in preterm labor are associated with improved infant outcomes; however, little is known about the effects of antenatal corticosteroids before 24 weeks' gestation. In an analysis of data (1993-2009) from 10 541 infants born at 22 to 25 weeks' gestation at 23 academic perinatal centers, Carlo and colleagues found that among infants born at 23 to 25 weeks’ gestation, antenatal exposure to corticosteroids was associated with lower rates of death or neurodevelopmental impairment compared with nonexposure.

Article (AUTHOR VIDEO INTERVIEW)

Whether androgen deprivation therapy (ADT) causes excess cardiovascular (CV) deaths among men with prostate cancer is controversial. In a pooled analysis of data from 8 clinical trials involving 4141 men with unfavorable-risk, nonmetastatic prostate cancer who were randomly assigned to ADT or placebo, Nguyen and colleagues found no evidence that ADT is associated with excess CV mortality. In an editorial, Kelly and Gomella discuss the competing risks of ADT.

Ms S, an 86-year-old woman with a history of occasional mild epigastric discomfort, presented to the emergency department after a fall at home. On evaluation, she had melena and a hemoglobin level of 7.6 g/dL, and a duodenal ulcer was observed on endoscopy. Almadi and colleagues discuss the management of patients with gastrointestinal bleeding who are receiving antiplatelet or anticoagulation therapy, including when to restart these therapies and interventions to reduce the risk of bleeding recurrence.

A 23-year-old woman was referred for evaluation of a femoral neck fracture. Computed tomography scan revealed lytic lesions in the pelvis and both femurs. What would you do next?

“There is probably no higher accolade a physician can give a peer than to say, ‘I trust him enough to be my own doctor.’” From “His Patients. My Patients.”

Annual cervical cancer screening is discouraged in separate guidelines proposed by the US Preventive Services Task Force and a consortium led by the American Cancer Society.

Next-generation DNA sequencing, regulation, and paternalism

New HHS data collection standards

Call for Papers

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

Join Daniel Leffler, MD, MS, on Wednesday, December 21, at 2 PM eastern time to discuss celiac disease. To register, go to http://www.ihi.org/AuthorintheRoom.

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

How would you manage a house officer with a needlestick injury? Go to www.jama.com to read the case. Submit your response by January 1 for possible online posting.

For your patients: Information about appendectomy.

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