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This Week in JAMA
May 5, 2010

This Week in JAMA

JAMA. 2010;303(17):1669. doi:10.1001/jama.2010.554

Preventing influenza by vaccination reduces the risk of subsequent vascular events. Tseng and colleagues Article examined the association between pneumococcal vaccination and the risk of vascular events in a prospective cohort study of men aged 45 years or older who were enrolled in a single health care system. The authors found no association between receipt of the pneumococcal vaccine and the risk of incident acute myocardial infarction or stroke. In an editorial, Madjid and Musher Article discuss complexities in evaluating the effects of vaccines on clinical outcomes.

Azithromycin therapy is recommended for patients with cystic fibrosis and chronic Pseudomonas aeruginosa infection. In a multicenter, placebo-controlled trial, Saiman and colleagues assessed whether treatment with azithromycin for 24 weeks improves lung function and reduces pulmonary exacerbations in children and adolescents with cystic fibrosis who are not infected with P aeruginosa. The authors report that compared with placebo, treatment with azithromycin was not associated with improvement in pulmonary function during the 24-week trial. In an exploratory analysis, azithromycin treatment was associated with a reduction in pulmonary exacerbations.

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Readmission after hospitalization for heart failure is common; however, whether early physician follow-up after hospital discharge can reduce hospital readmission is not known. In an analysis of Medicare claims and data from 2 registries of patients hospitalized with heart failure, Hernandez and colleagues examined the association between outpatient follow-up within 7 days of hospital discharge and hospital readmission within 30 days. The authors found that 21.3% of patients had hospital readmissions within 30 days of discharge. However, among hospitals with higher rates of follow-up within 1 week of discharge, the risk of 30-day readmission was lower.

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New data on gastric cancer are reported in 2 articles in this issue. Anderson and colleagues Article analyzed US cancer data from 1977 through 2006 and found that the incidence rate of noncardia gastric cancer declined among all race and age groups except for whites aged 25 to 39 years, among whom the incidence increased. In the second article, investigators with the Global Advanced/Adjuvant Stomach Tumor Research International Collaboration Group Article report results of a meta-analysis of individual patient data from 17 randomized trials of adjuvant chemotherapy for resectable gastric cancer. The investigators found that patients who received postoperative chemotherapy had a greater survival benefit than patients treated with surgery alone. In an editorial, Shah and Ajani Article discuss the heterogeneous nature of gastric cancer.

In a systematic review of the literature, van der Windt and colleagues found that among adult patients who present to primary care physicians with chronic abdominal symptoms, 2 serum antibody tests—IgA antitissue transglutaminase antibody and IgA antiendomysial antibody—have high sensitivity and specificity for diagnosing celiac disease.

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“Whether spoken or unspoken, disclosure . . . , I feared, would evoke mixed reactions.” From “Disclosure.”

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New research suggests that attempting to reduce cardiovascular risks in certain patients by aggressively treating high lipid levels and hypertension offers no benefit over standard treatment and may even increase harm.

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Implementing accountable care organizations

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History and health reform implementation

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Join Roger Chou, MD, Wednesday, May 19, from 2 to 3 PM eastern time to discuss predicting whether low back pain may become persistent and disabling. To register, go to http://www.ihi.org/AuthorintheRoom.

How would you counsel a 42-year-old man with hypercholesterolemia who is considering whether to drink alcohol to improve his cardiovascular health? Go to www.jama.com to read the case, and submit your response, which may be selected for online publication. Submission deadline is May 23.

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 stomach cancer.

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