This Week in JAMA
Detection of Cervical Cancer Precursors
In a cluster randomized trial involving participants in a cervical cancer screening program, Siebers and colleagues (ARTICLE) assessed the accuracy of liquid-based cytology compared with conventional Papanicolaou (Pap) test cytology to detect histologically confirmed cervical intraepithelial neoplasia. The authors report that liquid-based cytology was neither more sensitive nor more specific than conventional Pap tests for the detection of cervical cancer precursors. In an editorial, Schiffman and Solomon (ARTICLE) discuss the role of cytology in current and future cervical cancer prevention strategies.
Cardiometabolic Risk of Antipsychotics
Correll and colleagues (ARTICLE) assessed the association of 12-week treatment with aripiprazole, olanzapine, quetiapine, or risperidone with body composition and metabolic parameters in a cohort of antipsychotic-naive youth aged 4 to 19 years. The authors report that all 4 medications were associated with significant weight gain and variable adverse effects on lipid levels and other metabolic parameters. In an editorial, Varley and McClellan (ARTICLE) discuss the implications of these findings for the care of children and adolescents with serious psychiatric illness.
Geographic Access to Burn Care Facilities
In an analysis of national census, air medical transport, and street network databases, Klein and colleagues examined geographic access to verified burn care facilities in the United States. The authors found that nearly 80% of the US population lives within 2 hours by ground transport or helicopter transport of a verified burn center; however, there is significant regional variation in geographic proximity to a burn center.
CLINICIAN'S CORNER
Mortality Among Patients Starting Dialysis
Cardiovascular mortality is often considered the main cause of death among patients receiving dialysis. In an analysis of causes of death among European patients starting dialysis, de Jager and colleagues found that dialysis patients have an increased risk of death compared with the general population. During the first 3 years of dialysis, patients experienced similar risks of cardiovascular and noncardiovascular death.
Pancreatic Cancer in Families With Lynch Syndrome
Lynch syndrome—an inherited cause of colorectal cancer—has been associated with a number of extracolonic tumors. To assess the risk of pancreatic cancer in Lynch syndrome, Kastrinos and colleagues examined cancer histories from 147 families with germline mismatch repair gene mutations characteristic of Lynch syndrome and found that the lifetime risk of developing pancreatic cancer was increased compared with the US population.
DNA Aβ42 Trimer Immunization for Alzheimer Disease
To assess the effectiveness and safety of a potential therapy for Alzheimer disease (AD), Lambracht-Washington and colleagues compared the immune response after immunization with DNA β-amyloid1-42 (Aβ42) trimer or Aβ42 peptide in a mouse model. The authors report that the DNA Aβ42 trimer immunization protocol resulted in potentially effective Aβ42 peptide antibody levels with a low potential to cause brain inflammation—an adverse effect seen in a prior clinical trial of an Aβ42 peptide vaccine for AD.
A Piece of My Mind
“Beyond the clinical interview and physical examination is a simple connection between two human beings. Empathic statements are instruments we use to acknowledge the other's humanity.” From “A Gift of Time.”
Medical News & Perspectives
The US Food and Drug Administration is intensifying efforts to bring swift action against clinical researchers who falsify data or who fail to follow regulations intended to protect human research participants.
Commentaries
Health care choice in the United States and Canada
Honoring patient-centered care
Reform of continuing medical education
Author in the Room Teleconference
Join Michael S. Krasner, MD, November 18, 2009, from 2 to 3 PM eastern time to discuss the association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. To register, go to http://www.ihi.org/AuthorintheRoom.
Readers Respond
How would you care for a 66-year-old man with an abdominal aortic aneurysm? Go to www.jama.com to read the case, and submit your response, which may be selected for online publication. Submission deadline is November 8.
