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This Week in JAMA
October 22/29, 2003

This Week in JAMA

JAMA. 2003;290(16):2095. doi:10.1001/jama.290.16.2095
Mammography in the United States and United Kingdom

Mammography screening in the United States differs from that in the United Kingdom in a variety of ways, including clinical setting, ages of women screened, interval between screening examinations, and follow-up of suspicious findings. Smith-Bindman and colleagues compared outcomes of screening mammography in the 2 countries and found that rates of recall for further diagnostic evaluation and rates of open surgical biopsy that did not result in a breast cancer diagnosis were approximately twice as high in the United States as in the United Kingdom, but breast cancer detection rates were similar.

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Psychosocial Factors and Risk of Hypertension

Evidence on the association between psychosocial factors and risk of hypertension has been inconsistent. Yan and colleaguesArticle analyzed data from the Coronary Artery Risk Development in Young Adults study, a population-based, prospective study of adults aged 18 to 30 years, to examine the role of 5 psychosocial factors—hostility, time urgency/impatience, achievement striving/competitiveness, depression, and anxiety—on long-term risk of hypertension. Of these factors, time urgency/impatience and hostility were associated with increased 15-year risk of hypertension. In an editorial, Williams and coauthorsArticle discuss biobehavioral mechanisms and gene-environment interactions that mediate the influence of psychosocial factors on the development and course of cardiovascular disease.

Efficacy of Gefitinib in Non–Small Cell Lung Cancer

Gefitinib is an oral drug that inhibits the epidermal growth factor receptor (EGFR), a cell-signaling mediator involved in cancer cell growth, proliferation, and metastasis, by blocking EGFR tyrosine kinase. Kris and colleagues conducted a randomized trial to compare 250-mg and 500-mg daily doses of gefitinib among patients with stage IIIB or IV non–small cell lung cancer persisting after at least 2 regimens of chemotherapy. Rates of disease-related symptom improvement, radiographic tumor regression, and projected 1-year survival were not significantly different in the 2 dosage groups.

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Long-term Effects of Intensive Diabetes Treatment

In the Diabetes Control and Complications Trial (DCCT), a randomized trial comparing intensive treatment of type 1 diabetes with conventional treatment, participants in the intensive treatment group were exposed to lower glycemic levels over an average of 6.5 years than were participants who received conventional treatment. At the end of the DCCT, participants were followed up in the Epidemiology of Diabetes Interventions and Complications (EDIC) Study, and all participants were encouraged to use intensive treatment. Although glycemic levels during the EDIC study no longer differed substantially between the 2 original treatment groups, the Writing Team for the DCCT/EDIC Research Group report that significantly fewer participants in the previous intensively treated group developed microalbuminuria, clinical albuminuria, or hypertension during the 7 to 8 years of the EDIC study.

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Survival After Common Bile Duct Injury

Flum and colleagues analyzed data from Medicare claims to determine the population-level risk of death after common bile duct injury during cholecystectomy. Mortality risk during the 9.2-year follow-up was significantly higher among patients with a common bile duct injury than among patients without a common bile duct injury. Survival after common bile duct injury improved when the bile duct repair was performed by a different, more experienced surgeon than the one who performed the cholecystectomy.

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Medical News & Perspectives

Virtual reality technology is finding a niche in medicine for the treatment of patients with phobias and other conditions and for physician training.

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Killip Class and Acute Coronary Syndromes

Analysis of data from 4 large clinical trials indicates that the Killip classification, which stratifies risk according to the presence and severity of heart failure in patients with acute myocardial infarction, is a powerful independent predictor of all-cause mortality in patients with non–ST-elevation acute coronary syndromes.

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CLINICIAN'S CORNER

Mrs B, a 60-year-old woman with persistent atrial fibrillation, is considering undergoing elective cardioversion followed by antiarrhythmic therapy. Singer discusses the epidemiology and natural history of atrial fibrillation and risks and benefits of anticoagulation therapy and cardioversion.

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JAMA Patient Page

For your patients: Information about type 1 diabetes.

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