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This Week in JAMA
February 1, 2012

This Week in JAMA

JAMA. 2012;307(5):431. doi:10.1001/jama.2012.69

Among many women diagnosed with breast cancer, breast conservation surgery (partial mastectomy) is often the initial treatment. However, reexcision to achieve an appropriate tumor-free margin is often necessary, and variability in the reexcision rate across institutions or surgeons may reflect quality of care. In an analysis of data from 2206 women with invasive breast cancer who underwent partial mastectomy at 4 institutions between 2003 and 2008, McCahill and colleagues assessed hospital and surgeon-specific variation in reexcision rates following partial mastectomy. The authors report that 23% of the women underwent reexcision, and they found substantial surgeon and institutional variation in reexcision rates that could not be explained by patients' clinical characteristics. In an editorial, Morrow and Katz discuss quality measures for breast cancer surgery.


Performance measures, particularly those linked to pay for performance, may have unintended consequences for safety-net institutions, which care for a disproportionate share of Medicaid and uninsured patients. In an analysis of data from 396 hospitals participating in the 2008 National Hospital Ambulatory Care Survey, Fee and colleagues assessed emergency department (ED) compliance with proposed length-of-stay measures for admitted and discharged patients. The authors found that compliance with the proposed ED length-of-stay measures did not differ between safety-net and non–safety-net hospitals. In an editorial, Emerman discusses challenges, opportunities, and risks associated with reporting of ED length of stay.


Two articles in this issue report estimates of the current prevalence of obesity and trends in obesity and body mass index (BMI) among children, adolescents, and adults in the United States based on analyses of data from successive cycles (1999-2010) of the National Health and Nutrition Examination Surveys. Ogden and colleagues report that the prevalence of obesity in children and adolescents was 16.9% in 2009-2010, which reflects no change compared with 2007-2008. However, a trend analysis indicated a significant increase in obesity prevalence in boys (but not girls) between 1999 and 2010. In a second article, Flegal and colleagues report that the prevalence of adult obesity in 2009-2010 was 35.5% among men and 35.8% among women—findings that do not differ significantly from 2003-2008 estimates of obesity among US adults.


Ms K, a 14-year-old with a BMI of 40, has been struggling to lose weight since age 8. She has experienced peer harassment related to her obesity, and there is significant tension between Ms K and her parents about her eating habits and progressive weight gain. In this Clinical Crossroads article, Ludwig discusses childhood obesity, medical and psychosocial consequences of obesity, treatment challenges, and parenting strategies to promote long-term behavior change.


Implementing a patient-centered care model that respects the patient's values and preferences will require physicians to be better trained in communicating with patients.


Physician medical identity theft


Newborn genomic screening: hazards and challenges


Specialization in medicine: how much is appropriate?


“The children of physicians, especially in the 1950s, could be forgiven for feeling a bit smug. Doctors were then held in maximum regard, and that reverence spilled over to their offspring.” From “A Doctor's Kid.”


Join George A. Bray, MD, Wednesday, February 15, from 2 to 3 PM eastern time to discuss the effect of dietary protein content on weight. To register, go to http://www.ihi.org/AuthorintheRoom.

Dr Bauchner summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

Dr A, a primary care physician with 30 years’ experience, moved from a small to a large practice. He is frustrated by the focus on quality improvement for populations of patients rather than individuals. What would you advise him on current and future quality improvement initiatives? Go to www.jama.com to read the case. Submission deadline is March 4.

For your patients: Information about prostatitis.