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This Week in JAMA
December 1, 2010

This Week in JAMA

JAMA. 2010;304(21):2323. doi:10.1001/jama.2010.1741

Some data suggest that omega-3 polyunsaturated fatty acids may be a safe and effective treatment option for patients with atrial fibrillation (AF). In a randomized, placebo-controlled, multicenter trial that enrolled patients with documented symptomatic paroxysmal or persistent AF and no structural heart disease, Kowey and colleagues assessed the efficacy and safety of pure prescription formulation high-dose (4 g/d) omega-3 fatty acids for the prevention of recurrent symptomatic AF. The authors report that compared with placebo, prescription omega-3 did not reduce the recurrence of symptomatic AF.

Active surveillance is an alternative to initial surgical or radiation treatment of patients with low-risk clinically localized prostate cancer, but long-term outcomes and the effect on quality of life have not been well characterized. Hayes and colleagues Article report results of a decision analysis that examined the quality-adjusted life expectancy of active surveillance compared with initial treatment (defined as radical prostatectomy, radiation therapy, or brachytherapy) in hypothetical cohorts of 65-year-old men with newly diagnosed and clinically localized low-risk prostate cancer. The authors found that active surveillance was a reasonable approach; however, the optimal strategy was highly dependent on individual patient preferences for surveillance or treatment. In an editorial, Thompson and Klotz Article discuss active surveillance as an option for men with low-risk prostate tumors.

Maintenance therapies for antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis are limited by partial efficacy and toxicity. In an open-label, multicenter randomized trial, Hiemstra and colleagues Article tested the hypothesis that mycophenolate mofetil is more effective than azathioprine for preventing disease relapse. Patients were followed up for a median of 39 months, and the authors found that mycophenolate mofetil was less effective than azathioprine for maintaining remission in patients with ANCA-associated vasculitis. In an editorial, Hoffman Article discusses research advances and therapeutic interventions for systemic vasculitis.

Some reports have suggested that mitochondrial dysfunction and altered energy metabolism may play a role in autism. In an exploratory study involving 10 children with confirmed autism and 10 age-matched, genetically unrelated and neurotypically developing children, Giulivi and colleagues assessed mitochondrial function and mitochondrial DNA abnormalities in peripheral blood lymphocytes. The authors report that children with autism were more likely to have mitochondrial dysfunction and mitochondrial DNA overreplication and deletions than typically developing children.

Multiple myeloma is preceded by precursor states of monoclonal gammopathy of undetermined significance (MGUS) and smoldering myeloma. Landgren and Waxman present the case of a 72-year-old man who has an 11-year history of MGUS and recent progression to multiple myeloma. They discuss current understanding of myeloma precursor disease, risk stratification, and clinical management of patients—including the potential for developing treatment strategies to delay or prevent progression to multiple myeloma.

“[T]he exploration was mine to undertake. I was the one to balance a greater prospect of cure against the risk of earlier death.” From “Decisions, Decisions.”

Successful health reform will require nurses to play a larger role in the health care system, including taking on greater leadership responsibilities, according to a report from the Institute of Medicine.

Addressing food insecurity

Outcomes-based health care: a view from the United Kingdom

VA rules change: trauma documentation and PTSD

Join Julia Neily, RN, MS, MPH, and James P. Bagian, MD, Wednesday, December 15, from 2 to 3 PM eastern time to discuss implementation of a medical team training program and surgical mortality. 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 multiple myeloma.