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This Week in JAMA
February 18, 2009

This Week in JAMA

JAMA. 2009;301(7):695. doi:10.1001/jama.2009.154

To assess trends in the incidence of methicillin-resistant Staphylococcus aureus (MRSA) central line–associated bloodstream infections in adult and pediatric intensive care units (ICUs), Burton and colleagues Article analyzed 1997 to 2007 data reported to a voluntary Centers for Disease Control and Prevention national infection surveillance network. The authors found that during the decade of study, the incidence of MRSA central line–associated bloodstream infections declined in adult ICUs and remained stable in pediatric ICUs. In an editorial, Climo Article discusses the importance of identifying the infection control practices that may be associated with these reductions in MRSA infections.

Tumor necrosis factor α (TNF-α) inhibitors are associated with an increased risk of bacterial infections, but whether they are also associated with reactivation of latent viral infections is not known. In an analysis of data from a prospective cohort of patients initiating treatment with biological agents for rheumatoid arthritis, Strangfeld and colleagues Article assessed whether treatment with TNF-α inhibitors is associated with higher rates of herpes zoster compared with treatment with conventional disease-modifying antirheumatic drugs. The authors report that treatment with monoclonal anti–TNF-α antibodies (eg, adalimumab, infliximab) appears to be associated with an increased risk of herpes zoster. In an editorial, Whitley and Gnann Article discuss the evidence linking TNF-α inhibitor therapy with reactivation of latent varicella-zoster virus and the implications for patient care.

Dysregulation of guanylyl cyclase 2C (GUCY2C), a paracrine hormone receptor and intestinal tumor suppressor, is associated with neoplastic transformation, and GUCY2C is a marker expressed by colorectal tumors. In a prospective study of patients with colorectal cancer, Waldman and colleagues tested the utility of assessing GUCY2C expression—quantified by reverse transcriptase–polymerase chain reaction—in histologically negative (pN0) lymph nodes to identify occult metastases and examined the association of GUCY2C expression with time to recurrence. The authors report that expression of GUCY2C (GUCY2C+) in lymph nodes free of tumor cells by histopathology was independently associated with time to recurrence and disease-free survival in patients with lymph node negative colorectal cancer.

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Many cancer survivors have the desire and ability to return to work after cancer diagnosis and treatment. However, the association of cancer survivorship with unemployment is not clear. In a meta-analysis of data from 26 studies that included adult cancer survivors, healthy controls, and employment as an outcome, de Boer and colleagues found that cancer survivors were more likely to be unemployed than healthy individuals. The authors report that survivors of breast and gastrointestinal cancers and cancers of the female reproductive organs and patients living in countries or times with relatively high unemployment rates were at particular risk of unemployment.

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“This was a family that had known suffering as a way of life—nothing was easy.” From “Southern Comfort.”

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The US Food and Drug Administration is doing too little to police conflicts of interest among clinical trial investigators, according to a report by the Department of Health and Human Services' Office of Inspector General.

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Transformation of health care at the front line

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Clinicians in quality improvement: a new career pathway

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Penicillin treatment of syphilis

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

How would you manage a 76-year-old patient with multiple medical problems and recurrent Clostridium difficile colitis? Go to www.jama.com to read the case and submit your response, which may be selected for online publication. Submission deadline is February 25.

For your patients: Information about syphilis.

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