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This Week in JAMA | November 28, 2012|

This Week in JAMA FREE

JAMA. 2012;308(20):2059. doi:10.1001/jama.2012.3348.
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HEART FAILURE THERAPY AND RISK OF MORTALITY

Two articles in this issue address associations between heart failure therapies and mortality. In an analysis of registry data from 5887 patients hospitalized with heart failure and reduced ejection fraction, Hernandez and colleagues found that patients who initiated aldosterone antagonist therapy at hospital discharge had lower rates of heart failure readmission, and similar rates of all-cause mortality and cardiovascular readmissions as patients not treated with aldosterone. Lund and colleagues analyzed prospective registry data from 16 216 patients with heart failure and preserved ejection fraction and found that use of renin-angiotensin system antagonists was associated with lower rates of all-cause mortality. In an editorial, Fang discusses the implications of these findings for the treatment of heart failure.

WARFARIN AFTER BIOPROSTHETIC AORTIC VALVE PLACEMENT

The appropriate duration of anticoagulation therapy after bioprosthetic aortic valve replacement is not clear. Mérie and colleagues analyzed data from 4075 patients who had bioprosthetic aortic valve replacement surgery and found that warfarin discontinuation within 3 months of surgery was associated with an increased risk of stroke, thromboembolic complications, and cardiovascular death and found that discontinuation between 3 and 6 months of surgery was associated with an increased risk of cardiovascular death. In an editorial, Mehta and Weitz discuss anticoagulation after bioprosthetic aortic valve implantation.

5-DOSE DTAP SERIES AND PERTUSSIS, CALIFORNIA, 2010

California has experienced a resurgence of pertussis despite high diphtheria, tetanus, and acellular pertussis vaccine (DTaP) coverage. In a case-control study involving children who were aged 4 to 10 years and living in 15 California counties in 2010, Misegades and colleagues examined the association between pertussis and receipt of the 5-dose DTaP series. The authors found that cases—children who had or were suspected of having pertussis—were less likely to have received all 5 doses of DTaP and that the odds of pertussis increased as the time since last DTaP dose lengthened. In an editorial, Shapiro discusses reasons for an apparent resurgence of pertussis.

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CLINICIAN'S CORNER MANAGEMENT OF GOUT

The incidence of gout is increasing, and comorbid conditions present patient management challenges. Using the case of Mr R, a 57-year-old man with a history of podagra, hyperuricemia, and mild renal insufficiency, Shmerling discusses the diagnosis of gout, treatment of acute attacks, and prevention of recurrent episodes.

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JAMA CLINICAL CHALLENGE

Three months after travel in Asia and the Middle East, a patient with a history of diabetes presented with a painful, fluctuant neck mass. Outpatient incision and drainage were scheduled and empirical oral clindamycin initiated. Eight days later he returned with worsening neck pain. What would you do next?

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MEDICAL NEWS & PERSPECTIVES

New research suggests that using UV light to disinfect hospital rooms and that decolonizing patients in intensive care units who carry methicillin-resistant Staphylococcus may help reduce hospital-acquired infections.

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VIEWPOINTS

Sherley v Sebelius: the future of stem cell research

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Linking physician performance with payment

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Medical documentation in the electronic era

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Centralized conflict of interest disclosure

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A PIECE OF MY MIND

“The EMR created Virtual Tommy, and within the medical home model, with its emphasis on non–face-to-face interactions, he flourished.” From “Virtual Grief.”

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AUTHOR IN THE ROOM TELECONFERENCE

Join Laura N. Gitlin, PhD, and coauthors December 19 from 2 to 3 PM eastern time to discuss nonpharmacologic management of behavioral symptoms in dementia. To register, go to http://www.ihi.org/AuthorintheRoom.

EDITOR'S AUDIO SUMMARY

Dr Gaziano summarizes and comments on this week's issue. Go to www.jama.com

JAMA PATIENT PAGE

For your patients: Information about gout.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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