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This Week in JAMA
JAMA. 2007;297:2317.
Folic Acid for Prevention of Colorectal Adenomas
Epidemiological studies have suggested that folate supplementation may prevent colorectal neoplasia. In the Aspirin/Folate Polyp Prevention Study, participants who had a history of colorectal adenoma were randomly assigned to receive 1 mg/d of folic acid or placebo and separately randomized to receive aspirin (81 or 325 mg/d) or placebo. Two follow-up colonoscopies were performed at 3 years and at 6 or 8 years. Cole and colleagues (SEE ARTICLE) report the trial results related to folic acid supplementation. The investigators found that 1 mg/d of folic acid did not reduce the risk of colorectal adenomas and may be associated with an increased risk of colorectal and other neoplasias. In an editorial, Ulrich and Potter (SEE ARTICLE) discuss the relationship of the timing of folate administration to cancer progression and objectives for future research.
Mutations in Hereditary Diffuse Gastric Cancer
Germline mutations in the epithelial cadherin (CDH1) gene are found in 30% to 40% of families with hereditary diffuse gastric cancer (HDGC). Kaurah and colleagues (SEE ARTICLE) assessed the frequency and penetrance of mutations in the CDH1 gene in 38 families with HDGC to determine whether recurring mutations were a result of independent (chance) mutational events or common ancestry. The authors report 13 different mutations in 15 of the 38 families, which could be linked to both independent mutational events and common ancestry. A potential founder mutation was identified in 4 families from Newfoundland. In an editorial, Kangelaris and Gruber (SEE ARTICLE) discuss clinical implications of these findings for HDGC families and the contributions and limits of current methods of gene sequencing to detect deleterious mutations.
Outcomes of Pay for Performance in Acute MI
Financial incentives to hospitals to increase adherence to performance measures have been advanced as a way to improve quality. Glickman and colleagues report results of an external evaluation of a Centers for Medicare & Medicaid Services (CMS) pay-for-performance pilot project in which they compared trends in cardiac care and outcomes among hospitals that were or were not part of the CMS project. In an analysis of data from 105 383 patients with acute non–ST-segment elevation myocardial infarction (MI), the authors found no evidence that hospitals participating in the pay-for-performance program had improved outcomes on a composite measure of 6 rewarded therapies for acute MI, had improved in-hospital mortality rates, or had adversely affected processes of care not subject to the financial incentives.
(SEE ARTICLE)
Rectal Administration of Artemisinin for Malaria
In a systematic review of studies assessing the pharmacokinetics, efficacy, and safety of rectally administered artemisinin derivatives for severe malaria, Karunajeewa and colleagues found that the 4 available drugs appear to be safe and promptly clear malaria parasites. However, they found marked interindividual variability in drug bioavailability.
(SEE ARTICLE)
CLINICIAN'S CORNER
Dementia Screening
The Rational Clinical Examination
Diagnosing cognitive impairment can be challenging, particularly during the limited time allotted for a typical primary care visit. Holsinger and colleagues report results of a literature review of the accuracy and practicality of brief tests to screen patients for dementia in primary care encounters.
(SEE ARTICLE)
A Piece of My Mind
"I can no longer hear one of my favorite sounds of growing up: rain hitting the roof while I lay in bed going to sleep." From "The Sounds of Silence."
(SEE ARTICLE)
Medical News & Perspectives
The deadly shooting rampage at Virginia Polytechnic Institute and State University has thrust into the spotlight questions about how the mental health care of college and university students is being monitored.
(SEE ARTICLE)
Pesticide Testing
Ethics of pesticide toxicity testing in human subjects.
(SEE ARTICLE)
Author in the Room Teleconference
Join Steven R. Steinhubl, MD, on June 20, 2007, from 2 to 3 PM eastern time to discuss the role of aspirin dosage on the prevention of cardiovascular disease. To register, go to http://www.ihi.org/AuthorintheRoom.
Audio Commentary
Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl
JAMA Patient Page
For your patients: Information about dementia.
(SEE ARTICLE)
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