This Week in JAMA FREE

In a multicenter prospective study that enrolled women with early-stage (T1 or T2 node-negative) breast cancer, Giuliano and colleagues Article assessed the prevalence and significance of sentinel lymph node or bone marrow micrometastases detected with immunochemical staining but not seen with routine pathological or clinical examination. Patients were followed up for a median 6.3 years, and the authors found that occult metastases were not associated with decreased overall survival when clinicopathological factors were considered. In an editorial, Merkow and Ko Article discuss the importance of experimental and observational studies to inform evidence-based surgical practice.

Previously, Hack and colleagues reported that 8-year-olds who were born at extremely low-birth-weight (ELBW) had higher rates of chronic conditions than children who were born at normal-birth-weight. In this issue, they report that between the ages of 8 and 14 years, the rates of chronic conditions overall, and asthma specifically, did not change, but the rate of obesity increased among the ELBW children. Compared with children of normal-birth-weight, rates of many chronic conditions were higher among the ELBW children, but there were no significant differences in rates of asthma or obesity.

Medicare Part D has been associated with increased use of prescription medications and reduced out-of-pocket costs; however, whether Medicare Part D affects nondrug medical spending is not clear. McWilliams and colleagues explored this question in an analysis of national survey data and linked Medicare claims from 2004-2007. The authors found that Medicare Part D implementation was associated with significant differential reductions in nondrug medical spending—particularly for acute and postacute care—among beneficiaries with limited prior drug coverage.

Barrett esophagus is believed to be a precursor of esophageal adenocarcinoma. Orloff and colleagues assembled several patient cohorts to identify risk alleles or mutated genes associated with the 2 diseases. The authors found germline mutations in 3 genes (MSR1, ASCC1, and CTHRC1) in approximately 11% of the patients studied. They report that MSR1 was significantly associated with Barrett esophagus and esophageal adenocarcinoma in both the derivation and validation samples.

Many physicians lack formal training in the evaluation of patients' medical decision-making capacity. Sessums and colleagues discuss characteristics of valid, reliable, and clinically useful tools for assessing and documenting a patient's capacity for medical decision making.

“Meeting [Jaylon’s] eyes as I slid the heavy tome off his wrist, I felt a moment of male bonding, unspoken, knowing ‘We did it!’ and ‘It worked!’ Well, I think it worked.” From “Throwback.”

A new tool to help primary care physicians determine whether patients with depression are in remission focuses on feelings of well-being rather than the absence of depression symptoms.

Dietary supplement regulation

Physician stewardship of health care

International health comparisons

Organ transplantation in China

Join Ross Zafonte, DO, Wednesday, August 17, from 2 to 3 PM eastern time to discuss sports-related concussion in adolescents. To register, go to http://www.ihi.org/AuthorintheRoom.

Dr Bauchner summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

Should a healthy 42-year-old man at low risk of HIV infection undergo screening? Read the case at www.jama.com. Submit your response by August 7 for possible online posting.

Theme Issue on Violence and Human Rights

For your patients: Information about tension-type headache.