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This Week in JAMA
March 6, 2013

This Week in JAMA

JAMA. 2013;309(9):849. doi:10.1001/jama.2012.145266

Patients with rheumatoid arthritis have a disproportionately increased risk of varicella-zoster virus reactivation (herpes zoster). Whether initiation of anti−tumor necrosis factor (anti-TNF) therapy is associated with the risk of herpes zoster is not clear. Winthrop and colleagues examined this question in a retrospective cohort study involving 56 066 patients with rheumatoid arthritis; inflammatory bowel disease; and psoriasis, psoriatic arthritis, and ankylosing spondylitis who were new users of disease-modifying antirheumatic drugs. The authors found that compared with patients who initiated nonbiologic disease-modifying therapies, those who initiated anti-TNF therapies were not at higher risk for herpes zoster.

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Left ventricular ejection fraction is an important—but imperfect—prognostic factor in patients with nonischemic dilated cardiomyopathy. In a prospective cohort of 472 patients with nonischemic dilated cardiomyopathy referred for cardiovascular magnetic resonance imaging, Gulati and colleagues assessed whether myocardial fibrosis is an independent predictor of mortality. The authors report that both the presence and extent of myocardial fibrosis were associated with all-cause mortality and assessment of fibrosis provided independent prognostic information beyond left ventricular ejection fraction in this patient population. In an editorial, Gupta and colleagues discuss the use of cardiac magnetic resonance imaging in clinical practice.

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Regional myocardial wall thinning is considered to represent chronic myocardial infarction and scar tissue; however, several reports from patients undergoing cardiac magnetic resonance imaging have suggested the possibility that regional myocardial wall thinning may occur with little or no scar formation. In a study involving 1055 consecutive patients with coronary artery disease (CAD) who underwent cardiac magnetic resonance, Shah and colleagues found that 201 (19%) had regional wall thinning. Among a subset of 37 patients with limited scar burden (<50% of the thinned region), improved contractility and resolution of wall thinning were observed after cardiac revascularization.

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Mr O is a 71-year-old man with a long history of chronic low back pain. He experienced reasonable pain control when treated with oxycodone-acetaminophen, but this treatment was stopped when urine drug testing was unexpectedly negative on 2 occasions. Alford discusses the effectiveness and safety of long-term opioid therapy for chronic pain, patient assessment and education at treatment onset, and medication monitoring to ensure benefit and minimize harm during long-term opioid use.

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In a JAMA Clinical Evidence Synopsis, Wong and colleagues report that analysis of data from 12 randomized trials (12 168 patients) of antiplatelet therapy in patients with stable intermittent claudication demonstrated that antiplatelet agents are associated with lower rates of all-cause and cardiovascular mortality compared with placebo.

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Compliance with sweeping changes to federal rules intended to improve privacy and security of patient records will be a challenge for medical practices and hospitals.

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Keeping an eye on distracted driving

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Improving opioid prescribing

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Influenza prevention update

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Response to the outbreak of invasive fungal infection

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“Possessing a moral compass is the basis on which we develop the personal values that are reflected in our professional pursuits.” From “Swimming in the Sea of Galilee.”

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The JAMA Network reader

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

Join Daniel J. Buysse, MD, March 20, 2013, from 2 to 3 PM eastern time to discuss insomnia. To register, go to http://www.ihi.org/AuthorintheRoom.

For your patients: Information about tuberculosis.

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