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This Week in JAMA
March 24 2010

This Week in JAMA

JAMA. 2010;303(12):1119. doi:10.1001/jama.2010.319

Laboratory reporting of estimated glomerular filtration rate (GFR) is common, but little is known about the implications for health care resource use. Hemmelgarn and colleagues Article examined trends in nephrologist visits and health care resource use before and after implementation of estimated GFR reporting in Alberta, Canada, and found that reporting of estimated GFR was associated with an increase in first visits to a nephrologist, particularly among women, patients with more severe kidney dysfunction, patients who were older, and those with comorbidities. In an editorial, Glassock Article discusses limitations of the current reliance on estimated GFR to define and classify chronic kidney disease.

In an analysis of data from a longitudinal cohort study of British civil servants, Stringhini and colleagues Article examined the contribution of health behaviors (eg, smoking, alcohol consumption, diet, and physical activity) to social inequalities in mortality. The authors found that lower socioeconomic position was associated with higher mortality and that health behaviors explained a substantial portion of the social inequality in mortality, particularly when the behaviors were assessed repeatedly during the 24-year follow-up. In an editorial, Dunn Article discusses the interaction of personal health behaviors with social and economic determinants of health.

High resting blood pressure is a well-established risk factor for cardiovascular disease, but less is known about the relationship between blood pressure and long-term outcomes in situations of acute stress, such as acute chest pain. In a prospective cohort study of patients admitted to the medical intensive care unit for acute chest pain, Stenestrand and colleagues found that admission supine systolic blood pressure was inversely related to 1-year mortality.

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In an analysis of data from a prospective cohort study of healthy women who had a mean age of 54.2 years and consumed a usual diet at baseline, Lee and colleagues examined the association of different amounts of physical activity with long-term changes in weight. The authors found that the women gained a mean 2.6 kg during 13 years of follow-up. Physical activity was inversely associated with weight gain only among women of normal weight. Women successful in maintaining normal weight averaged approximately 60 minutes a day of moderate-intensity activity throughout the study.

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In a systematic review and meta-analysis, Bassler and colleagues assessed the treatment effect in truncated randomized clinical trials (RCTs)—those stopped early based on the finding of an apparently beneficial treatment effect—and compared these with the treatment effect in RCTs that addressed the same research question but were not stopped early. The authors report that truncated RCTs were associated with larger effect sizes than RCTs not stopped early, independent of statistical stopping rules, and greatest in studies with a small number of events.

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“He wants to talk about the past, his old friends, and how the town has changed. His comments start off making sense, and then take sharp turns into a world of fantasy and confabulation.” From “To Bed With Dad.”

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Inappropriate interventions by physicians may be contributing to rising rates of preterm births, recent studies suggest.

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Consequences of incremental health care reform

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Informed consent to promote patient-centered care

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Psychiatrists' financial conflicts of interest

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Setting the RECORD straight

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Ensuring integrity in industry-sponsored research

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Join Mary E. Tinetti, MD, Wednesday, April 21, from 2 to 3 PM eastern time to discuss the evaluation of and treatment for patients who fall. 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.

For your patients: Information about randomized controlled trials.

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