This Week in JAMA

JAMA. 2010;303(16):1569 (doi:10.1001/jama.2010.497)

http://jama.ama-assn.org/cgi/content/full/303/16/1569
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 THIS WEEK IN JAMA
APRIL 28, 2010
A Piece of My Mind
“What was his bedside manner like?
Was he curious about interesting
cases? How did he feel about the
power of medicine to change people’s
lives? I had no answers for these ques-
tions.” From “Nana’s Words.”
SEE PAGE 1577
Medical News
& Perspectives
Widespread off-label prescribing of
antipsychotic drugs continues despite
serious concerns about the drugs’
metabolic and cardiac risks.
SEE PAGE 1582
Commentary
Patient-centered medical homes: why
now?
SEE PAGE 1644
Author in the Room
Teleconference
Join Roger Chou, MD, Wednesday,
May 19, from 2 to 3 PM eastern time
to discuss predicting whether low back
pain may become persistent and dis-
abling. To register, go to http://www.ihi
.org/AuthorintheRoom.
Readers Respond
How would you counsel a 42-year-old
man with hypercholesterolemia who is
considering whether to drink alcohol to
improve his cardiovascular health? Go
to www.jama.com to read the case, and
submit your response, which may be se-
lected for online publication. Submis-
sion deadline is May 23.
Audio Commentary
Dr DeAngelis summarizes and com-
ments on this week’s issue.
www.jama.com
JAMA Patient Page
For your patients: Information about
older drivers and cognitive impairment.
SEE PAGE 1660
©2010 American Medical Association. All rights reserved.
Downloaded from www.jama.com at HINARI on May 10, 2010
B-Vitamin Therapy and Diabetic Nephropathy
Patients with diabetic nephropathy often have high plasma homocysteine levels. In a
randomized placebo-controlled trial, House and colleagues assessed whether high doses
of B-vitamin therapy—an intervention known to lower homocysteine levels—could slow
the progression of diabetic nephropathy. During a mean (SD) 31.9 (14.4) months of
follow-up, the authors found that compared with placebo, high doses of B vitamin were
associated with lower levels of homocysteine but a more rapid decline in renal function
and higher rates of myocardial infarction and stroke.
SEE PAGE 1603
Coronary Artery Calcium Score and Risk Prediction
The coronary artery calcium score has been shown to be associated with the risk of
future coronary heart disease (CHD) events. In an analysis of data from the Multi-Ethnic
Study of Atherosclerosis—a population-based cohort without known cardiovascular dis-
ease at baseline—Polonsky and colleagues found that adding the coronary artery cal-
cium score to a prediction model based on traditional risk factors improved the classifica-
tion of incident CHD risk and placed more individuals in the most extreme risk
categories. In an editorial, Ioannidis and Tzoulaki define characteristics of clinically useful
predictors of disease risk and discuss whether the coronary artery calcium score is ready
for routine use.
SEE PAGE 1610 AND EDITORIAL ON PAGE 1646
Hematopoietic Stem Cell Transplantation
To assess current global use of hematopoietic stem cell transplantation, Gratwohl and
colleagues from the Worldwide Network for Blood and Marrow Transplantation ana-
lyzed data from a retrospective survey representing patients who received transplants in
2006 at 1327 centers in 71 participating countries. The authors found significant differ-
ences in transplant rates between countries and continental regions by indication and
donor type. They also report macroeconomic factors including gross national income,
governmental health care expenditures, and transplant team density that were associ-
ated with transplant rates.
SEE PAGE 1617
Cancer Imaging Among Medicare Beneficiaries
Dinan and colleagues analyzed nationally representative Medicare claims for beneficia-
ries diagnosed with breast, colorectal, lung, or prostate cancer; leukemia; or non-
Hodgkin lymphoma in 1999 through 2006 to assess changes in the use and cost of diag-
nostic imaging. The authors report that conventional radiograph rates decreased or
remained the same during the period of study, whereas the use of other imaging tech-
niques increased significantly and outpaced total cancer costs to Medicare.
SEE PAGE 1625
CLINICIAN’S CORNER
The Older Driver With Cognitive Impairment
Care of the Aging Patient
Mr W is a 92-year-old retired college professor who lives with his wife in a community
with little public transportation. He reports some memory loss and has greater difficulty
determining driving routes. Recent neuropsychological testing is consistent with mild
cognitive impairment. Carr and Ott summarize the literature on dementia and driving
and discuss evidence-based assessment of fitness-to-drive and physicians’ legal and ethi-
cal obligations. A commentary by Eby and Molnar discusses the role of physicians in
evaluating patients’ fitness to drive.
SEE PAGES 1632 AND 1642
(Reprinted) JAMA, April 28, 2010—Vol 303, No. 16 1569