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This Week in JAMA
May 15, 2013

This Week in JAMA

JAMA. 2013;309(19):1957. doi:10.1001/jama.2013.4980

The Age-Related Eye Disease Study (AREDS) demonstrated that supplementation with the AREDS formulation—vitamins C and E, beta carotene, and zinc—reduced the risk of progression to advanced age-related macular degeneration (AMD). In the AREDS2 study, which enrolled 4203 individuals at risk of AMD progression, investigators assessed the effect of adding lutein plus zeaxanthin, docosahexanoic acid plus eicosapentanoic acid, or both to the AREDS formulation and found no further reduction in the risk of progression to advanced AMD.

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In an extended follow-up of 215 stress-continent women who underwent abdominal sacrocolpopexy for symptomatic pelvic organ prolapse and who were randomly assigned to undergo concomitant urethropexy or not, Nygaard and colleagues found similar rates of anatomic and symptomatic pelvic organ prolapse failure a median 7 years after surgery in both randomized groups. Women who underwent urethropexy had a longer time to stress urinary incontinence. In an editorial, Iglesia discusses long-term outcomes of pelvic organ prolapse surgery and implications for shared decision making.

See Article, Editorial, and Author Audio Interview

Among patients receiving an implantable cardioverter-defibrillator (ICD) for primary prevention, dual-chamber devices are often implanted even without clear indications for pacing. Peterson and colleagues compared patient outcomes following placement of single- and dual-chamber ICDs in a retrospective cohort study that involved 32 034 patients. In analyses that included propensity-score matching based on patient, clinician, and hospital factors, the authors found a higher rate of device-related complications and similar risks of 1-year mortality and hospitalization associated with dual-chamber than with single-chamber ICDs.

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Identifying Patients at Risk of Glaucoma

Glaucoma can have an insidious onset leading to diagnostic delay. In a systematic review and meta-analysis of data from 41 studies and nearly 100 000 individuals, Hollands and colleagues assessed the accuracy of examination findings and relevant risk factors for diagnosing primary open-angle glaucoma and sought to determine whether there is a role for generalist physicians in glaucoma screening. The authors report that an increased cup-to-disc ratio, cup-to-disc asymmetry, disc hemorrhage, and elevated intraocular pressure, as well as high myopia, family history, black race, and advanced age, increase the risk of primary open-angle glaucoma. Quality evidence was lacking to assess the role of generalist physicians in glaucoma screening.

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From The JAMA Network

An article in the August 2012 issue of the Archivesof Dermatology reported a lower risk of incident myocardial infarction in patients with psoriasis treated with tumor necrosis factor (TNF) inhibitors than in patients treated with topical agents. Armstrong discusses the study findings and uncertainties regarding the cardiovascular benefits of TNF inhibitors in patients with psoriasis.

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Physicians should approach their use of social media and other digital communication tools with care, according to a new report on online professionalism.

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Cost consequences of 340B drug discount program

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Contraceptives, the law, and evidence-based preventive care: a fundamental primary care service vs religious prerogative

See Viewpoint, Viewpoint and Online Poll at www.jama.com

Social determinants of health within the patient-centered medical home

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“[P]atient-centered care shouldn't be about changing the ‘what’; it should be about changing the ‘how.’” From “Patient's Sister, Seeking Job.”

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Dr Bauchner summarizes and comments on this week's issue, including Viewpoints, Editorials, Original Contributions, and clinical content. Go to http://jama.jamanetwork.com/multimedia.aspx#Weekly

For your patients: Information about misuse of opioid medication.

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