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This Week in JAMA
March 16, 2011

This Week in JAMA

JAMA. 2011;305(11):1061. doi:10.1001/jama.2011.323

Some patients have high levels of platelet reactivity while taking clopidogrel, which places them at increased risk of cardiovascular events. In a randomized trial that enrolled patients with high on-treatment platelet reactivity after percutaneous coronary intervention (PCI) and drug-eluting stent placement, Price and colleagues Article compared the effects of 6 months of high-dose vs standard-dose clopidogrel therapy on a composite outcome that included cardiovascular death, nonfatal myocardial infarction, and stent thrombosis. The authors found no difference in the incidence of the composite outcome among patients who received high- vs standard-dose clopidogrel therapy. In an editorial, Gurbel and Tantry Article discuss the study findings and current investigations of personalized antiplatelet therapy.

California has led the nation in using public policies to reduce cigarette smoking. In an analysis of 1965-2007 data from adult respondents to 2 population-based surveys, Pierce and colleagues assessed smoking intensity patterns over time and by birth cohort for residents of California and the rest of the nation. Among their findings were that the population prevalence of smoking 20 or more cigarettes per day declined significantly between 1965 and 2007, the prevalence of smoking 10 or more cigarettes per day declined across successive birth cohorts, and declines in both measures of smoking intensity were greater in California than the rest of the nation.

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In an analysis of 2007 data from fee-for-service Medicare beneficiaries, Welch and colleagues examined the relationship between diagnosis frequency of 9 serious chronic conditions and case-fatality rates across 306 hospital referral regions. The authors found an inverse relationship between the regional diagnosis frequency and the case-fatality rate for the chronic conditions examined.

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Some observational data suggest there is an association between levels of serum phosphorus, parathyroid hormone (PTH), and calcium and the risks of cardiovascular disease and death among patients with chronic kidney disease (CKD). Clinical practice guidelines recommend specific treatment targets for these biomarkers of bone and mineral disorders. Palmer and colleagues Article assessed the quality of evidence for these associations in a systematic review and meta-analysis and concluded that the evidentiary basis for a strong, consistent, and independent association between serum calcium and parathyroid hormone levels and the risk of death and cardiovascular events among patients with CKD disease is poor. However, they did find an association between higher serum phosphorus levels and mortality. In an editorial, Kestenbaum Article discusses disturbances in mineral metabolism in CKD and the need for placebo-controlled clinical trials to assess whether treatment can improve clinical outcomes.

Rubinow and Hirsch discuss factors that can produce variability in the hemoglobin A1c assay and alternative methods of assessing glycemic control.

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“How could it happen that Kerry, with so much love in his life and such a bright future ahead, ended his life this way?” From “Time to Reconsider.”

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Scientists are seeking better ways to prevent influenza infections by improving the speed of influenza vaccine production and boosting the vaccine's effectiveness.

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Physician communication: to talk or to text?

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Improving informed consent in clinical care

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Evidence, statistical association, and causation

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Join Monica Morrow, MD, Wednesday, April 20, from 2 to 3 PM eastern time to discuss whether women with invasive breast cancer and sentinel node metastasis should or should not have axillary dissection. To register, go to http://www.ihi.org/AuthorintheRoom.

How would you manage a 61-year-old woman with an unprovoked venous thromboembolism? Go to www.jama.com to read the case, and submit your response, which may be selected for online publication. Submission deadline is April 3.

For your patients: Information about colonoscopy.

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