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In This Issue of JAMA
March 17, 2015

Highlights

JAMA. 2015;313(11):1077-1079. doi:10.1001/jama.2014.11637
Research

In a prior analysis, the Dual Antiplatelet Therapy (DAPT) study investigators found that among 9961 study participants who underwent coronary artery stenting with placement of a drug-eluting stent, aspirin and thienopyridine use beyond 12 months resulted in reductions in stent thrombosis and major adverse cardiac and cerebrovascular events (MACCE). In this article, Kereiakes and colleagues report that among the 1687 DAPT study participants who received a bare metal stent and tolerated 12 months of thienopyridine, random assignment to continue thienopyridine (vs placebo) for an additional 18 months did not result in statistically significant differences in stent thrombosis, MAACE, or moderate or severe bleeding.

Continuing Medical Education

Approximately 1.6 million women in the United States have breast biopsies each year with subsequent treatment management dependent on the pathology diagnosis. In a study that involved 115 pathologists from 8 states who independently interpreted a test set of breast biopsies, Elmore and colleagues sought to quantify the magnitude of diagnostic agreement between the pathologists’ diagnosis and a consensus panel reference diagnosis for each case. The authors report that overall concordance between the pathologists’ interpretations and the reference diagnoses was 75.3%. In an Editorial, Davidson and Rimm discuss implications of the study findings for patients, clinicians, and pathologists.

Editorial

Author Video Interview

In an analysis of data from 8634 patients with colorectal cancer and 8553 matched controls of European descent, Nan and colleagues tested gene-by-environment interactions between regular use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) and single-nucleotide polymorphisms (SNPs) in relation to colorectal cancer risk. The authors found an association between use of aspirin or NSAIDs and lower risk of colorectal cancer risk that differed according to genetic variation at 2 SNPs on chromosomes 12 and 15. In an Editorial, Wender discusses gene-environment interactions and risk if colorectal cancer.

Editorial

To assess whether early spine imaging improves outcomes among older adults with back pain, Jarvik and colleagues analyzed prospective data from patients aged 65 years or older with a new primary care visit for low back pain without radiculopathy. Patients who underwent early imaging (within 6 weeks of the index visit; n=1523) were propensity score-matched with patients who did not. The authors found that early imaging was not associated with less pain or disability at 1-year follow-up.

Author Audio Interview

Clinical Review & Education

In this From The JAMA Network article, Friedman discusses 3 articles published in JAMA Psychiatry that report new data regarding risk factors for military suicides from the Army Study to Assess Risk and Resilience in Servicemembers. He highlights insights from the study that can inform new approaches to improve mental health and prevent suicide among military personnel.

This JAMA Clinical Guidelines Synopsis article by Bird and Davis summarizes the 2014 US Preventive Services Task Force guideline for abdominal aortic aneurysm screening in asymptomatic adults. The guideline supports 1-time screening with ultrasonography for men aged 65 to 75 years who have ever smoked. There is inadequate evidence to support screening in women.

An elderly man presented with a diffuse rash and intractable pruritus of several months’ duration. Twenty years ago he was diagnosed with dermatitis herpetiformis; however, he reported treatment with sulfapyridine and dapsone was of limited benefit. He also reported having chronic diarrhea that improved with a gluten-free diet. Physical examination revealed widely distributed grouped papules and vesicles and extjensive excoriations. What would you do next?

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