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Pain and depression among patients with cancer are often unrecognized, undertreated, or both. In a randomized trial that enrolled geographically dispersed patients with cancer-related depression, pain, or both, Kroenke and colleagues assessed the effects of centralized telephone-based care management by a nurse-physician team combined with home-based automated symptom monitoring by voice recording or Internet on pain and depression severity. The authors report that compared with patients who were randomly assigned to receive usual care, those who received the telecare management intervention experienced greater improvement in pain and depression during the 12-month trial.
Survivors of childhood cancer are at greater risk of premature mortality than the general population. In an analysis of data from the population-based British Childhood Cancer Survivor Study, Reulen and colleagues assessed cause-specific mortality and absolute excess mortality risk among 17 981 survivors of childhood cancers diagnosed between 1940 and 1991. The authors found that excess mortality from second primary cancers and circulatory disease persisted more than 25 years after a childhood cancer diagnosis.
In an analysis of data from a national end-stage renal disease (ESRD) registry, O’Hare and colleagues examined regional variation in the treatment of ESRD in a cohort of 41 420 adults aged 65 years or older who started chronic dialysis or received a kidney transplant between June 1, 2005, and May 31, 2006. The authors found substantial regional differences in the treatment of ESRD in older adults—including whether treatment was received from a nephrologist before ESRD onset, the use of peritoneal dialysis vs hemodialysis, discontinuation of hemodialysis before death, and receipt of hospice care—that were not explained by differences in patient characteristics at the time of ESRD diagnosis.
In a nationally representative survey of physicians, DesRoches and colleagues Article assessed physicians' beliefs, preparedness, and experience related to colleagues who are impaired or incompetent to practice medicine. The authors found that 64% of respondent physicians support the professional commitment to report impaired colleagues to a relevant authority. However, a substantial majority of physicians reported not being prepared to deal effectively with such colleagues, and when faced with an impaired or incompetent colleague, many did not follow through on the obligation to make a report. In an editorial, Wynia Article discusses the fundamental essence of self-regulation to medical professionalism and the role of external regulatory mechanisms.
A very small minority of patients infected with human immunodeficiency virus (HIV) remain clinically well without antiretroviral therapy. Migueles and Connors review clinical features and possible mechanisms underlying nonprogressive HIV infection and discuss their potential relevance to the design of an HIV/AIDS vaccine and immune-based therapies.
“Even as I tried to calmly deliberate the options in front of me, I could feel my objectivity slipping further away, only to be replaced with a terrified patient who was quickly losing the ability to think straight.” From “The Hike.”
Scientists are attempting to develop better tools for early identification of individuals at risk for developing schizophrenia, as well as interventions to help prevent the disorder in such at-risk persons.
Lifestyle medicine competencies
Learning accountability for patient outcomes
Checklists and guidelines
Regulating radiation exposure from medical imaging
Updated ICMJE conflict of interest reporting form
How would you manage a 29-year-old woman with flulike symptoms? Go to www.jama.com to read the case, and submit your response, which may be selected for online publication. Submission deadline is August 8.
For your patients: Information about kidney failure.
Theme Issue on HIV/AIDS
This Week in JAMA . JAMA. 2010;304(2):127. doi:10.1001/jama.2010.952
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