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This Week in JAMA
July 4, 2012

This Week in JAMA

JAMA. 2012;308(1):9. doi:10.1001/jama.2012.3078

Patients with immune-mediated diseases are at increased risk of herpes zoster (HZ). Despite this risk, the HZ vaccine is not recommended for patients with immune-mediated diseases who are receiving immunosuppressive medications due to concern that these individuals may develop varicella infection from the vaccine virus strain. In a retrospective cohort study of 463 541 Medicare beneficiaries with selected immune-mediated diseases, Zhang and colleagues found that among patients exposed to immune-modulating therapy, receipt of HZ vaccine was not associated with a short-term (within 42 days) increase in HZ incidence and was associated with a reduced risk of HZ over a median 2 years' follow-up.


In an analysis of data from all US Department of Defense (DOD) TRICARE beneficiaries eligible for care in 2005-2010—representing more than 56 million individuals of all ages and including both nonactive and active duty personnel—Landrum and colleagues assessed incidence rates of community-onset and hospital-onset Staphylococcus aureus infections. Among the authors' findings were that annual rates of both community-onset and hospital-onset methicillin-resistant S aureus (MRSA) bacteremia have decreased in parallel since 2005, while rates of community-onset skin and soft tissue MRSA infections have declined more recently.


To examine the association between a health center's rating as a patient-centered medical home (PCMH) and health center operating costs, Nocon and colleagues analyzed 2009 survey data from administrators of 669 nationally representative federally funded health centers and health center cost data from the Uniform Data System reports. Based on the administrator survey data, the authors used the Safety Net Medical Home Scale to assign a PCMH score to each center. The authors found that higher scores—indicating better performance—were associated with higher health center operating cost. In an editorial, Reid and Larson discuss the financial implications of PCMHs and their place in health care system reform.


Some veterans are eligible to enroll simultaneously in a Medicare Advantage plan and the Veterans Affairs (VA) health care system, which could result in duplicate federal spending for their health care. In an analysis of VA and Medicare Advantage health plan data (2004-2009) from more than 1.2 million dual-enrolled veterans, Trivedi and colleagues found a substantial and increasing amount of potentially duplicative federal spending for individuals who were dual enrolled in the 2 separate managed care programs.


A 76-year-old woman developed delirium after undergoing a colectomy and again 3 months later following surgery to close an ileostomy. Marcantonio discusses the diagnosis, prevention, and treatment of postoperative delirium.


Programs to provide housing for chronically homeless individuals are demonstrating that such efforts can dramatically cut public costs.


Battered-child syndrome: 50 years later


Reporting child abuse


Expert testimony in “shaken baby” cases


“I discovered that I had an emotional reaction that went beyond the physical and the pain.” From “How I Ended Up Watching Myself.”


The JAMA Network Journals


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

Join Peter B. Bach, MD, MAPP, and George T. O’Connor, MD, Wednesday, July 18, from 2 to 3 pm eastern time to discuss the benefits and harms of computed tomographic screening for lung cancer. To register, go to http://www.ihi.org/AuthorintheRoom.

For your patients: evaluating possible infections in early infancy.