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JAMA. 2001;285(22):2823. doi:10.1001/jama.285.22.2823.
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TGF-Β1 GENE POLYMORPHISM AND BREAST CANCER RISK

Evidence suggests that increased expression of transforming growth factor β1 (TGF-β1) may decrease susceptibility to cancer. As part of the Study of Osteoporotic Fractures, a prospective study of white, community-dwelling women aged 65 years or older, Ziv and colleaguesArticle studied the association between breast cancer risk and the T→C transition at nucleotide 29 of the TGF-β1 gene, which is associated with increased serum levels of TGF-β1. The C/C genotype at nucleotide 29 was associated with a markedly reduced risk of breast cancer compared with the T/C and T/T genotypes. In an editorial, ArmstrongArticle discusses ways to improve the conduct and interpretation of genetic epidemiological studies of cancer risk.

ESTIMATING STROKE RISK IN PATIENTS WITH ATRIAL FIBRILLATION

Recommendations for antithrombotic therapy for patients with atrial fibrillation vary depending on the estimated risk of stroke. Gage and colleagues combined 2 existing stroke-risk classification schemes (the Atrial Fibrillation Investigators scheme and the Stroke Prevention and Atrial Fibrillation scheme) to form a new stroke risk index, CHADS2, and assessed the predictive accuracy of all 3 schemes using data from a registry of Medicare beneficiaries hospitalized with atrial fibrillation. The CHADS2 index assigned 1 point each for the presence of congestive heart failure, hypertension, age 75 years or older, and diabetes mellitus, and 2 points for history of stroke or transient ischemic attack. All 3 classification schemes predicted ischemic stroke better than chance, but the CHADS2 index was the most accurate predictor.

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QUALITY IMPROVEMENT WITH ACHIEVABLE BENCHMARKS

An achievable benchmark is a performance standard for a specific indicator of care, such as the proportion of eligible patients receiving influenza vaccine, based on the average performance for the top 10% of physicians being assessed. Kiefe and colleagues randomly assigned physicians to receive a multimodal quality improvement intervention (control group) or the quality improvement intervention plus achievable benchmark feedback for 5 process of care quality indicators. Improvement in physician performance was significantly greater in the achievable benchmark feedback group compared with the control group for 3 of the 5 quality measures.

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ADVANCE CARE PLANNING AMONG PERSONS WITH HIV

The prognosis for persons infected with the human immunodeficiency virus (HIV) has improved substantially, but many persons infected with HIV will die from the infection, and advance care planning is still needed. Wenger and colleagues interviewed a nationally representative sample of persons infected with HIV about end-of-life discussions with physicians, advance directive use, and willingness to tolerate future adverse health states. Of the 2864 study participants, 50% had discussed some aspect of end-of-life care with their health care practitioner, and only 38% had completed an advance directive. Blacks and Latinos reported discussing end-of-life care issues less frequently than whites, and patients infected with HIV via injection drug use and patients with less education reported less frequent communication with physicians about end-of-life issues. The most important predictor of advance directive completion was whether the practitioner had discussed the topic.

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APOLIPOPROTEIN E ∊4 AND SLEEP-DISORDERED BREATHING

Apolipoprotein E, a protein involved in lipid metabolism, has 3 major allelic variants. The ∊4 allele has been associated with an increased risk of Alzheimer disease and cardiovascular disease. Among middle-aged adults participating in a longitudinal study of sleep disorders, Kadotani and colleagues found that the prevalence of moderate-to-severe sleep-disordered breathing was significantly higher among adults with ApoE ∊4, and the severity of sleep-disordered breathing increased as the number of ∊4 alleles that an individual carried increased.

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CONTEMPO UPDATES

Advances in schizophrenia genetics research.

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MEDICAL NEWS & PERSPECTIVES

Successful trials of a drug designed to counter genetic mutations responsible for 2 forms of cancer portend a wave of novel therapies that will transform the way cancer is treated, said researchers at the recent American Society of Clinical Oncology meeting.

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HRT AND NONVERTEBRAL FRACTURES

In this meta-analysis of randomized trials of hormone replacement therapy (HRT)Article, estrogen therapy significantly reduced the risk of nonvertebral fractures, particularly among women younger than 60 years. In an editorial, Grady and CummingsArticle examine the validity of the evidence.

COPING RESPONSES AT THE END OF LIFE

The story of Mr N, a 77-year-old man with metastatic pancreatic cancer, illustrates common psychological concerns and coping responses of patients with life-threatening illnesses and how physicians can assess and address the psychological concerns and emotional distress of patients at the end of life.

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JAMA PATIENT PAGE

For your patients: Information about sleep apnea.

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