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This Week in JAMA
March 28, 2012

This Week in JAMA

JAMA. 2012;307(12):1229. doi:10.1001/jama.2012.359

After surgery for gastrointestinal stromal tumor, 12 months of adjuvant therapy with imatinib improves relapse-free survival; however, eventual tumor progression is common. In a randomized trial of 400 patients with resected gastrointestinal stromal tumors, Joensuu and colleagues found that compared with 12 months of adjuvant imatinib therapy, 36 months of treatment improved recurrence-free and overall survival. In an editorial, Blanke discusses adjuvant therapy for patients with gastrointestinal stromal tumors.

Yang and colleagues examined trends in 7 cardiovascular health metrics that reflect tobacco use, physical activity, blood pressure, glucose and cholesterol levels, body mass index, and dietary content and their relationship with mortality in an analysis of data from 44 959 participants in the National Health and Nutrition Examination Surveys (NHANES; 1988-2010) and a subset (n = 13 312) from the NHANES III Linked Mortality File. The authors found that meeting a greater number of the cardiovascular health metrics was associated with lower risks of total and cardiovascular disease–related mortality. In an editorial, Lloyd-Jones discusses strategies to improve cardiovascular health.

Karaca-Mandic and colleagues examined the relationship between medication cost-sharing with medication and health care services use in an analysis of pharmacy and health care services claims for 8834 US children who initiated asthma control therapy between 1997 and 2007. The authors report that greater medication cost-sharing was associated with a small reduction in medication use and more asthma-related hospitalizations among children aged 5 years or older. In an editorial, Ungar discusses medication cost-sharing and health outcomes among children with asthma.

ArticleArticle  AUTHOR AUDIO INTERVIEW

Myotonic dystrophy type 1 is associated with a high risk of sudden death. In an analysis of registry data from 486 patients with myotonic dystrophy–associated conduction abnormalities, Wahbi and colleagues found that compared with a noninvasive strategy, patients who were managed with an invasive strategy that involved systematic electrophysiological studies and prophylactic permanent cardiac pacing when the HV interval exceeded 70 milliseconds had a higher rate of 9-year survival.

To address whether patients' low-density lipoprotein cholesterol (LDL-C) levels should be the primary target to initiate and titrate lipid-lowering therapy, Boekholdt and colleagues analyzed patient data from 8 statin therapy randomized trials (38 153 patients). The authors assessed the comparative value of LDL-C, non–high-density lipoprotein cholesterol (non–HDL-C), and apolipoprotein B levels in predicting cardiovascular event risk and found that on-treatment levels of each parameter were strongly associated with incident cardiovascular events, with non–HDL-C having the strongest association.

A 60-year-old man with a history of multiple fractures after minor trauma is being evaluated for anemia. Physical examination reveals blue sclerae. What would you do next?

New research probes issues of the value of fetal surgery to treat spina bifida, signs of impending uterine rupture, and potential drug interactions in pregnant women.

Are medical conferences useful?

HCV screening in jails

Innovative health care models and financing

“In clinical practice and teaching, whether we are aware of this or not, we have enslaved ourselves to the idea of the cutting edge.” From “Our Ubiquitous Technology.”

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

How would you manage a 75-year-old woman in complete clinical remission after stage IIIC epithelial ovarian cancer? Read the case at www.jama.com. Submit your response by April 1 for possible online posting.

Join James T. Pacala, MD, MS, April 18 from 2 to 3 PM eastern time to discuss hearing deficits in older patients. To register, go to http://www.ihi.org/AuthorintheRoom.

For your patients: Information about peptic ulcer disease.

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