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This Week in JAMA
November 11, 2009

This Week in JAMA

JAMA. 2009;302(18):1937. doi:10.1001/jama.2009.1645

Prone positioning has been suggested for patients with the acute respiratory distress syndrome (ARDS) and severe hypoxemia; however, conclusive evidence of a survival benefit is lacking. In a multicenter trial, Taccone and colleagues Article randomly assigned 342 adult patients with ARDS and moderate or severe hypoxemia to undergo supine or 20-h/d prone positioning. The investigators found that prone and supine patients had similar 28-day and 6-month mortality. In an editorial, Slutsky Article discusses the care of patients with acute lung injury and clinical research to improve outcomes.

In an analysis of data from a nationally representative survey of Danish women, Gärtner and colleagues Article examined the prevalence of and factors associated with persistent pain after breast cancer surgery. The authors found that 2 to 3 years after breast cancer treatment, 47% of women reported pain symptoms. Factors associated with chronic pain included young age (< 40 years) and receipt of adjuvant radiotherapy. In an editorial, Loftus and Laronga Article discuss the evaluation of patients with chronic pain after breast cancer surgery.

To assess the associations of major blood lipids and apolipoproteins with the risk of coronary heart disease and ischemic stroke, investigators with The Emerging Risk Factors Collaboration analyzed population-based prospective data from 302 430 individuals who were free of vascular disease at study enrollment. The investigators' findings suggest that lipid assessment in vascular disease can be simplified by measuring either total and high-density lipoprotein cholesterol levels or apolipoprotein (apoA1 and apoB) levels without the need to fast and without regard to triglyceride levels.

In a case-control study, Bodmer and colleagues examined the association between the use of statins and the risk of incident gallstone disease followed by cholecystectomy. They found that compared with never-users, long-term use (>1.5 years) of statins was associated with a decreased risk of gallstones with cholecystectomy.

Shaw and colleagues Article examined the current state of medical regulation (“recertification”) in the United States, Canada, and the United Kingdom and found evidence of increasing external pressure from payers and patients for accountability and transparency, which is leading to a shift from reliance on professional self-regulation toward shared regulation between the profession and other stakeholders. In an editorial, Chantler and Ashton Article discuss the purpose and limits of professional self-regulation.

Mr F is a 66-year-old man who underwent chest computed tomography to investigate persistent upper abdominal pain that was unresponsive to proton pump inhibitors and was found to have an abdominal aortic aneurysm. Schermerhorn discusses risk factors for abdominal aortic aneurysm and issues surrounding its monitoring and treatment.

“They told us that Afghanistan would not be Iraq. From where I sit, on an endless plain of nothing known to the locals as the Desert of Death, I beg to differ.” From “Death and Life in Afghanistan.”

A silent epidemic of undiagnosed viral hepatitis B and C infections may soon become apparent as a larger cohort of individuals with such infections develops serious liver complications.

Issues facing clinical research sites

Genome-wide association studies and human disease

Join Michael S. Krasner, MD, November 18, 2009, from 2 to 3 PM eastern time to discuss the association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. 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 advise a 37-year-old man who seeks a new physician affiliated with a high-quality hospital? Go to www.jama.com to read the case, and submit your response, which may be selected for online publication. Submission deadline is November 29.

For your patients: Information about aortic aneurysms.

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