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This Week in JAMA
May 14, 2008

This Week in JAMA

JAMA. 2008;299(18):2121. doi:10.1001/jama.299.18.2121

Screening ultrasound may reveal small breast cancers not seen on mammography. Berg and colleagues Article report results of a clinical trial in which women at increased risk for breast cancer and presenting for routine mammography were randomly assigned to undergo either mammography plus ultrasound or mammography alone. Standardized scanning and interpretative criteria were used to compare the diagnostic yield of the 2 screening approaches. The authors found that the addition of a single screening ultrasound examination to mammography would detect an additional 1.1 to 7.2 cancers per 1000 high-risk women. In an editorial, Kuhl Article discusses the strengths and limitations of mammography, ultrasonography, and magnetic resonance imaging for breast cancer screening.

Arteriovenous fistulas are the preferred type of vascular access for hemodialysis; however, early failure due to thrombosis—often leading to inadequate maturation—limits their use. To determine whether administration of an antiplatelet agent reduces the likelihood of early failure, Dember and colleagues Article randomly assigned patients to receive either daily clopidogrel or placebo starting within 1 day of fistula creation. The authors found that clopidogrel reduced the risk of thrombosis but did not increase the proportion of fistulas that were suitable for dialysis at 6-week follow-up. In an editorial, Tonelli Article discusses implications of the study results for clinical practice and future studies of patients undergoing hemodialysis.

The health risks associated with exposure to fine particulate matter 2.5 μm (PM2.5) or less in diameter are well documented, but evidence regarding the health risks of coarse particulate matter with a diameter greater than 2.5 μm and less than 10 μm (PM10-2.5) is limited. Peng and colleagues analyzed data from 108 US counties and the Medicare National Claims History Files to estimate the risk of hospital admissions for cardiovascular and respiratory diseases associated with PM10-2.5 exposure. In analyses adjusted for PM2.5, the authors found no statistically significant associations between coarse particle exposure and hospital admissions for these diseases.

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Werner and colleagues analyzed 2004 to 2006 Centers for Medicare & Medicaid Services hospital performance data to assess trends in disparities in quality of care between hospitals with high and low percentages of Medicaid patients. The authors report that hospitals with high percentages of Medicaid patients—those often referred to as “safety-net hospitals”—had worse performance in 2004 and significantly smaller improvements over time compared with hospitals with low percentages of Medicaid patients.

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Applbaum and colleagues discuss the ethical response to patient or family requests for futile treatment, prompted by the case of Ms R, a 19-year-old woman who experienced a severe intracranial hemorrhage and whose family requested administration of a traditional medicinal substance after she was declared dead.

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“I’d always known that medical training had taught us to suppress our emotions in order to function, but I’d never realized to what extent.” From “Crying for My Grandmother.”

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New findings reveal that some patients who become infected with the West Nile virus experience substantial and long-lasting cognitive and functional impairments.

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An article in the May 12 Archives of Internal Medicine reports that exposure to particulate air pollution may increase deep vein thrombosis (DVT) risk.

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Nonpayment for preventable complications

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Barcoded medication administration

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Brinkley, quackery, and Fishbein

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Join Barbara Howard, PhD, and William Howard, MD, on May 21, 2008, from 2 to 3 PM eastern time to discuss lower blood pressure and cholesterol targets in diabetes. To register, go to http://www.ihi.org/AuthorintheRoom.

For your patients: Information about brain death.

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