This Week in JAMA FREE

In the randomized European Study Group for Pancreatic Cancer (ESPAC)-3 trial, which assessed whether 6 months of adjuvant treatment with fluorouracil plus folinic acid or gemcitabine is superior in terms of overall survival following complete resection of pancreatic adenocarcinoma, Neoptolemos and colleagues Article found no survival advantage among patients who received gemcitabine compared with patients who received fluorouracil. In an editorial, O’Reilly Article discusses established and investigational adjuvant therapy for pancreatic cancer.

Nevirapine—used to prevent mother-to-child human immunodeficiency virus (HIV) transmission—has been associated with selection of drug-resistant viral mutations, and therefore, it is recommended that nevirapine-exposed infants be switched to protease inhibitor (PI)–based therapy. Given the limitations of indefinite use of PI-based regimens in young children, Coovadia and colleagues assessed whether reuse of nevirapine would be as effective as a PI-based regimen (ritonavir-boosted lopinavir) in maintaining viral suppression in a randomized trial that enrolled nevirapine-exposed children who had achieved viral suppression on the initial PI-based regimen. At the 1-year follow-up, the authors found lower rates of viremia (defined as >50 copies/mL) among children who were switched to nevirapine than among children who continued on the PI-based regimen.

In an analysis of data from a population-based active surveillance study of influenza cases in Wisconsin, Belongia and colleagues compared clinical characteristics of pandemic 2009 influenza A(H1N1) with illnesses caused by other influenza A strains. Among the authors' findings were that individuals with 2009 H1N1 infection were younger than those with 2007-2008 (H3N2) infection (median age, 10 years and 25 years, respectively) and that the risk of most serious complications was not elevated among adults or children infected with 2009 H1N1 compared with other recent seasonal influenza A strains.

A rapid increase in multiresistant pneumococcal serotype 19A has been observed coincident with widespread implementation of heptavalent pneumococcal conjugate vaccination (PCV-7) of infants. In a post hoc analysis of data from a randomized placebo-controlled trial of the effect of PCV-7 on pneumococcal carriage, van Gils and colleagues found that compared with unvaccinated controls, infants who received PCV-7 vaccination at 2, 4, and 11 months (a 2 + 1-dose schedule) had increased nasopharyngeal acquisition of pneumococcal serotype 19A in the first 2 years of life.

In an analysis of data from a large academic primary care network, Hong and colleagues investigated the relationship between patient panel characteristics and physician quality rankings that were based on an aggregate of 9 commonly used Health Plan Employer and Data Information Set measures. The authors found that patient panels with greater proportions of underinsured, minority, and non–English-speaking patients were associated with lower physician quality rankings. Adjustment for differences in panel characteristics resulted in significant reclassification of physicians.

“Surgeons are blessed with steady hands for a reason: They reduce the trembling in the hands of worried family members, counteract pain and destruction, and alter creation for the better by fixing fault and disease within the body.” From “The Hands That Guide Me.”

Advances in preventing HIV infection and concerns about faltering funding in the developing world were focal points at the XVIII International AIDS Conference.

From the Archives Journals

A June Archives of Ophthalmology article reported that visual acuity screening was effective in detecting clinically significant myopia but not hyperopia or astigmatism in a random sample of 12-year-old children. Bradfield discusses vision screening programs.

Public reporting of hand hygiene

Health effects of the Gulf oil spill

Genetic data and medical records

Do IRBs protect research participants?

Call for Papers

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

For your patients: Information about pancreatic cancer.