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This Week in JAMA |

This Week in JAMA FREE

JAMA. 2008;299(5):489. doi:10.1001/jama.299.5.489.
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CANNABIS SMOKING AND PERIODONTAL DISEASE

ADVERSE EVENTS ASSOCIATED WITH STOPPING CLOPIDOGREL

Current guidelines recommend that patients hospitalized for acute coronary syndrome receive clopidogrel therapy for at least a month and up to a year. To determine whether patients are at increased short-term risk for adverse events when clopidogrel therapy is stopped, Ho and colleagues calculated rates of all-cause mortality or acute myocardial infarction in a retrospective cohort of patients with acute coronary syndrome who were treated either medically or with percutaneous coronary intervention and discharged with clopidogrel. The authors found a higher incidence of death and acute myocardial infarction during the initial 90 days after stopping clopidogrel than in later 90-day periods.

ENDOSCOPIC STAGING OF SUSPECTED LUNG CANCER

Disease staging with mediastinoscopy is recommended for patients with suspected lung cancer, but less invasive methods of staging would be preferable. In a study of 138 consecutive patients with suspected lung cancer, Wallace and colleagues compared the diagnostic accuracy of 3 methods of minimally invasive endoscopic staging (and combinations thereof). The authors found that endobronchial ultrasound-guided fine-needle aspiration (EBUS-FNA) was more sensitive than blind transbronchial needle aspiration (69% vs 36%, respectively), and the combination of EBUS-FNA and transesophageal endoscopic ultrasound-guided fine-needle aspiration had the highest estimated sensitivity (93%; 95% confidence interval, 81%-99%) for detection of lymph node involvement.

CAROTID PLAQUE COMPOSITION AND RESTENOSIS

A number of patient and lesion-related factors are associated with restenosis following carotid endarterectomy, but little attention has been focused on the histology of the initial atherosclerotic plaque. In the Athero-Express study, carotid plaques from patients undergoing primary carotid endarterectomy were examined histologically, and the patients had duplex ultrasound examinations 1 year after surgery to assess carotid artery restenosis. Hellings and colleagues report that patients whose plaques demonstrated low macrophage infiltration and a small or absent lipid core were at increased risk of restenosis compared with patients whose plaques were inflammatory and lipid rich.

CLINICIAN'S CORNER
CHRONIC ABDOMINAL PAIN

Ms C is a 32-year-old woman who has a 1-year history of epigastric pain and pressure that occur daily, last several hours, and are associated with early satiety and feelings of nausea. Lacy and Cash discuss the epidemiology, pathophysiology, diagnosis, and treatment of functional dyspepsia.

A PIECE OF MY MIND

“Although many have commented on the demise of the art of medicine in our increasingly technologically driven field, I would argue that never before has it been so important.” From “The Interpreter of Facts.”

MEDICAL NEWS & PERSPECTIVES

Although a number of organizations and companies are working to accelerate the use of electronic medical records, affordability, privacy concerns, and other unresolved issues are slowing widespread adoption by hospitals, physicians, and patients.

COMMENTARIES

Rethinking pandemic flu advice

Strengthen quality improvement research

End tobacco use in mental health facilities

HEALTH OF THE NATION
CALL FOR PAPERS

Authors are encouraged to submit manuscripts for an upcoming JAMA theme issue.

READERS RESPOND

How would you manage a 74-year-old man who has moderate daily alcohol use, memory loss, and progressive neuropathy? Go to www.jama.com to read the case and submit your response. Your response may be selected for online publication. Submission deadline is February 27.

JAMA PATIENT PAGE

For your patients: Information about periodontal disease.

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