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This Week in JAMA
April 7, 2010

This Week in JAMA

JAMA. 2010;303(13):1227. doi:10.1001/jama.2010.401

In a retrospective cohort analysis of Medicare claims data, Deyo and colleagues Article examined trends in lumbar spinal stenosis surgery and the association of complications, postoperative mortality, and resource use with surgical complexity. The authors found that the frequency of complex fusion procedures increased, while the rates of decompression and simple fusion procedures decreased from 2002 to 2007. Compared with decompression, fusion procedures were associated with increased risk of major complications, 30-day mortality, and resource use. In an editorial, Carragee discusses Article reasons for the increased rate of complex fusion procedures.

Methotrexate therapy induces remission in patients with juvenile idiopathic arthritis (JIA), but little is known about the relationship between treatment duration and disease flares. Foell and colleagues randomly assigned patients whose JIA was in clinical remission while taking methotrexate to continue methotrexate therapy for either 6 months or 12 months. The investigators report that no difference in relapse rate or time to relapse existed among patients receiving methotrexate for 12 vs 6 months.

Some studies have suggested that obese patients may receive lower quality care. In an analysis of Medicare and Veterans Health Administration beneficiary data, Chang and colleagues assessed whether performance on 8 common outpatient quality measures—related to diabetes care, adult vaccinations, and cancer screening—differed by patient weight status. The authors found no evidence that obese or overweight patients were less likely to receive recommended care than normal-weight patients.

Fibrosis is common in renal allografts and is associated with allograft dysfunction and failure. In 2 independent cohorts of kidney transplant donor-recipient pairs, Moore and colleagues examined the association of genetic variation in caveolin-1 (CAV1)—a cell membrane-associated inhibitor of tissue fibrosis—with transplant outcome. The authors report that the presence of a specific single-nucleotide polymorphism in the CAV1 gene (rs4730751) in kidney donors was associated with an increased risk of allograft failure.

To provide population-based estimates of acute care utilization and rehospitalizations among patients with sickle cell disease, Brousseau and colleagues analyzed 2005 and 2006 emergency department and inpatient databases from 8 states that together account for 33% of the US population with sickle cell disease. The authors found that patients averaged 2.59 (95% confidence interval, 2.53-2.65) encounters per year, with the highest use among 18- to 30-year-olds and patients with public insurance.

In a systematic review of prospective studies of patients with low back pain of less than 8 weeks' duration, Chou and Shekelle determined factors that predicted the development of persistent disabling symptoms, including maladaptive pain coping behaviors, nonorganic signs, high functional impairment, low general health status, and psychiatric comorbidities.

“The true problems of health care are overwhelmed by fear—and presented with no small amount of histrionics accented by the drama of television.” From “One Vote for Death Panels.”

The world's largest radiation oncology society and the US Food and Drug Administration are launching initiatives aimed at improving the safety of medical radiation.

Multiple comorbidities: the 21st-century challenge

Health reform at the bedside

White coat diplomacy

Eugene O’Neill, tuberculosis, and transformation

Join Mary E. Tinetti, MD, Wednesday, April 21, from 2 to 3 PM eastern time to discuss the evaluation of and treatment for patients who fall. To register, go to http://www.ihi.org/AuthorintheRoom.

For your patients: Information about juvenile idiopathic arthritis.