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This Week in JAMA
January 28, 2009

This Week in JAMA

JAMA. 2009;301(4):355. doi:10.1001/jama.2009.22

Although some studies have suggested that brain natriuretic peptide (BNP)–guided therapy is superior to conventional symptom-guided therapy for patients with heart failure, the data are not conclusive and are based on limited follow-up, and the studies focused on younger patients. Pfisterer and colleagues Article report results of the multicenter Trial of Intensified vs Standard Medical Therapy in Elderly Patients With Congestive Heart Failure (TIME-CHF) study, which compared 18-month survival free of all-cause hospitalizations and quality of life among patients aged 60 years or older who were randomly assigned to either an intensified BNP-guided strategy or conventional symptom-guided therapy for heart failure. The investigators found that patients receiving BNP-guided treatment had similar clinical and quality-of-life outcomes as patients receiving symptom-guided treatment. In an editorial, Piña and O’Connor Article discuss the clinical utility of BNP-guided therapy for heart failure.

Cure rates exceed 80% in pediatric acute lymphoblastic leukemia (ALL) but individual response to treatment varies. To explore host genetic factors that may affect treatment response, Yang and colleagues assessed the association of germline single nucleotide polymorphisms (SNPs) with treatment response at the end of remission induction chemotherapy in 2 cohorts of children with newly diagnosed ALL. Among the 476 796 germline SNPs analyzed, the authors identified 102 SNPs that were associated with residual disease status at the end of induction chemotherapy. Of these, 63 (61.7%) were associated with early treatment response, relapse, or antileukemic drug disposition.

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Women who were treated with chest radiation for a pediatric malignancy have a significantly increased risk of breast cancer. In an analysis of data from the Childhood Cancer Survivor Study, Oeffinger and colleagues Article assessed breast cancer surveillance practices among female pediatric cancer survivors who were treated with chest radiation. The authors report that 63.5% of women aged 25 to 39 years and 23.5% of women aged 40 to 50 years had not undergone mammography screening as recommended by current guidelines for follow-up of survivors of childhood cancer. In an editorial, Taylor and Taylor Article discuss potential explanations for the low rates of screening mammography in this population of women who are at high risk of breast cancer.

In a systematic review and meta-analysis, Met and colleagues assessed the accuracy of computed tomography angiography vs intra-arterial digital subtraction angiography for grading disease severity in patients with peripheral arterial disease (PAD). In an analysis of data from 20 studies that compared the 2 techniques, the authors found that computed tomography angiography provided accurate assessment of the presence and extent of PAD in patients with intermittent claudication. However, definitive conclusions could not be reached regarding the accuracy of computed tomography angiography in patients with critical limb ischemia.

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Products containing the long-acting β-agonists formoterol or salmeterol alone increase the risk of serious adverse effects in patients with asthma and should be banned, concluded a US Food and Drug Administration advisory panel.

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Relative child poverty, income inequality, and health

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Deconstructing medical Spanish

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Why guideline-making requires reform

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Join Mary M. McDermott, MD, February 18 from 2 to 3 PM eastern time to discuss treadmill exercise vs resistance training for patients with peripheral arterial disease. To register, go to http://www.ihi.org/AuthorintheRoom.

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

How would you manage smoking cessation treatment in a 51-year-old woman with a history of bipolar disorder and tobacco use for more than 35 years? Go to www.jama.com to read to the case and submit your response, which may be selected for online publication. Submission deadline is January 28.

For your patients: Information about acute lymphoblastic leukemia.

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