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This Week in JAMA |

This Week in JAMA FREE

JAMA. 2001;285(21):2681. doi:10.1001/jama.285.21.2681.
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JAMA-EXPRESS: RAMIPRIL VS AMLODIPINE AND HYPERTENSIVE RENAL DISEASE

The African American Study of Kidney Disease and Hypertension is an ongoing trial to compare the effects of 3 drugs—ramipril, amlodipine, and metoprolol—and 2 blood pressure goals on the progression of hypertensive renal disease in African American patients. The amlodipine treatment arm was terminated early due to safety concerns. In this analysis comparing the ramipril and amlodipine groups, Agodoa and colleaguesArticle report that among patients with baseline urine protein to creatinine ratio greater than 0.22 (urinary protein excretion greater than about 300 mg/d), the glomerular filtration rate (GFR) decline over 3 years was significantly slower in the ramipril group. The risk of the composite end point of GFR decline, end-stage renal disease, or death was significantly less in patients treated with ramipril. In an editorial, PapademetriouArticle discusses treatment of hypertension in patients with hypertensive nephrosclerosis.

PROTECTIVE EFFECT OF HDL CHOLESTEROL AGAINST STROKE

Elevated levels of high-density lipoprotein cholesterol (HDL-C) have been associated with reduced risk of coronary artery disease. To evaluate whether increased HDL-C levels are protective against ischemic stroke, Sacco and colleagues analyzed data from the Northern Manhattan Stroke Study, an incident case-control study in an elderly, multiethnic population. Overall, high levels of HDL-C (35 mg/dL or greater) were associated with a reduced risk of ischemic stroke. In subgroup analyses, the association between elevated HDL-C levels and reduced risk of ischemic stroke was significant among participants aged 75 years or older and was present among different racial and ethnic groups.

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OUTCOMES AFTER HOSPITALIZATION FOR HIP FRACTURE

Risk-adjusted outcomes have been used to assess the effectiveness and quality of care for a variety of clinical conditions. In this study of patients hospitalized with hip fracture at 4 hospitals, Hannan and colleagues used medical record data and information from interviews with patients and their proxies to develop models to predict functional status (locomotion) and mortality 6 months after hospitalization. Significant predictors of 6-month mortality included low prefracture locomotion, paid helper at home prior to fracture, and higher modified APACHE score; significant predictors of locomotion status included prefracture locomotion, age, and nursing home residence prior to fracture. Adjustment for baseline patient characteristics altered interhospital differences in outcomes, and the performance of 2 of the 4 hospitals differed for functional status and mortality outcomes.

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Α-GALACTOSIDASE REPLACEMENT THERAPY FOR FABRY DISEASE

Fabry disease is a rare X-linked recessive glycosphingolipid storage disorder without a specific treatment. It is caused by deficiency of the lysosomal enzyme α-galactosidase A that results in accumulation of globotriaosylceramide in a variety of cells, including endothelial, vascular smooth muscle, renal epithelial, and dorsal root ganglia neuronal cells. In this trial, Schiffman and colleagues found that patients with Fabry disease and neuropathic pain who received infusions of α-galactosidase A had significantly greater reductions in the severity of neuropathic pain and improvements in pain-related quality of life than patients who received placebo. Renal pathology, renal function, and cardiac conduction also improved in the α-galactosidase A group, and body weight increased.

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CANCER SCREENING IN ELDERLY PATIENTS

Walter and CovinskyArticle present a framework to guide cancer screening decisions in older patients that starts with quantitative estimates of life expectancy, risk of cancer death, and screening outcomes, and includes a qualitative consideration of the benefits and harms of cancer screening based on a patient's unique values and preferences. In an editorial, WelchArticle discusses the downsides of cancer screening and illustrates the difficulty of communicating information that patients need to make an informed choice.

A PIECE OF MY MIND

"The opportunity to reveal this part of their past, to uncover the recollections seared into their minds, and to recall the memories of their murdered loved ones seems to have strengthened the bonds of our patient-physician relationship." From "The List."

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MEDICAL NEWS & PERSPECTIVES

To reduce the number of suicides in the United States—approximately 30 000 deaths per year—Surgeon General David Satcher recently released the nation's first coordinated suicide prevention strategy.

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STROKE IN A HEALTHY 46-YEAR-OLD MAN

Mr R presented with headache, weakness of the left side of his face and left arm, and a right-sided Horner syndrome. Magnetic resonance imaging showed an infarction in the right frontal-parietal region, and cerebral angiography showed the underlying cause.

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TULAREMIA AS A BIOLOGICAL WEAPON

This fifth article in the series of consensus statements from the Working Group on Civilian Biodefense discusses medical and public health management after the use of tularemia as a bioweapon.

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JAMA PATIENT PAGE

For your patients: Information about low bone density and hip fracture.

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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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