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In This Issue of JAMA |

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JAMA. 2013;310(4):341-343. doi:10.1001/jama.2013.5222.
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Physicians’ Views About Controlling Health Care Costs

In a 2012 survey of 3897 randomly selected US physicians to assess physicians’ perceived roles and responsibilities in addressing health care costs, Tilburt and colleagues found that the responding physicians accepted some responsibility to address health costs, but they were more likely to assign major cost-reduction responsibility to other groups including, insurers, trial lawyers, hospitals and health systems, pharmaceutical and device manufacturers, and patients. The respondents expressed general agreement with several quality initiatives to reduce costs but reported less enthusiasm for cost-containment involving changes in payment models, such as eliminating fee-for-service payment. In an Editorial, Emanuel and Steinmetz discuss why physicians must take the lead in controlling health care costs.

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Racial Differences in Breast Cancer Survival

Racial disparities in breast cancer survival are recognized but poorly understood. In an analysis of population-based data from more than 29 000 Medicare beneficiaries diagnosed with breast cancer between 1991 and 2005 (7373 black women and 3 sets of 7375 white women matched on demographics, patient and tumor presentation characteristics, and treatment), Silber and colleagues found that differences in 5-year survival appear primarily related to presentation characteristics rather than differences in subsequent treatment. In an Editorial, Mandelblatt and colleagues discuss factors contributing to racial differences in breast cancer care and outcomes.

Related Editorial

Racoon Rabies Transmission via Organ Transplantation

In 2013, a kidney transplant recipient with no known relevant exposures died of rabies 18 months after the transplant. Vora and colleagues investigated the case and found that in retrospect the donor’s clinical presentation was consistent with rabies. Raccoon rabies virus was detected in archived brain tissue from the donor, and gene sequencing confirmed transplant as the route of transmission to the decedent. Three additional organ recipients were asymptomatic and without rabies virus–specific antibodies. In an Editorial, Kaul discusses donor-derived central nervous system infections in organ recipients.

Related Editorial

Kidney Stones and Risk of Coronary Heart Disease

Kidney stone disease is common, and some reports suggest an association with systemic diseases, including cardiovascular disease. To investigate the association between a history of kidney stones and the risk of coronary heart disease, Ferraro and colleagues analyzed data from 3 large prospective cohort studies that involved a total of 242 105 participants, 19 678 of whom had a history of kidney stones. The authors report that during 24 years of follow-up in men and 18 years in women, 16 838 incident cases of coronary heart disease occurred. In analyses adjusted for potential confounders, the authors found that a history of kidney stones was associated with a modest increased risk of coronary heart disease in women but not men.


Complicated Grief

Ms T is a 60-year-old woman whose husband died 9 months after being diagnosed with stage IV esophageal cancer. She and her husband had no children and they were inseparable through 28 years of marriage. In the 16 months since his death, Ms T has found it very hard to resume her daily life; she feels lost, and her grief is profound. In this Clinical Crossroads article, Simon summarizes findings from a systematic review of the literature on complicated grief, including associated risk factors, identification and clinical assessment, differential diagnosis, and treatment approaches.


Severe Intractable Postprandial Chest Pain

A patient with a 3-year history of chest pain and odynophagia reports recent exacerbation of symptoms and significant weight loss. Esophageal manometry reveals high swallowing pressures. A barium swallow was diagnostic. What would you do next?



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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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