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This Week in JAMA
May 13, 2009

This Week in JAMA

JAMA. 2009;301(18):1853. doi:10.1001/jama.2009.662

Five-year survival rates for some early stage cancers exceed 90%, but treatment can be associated with accelerated functional decline among older survivors. In a randomized trial, Morey and colleagues assigned older (aged 65-91 years) and overweight survivors of breast, colorectal, and prostate cancer either to a home-based program involving telephone counseling and mailed print materials promoting a healthful diet and exercise or to a delayed intervention (control) group. The authors assessed self-reported functional decline and found that participants in the intervention group had a reduced rate of functional decline compared with control group participants during a 12-month follow-up.

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Androgen deficiency is common in men with chronic heart failure (HF) and is associated with increased morbidity and mortality. Because estrogens are formed by the aromatization of androgens, it has been assumed that estrogen synthesis, degradation, or both may be disturbed in men with chronic HF, which may have adverse clinical consequences. In a prospective observational study of men with chronic HF and reduced left ventricular ejection fraction, Jankowska and colleagues assessed the relationship between serum concentration of estradiol and all-cause mortality. During a 3-year follow-up, the authors found that men with serum estradiol levels in the lowest or highest quintiles had increased rates of mortality compared with men with estradiol levels in the middle quintile.

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Authoritative groups have issued guidelines for organ donation after cardiac death, and the accreditation standards require hospitals to address donation after cardiac death. However, little is known about actual hospital policies relating to this event. In a survey of children's hospitals, Antommaria and colleagues assessed the status and content of policies addressing organ donation after cardiac death. The authors found that a majority of hospitals had policies or were in the process of developing them. In an analysis of existing policies, the authors found considerable variation among hospitals and between policies and authoritative reports, including the criteria applied to declare death, the articulation of established ethical norms in the premortem management of potential donors, and the role of palliative care.

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To assess the role of aspirin in the secondary prevention of cardiovascular events in patients with peripheral artery disease (PAD), Berger and colleagues Article performed a meta-analysis of data from 18 prospective randomized controlled trials of aspirin therapy, with or without dipyridamole, in patients with PAD. The authors found that treatment with aspirin alone or in combination with dipyridamole was not associated with a statistically significant reduction in cardiovascular events but was associated with a significant reduction in nonfatal stroke. In an editorial, McDermott and Criqui Article discuss limitations in the data analyzed by Berger et al and highlight the need for high-quality trials of aspirin for secondary prevention in patients with PAD.

“A system that overemphasizes statistics will inevitably produce physicians who become fixated on the same, to the detriment of both physician and patient alike.” From “Beyond the Numbers.”

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Concerns about potential conflicts of interest have spurred some medical associations to cut industry funding for educational activities.

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Primary care supply and shortages

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The chasm between intention and achievement in primary care

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Grow the US National Health Service Corps

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Commitment to community care

Article, Article, Article, Article, Article

F. Scott Fitzgerald's last days

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Join Lisa A. Cooper, MD, MPH, from 2 to 3 PM eastern time on May 20 to discuss treatment adherence and hypertension control. To register, go to http://www.ihi.org/AuthorintheRoom.

How would you manage a 64-year-old man with newly diagnosed prostate cancer? Go to www.jama.com, read the case, and submit your response by May 24 for possible publication.

For your patients: Information about heart failure

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