This Week in JAMA FREE

Soy foods contain isoflavones—natural estrogen receptor modulators with both estrogen-like and antiestrogenic properties. To assess the association of soy isoflavone intake with breast cancer recurrence or survival, Shu and colleagues Article analyzed data from the population-based Shanghai Breast Cancer Survival Study and found that soy food intake was inversely associated with both outcomes. In an editorial, Article Ballard-Barbash and Neuhouser discuss the issues in the design and interpretation of studies on health behaviors and breast cancer outcomes.

Cluster headache is characterized by excruciating and frequent headache clusters that may last for weeks or months. Triptans are commonly prescribed, but frequent dosing is not recommended. In a randomized crossover trial, Cohen and colleagues found that inhalation of high-flow (12 L/min) 100% oxygen at symptom onset was more likely to result in pain absence at 15 minutes than placebo high-flow air inhalation.

Statistically reliable measurements of physician performance require that physicians see a sufficient number of patients in a specific disease group—a potentially unachievable expectation of individual primary care physicians. In an analysis of 2005 Medicare data, Nyweide and colleagues Article examined whether primary care physicians in the same practice can collectively see sufficient Medicare patients to detect a meaningful difference between practices on several established measures of quality and cost. The authors found that relatively few primary care practices were large enough to detect a 10% difference in performance. In an editorial, Berwick Article discusses ways to improve the measurement of physician quality and performance.

In an analysis of data from a national registry of patients undergoing percutaneous coronary intervention, Tsai and colleagues assessed the risks associated with 2 antithrombotic medications—eptifibatide and enoxaparin—that undergo renal clearance and are contraindicated for use in patients undergoing dialysis. The authors report that 22.3% of patients undergoing dialysis received contraindicated antithrombotic medication, which was associated with a modestly increased risk of in-hospital bleeding but not in-hospital death.

Infants with severe T-cell lymphopenia often appear normal at birth and have no family history of immunodeficiency; however, their long-term prognosis is improved if the diagnosis of immunodeficiency is made early in life. In an analysis of DNA extracted from dried blood spots on newborn screening cards, Routes and colleagues found that quantification of small episomal pieces of DNA—T-cell receptor excision circles—can identify newborns with T-cell lymphopenia.

A 24-year-old man with a personal and family history of heart failure and dilated cardiomyopathy seeks genetic counseling for family planning purposes. Judge discusses screening, genetic testing, and counseling of patients at risk for inherited cardiomyopathies.

“[Katie] has become used to sitting in her mother's lap while she waits to see another oncologist, in another clinic, in another hospital, in the vain hope that her life can be saved.” From “Don't Touch Me.”

The risks associated with antidepressant use or untreated depression during pregnancy complicate treating depression.

Artificially sweetened beverages: cause for concern

Treatment of sickle cell pain

Eliminating “waste” in health care

Call for Papers

Authors are invited to submit manuscripts for a JAMA theme issue.

Join Laura Esserman, MD, MBA, Wednesday, December 16, from 2 to 3 PM eastern time to discuss screening for breast cancer and prostate cancer. To register, go to http://www.ihi.org/AuthorintheRoom.

How would you manage a 43-year-old man with exertional nausea, elevated troponin levels, and lateral ST depression on ECG? Go to www.jama.com, read the case, and submit a response by January 3. It may be selected for online publication.

For your patients: Information about cluster headache.