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This Week in JAMA
December 13, 2006

This Week in JAMA

JAMA. 2006;296(22):2651. doi:10.1001/jama.296.22.2651
Prostate Cancer and Survival in Elderly Men

Whether treatment of localized prostate cancer is beneficial for men 65 years and older is not clear. Wong and colleaguesArticle report results of a population-based observational cohort study that assessed survival in men aged 65 to 80 years who had low-risk or intermediate-risk prostate cancer and who chose treatment (radiation therapy or radical prostatectomy) vs observation. During a 12-year follow-up period, the authors found that men who received treatment had significantly longer survival than those who did not. In an editorial, Litwin and MillerArticle discuss the limitations of observational data for comparing treatment outcomes and the importance of individualized, patient-specific recommendations for prostate cancer management.

Hospital Performance Measures and Mortality Rates

Hospital performance on process of care measures are reported on publicly accessible Web sites and monitored for accreditation and other purposes. However, whether hospital performance correlates with or predicts hospital quality and better patient outcomes is unresolved. In a cross-sectional study of 3657 acute care hospitals, Werner and BradlowArticle assessed the relationship of 10 performance measures in the care of patients with acute myocardial infarction, heart failure, and pneumonia to the hospitals' condition-specific risk-adjusted mortality rates. Comparing high-performing hospitals with low-performing hospitals, the authors found only small differences in hospital risk-adjusted mortality rates. In a commentary, HornArticle discusses issues involved in research examining the relationship between performance measures and clinical outcomes.

C-Reactive Protein Polymorphisms and CVD Events

Elevated levels of C-reactive protein (CRP) are associated with an increased risk of cardiovascular disease (CVD) events, but whether CRP has a role in CVD pathogenesis is uncertain. In an analysis of data from the Cardiovascular Health Study, a prospective study of white participants and black participants 65 years and older at baseline, Lange and colleagues investigated whether polymorphisms in the CRP gene are associated with plasma CRP levels, carotid intima-media thickness (CIMT), and CVD events. The authors identified CRP gene polymorphisms that were associated with increased and decreased levels of plasma CRP and risks of myocardial infarction or stroke but none that were related to CIMT.

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Changes in Financial Burden for Health Care

To assess the financial burden of increasing health care costs on families, Banthin and Bernard analyzed nationally representative data from 1996 and 2003 for civilian, noninstitutionalized persons younger than 65 years and calculated out-of-pocket expenditures for health care. The authors estimate that in 2003, 48.8 million individuals lived in families that incurred total out-of-pocket health care expenditures (including insurance premiums) exceeding 10% of family income, an increase of 11.7 million persons since 1996. Of these individuals, 18.7 million had health expenditures exceeding 20% of family income, an increase of 7.3 million persons since 1996. The authors identified factors associated with having a high financial burden for health care.

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A Piece of My Mind

“I knew the medicine dripping into my veins was going to make me feel bad, very bad, for weeks at a time.” From “Taking My Poison.”

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Medical News & Perspectives

The conclusion from a large multicenter study that the risk of miscarriage following amniocentesis is far lower than previously believed may reassure physicians and their patients and lead to increased prenatal screening.

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CLINICIAN'S CORNER

In a meta-analysis of data from randomized clinical trials that compared folic acid supplementation with placebo or usual care in persons with preexisting vascular disease, no beneficial effect of folic acid supplementation on the risk of cardiovascular disease (CVD) or all-cause mortality was found.

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PGD of Hereditary Cancer

Regulatory, ethical, and social issues associated with preimplantation genetic diagnosis (PGD) of hereditary cancer syndromes.

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Author in the Room Teleconference

Join Louise C. Walter, MD, on December 20, 2006, from 2 to 3 PM eastern time to discuss PSA screening among elderly men with limited life expectancy. To register, go to http://www.ihi.org/AuthorintheRoom.

JAMA Patient Page

For your patients: Information about folic acid.

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