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This Week in JAMA |

This Week in JAMA FREE

JAMA. 2005;293(19):2315. doi:10.1001/jama.293.19.2315.
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GLUTEN INTRODUCTION AND CELIAC DISEASE AUTOIMMUNITY

Despite near universal exposure to gluten-containing wheat products, only a small percentage of susceptible individuals develop celiac disease, suggesting other factors are involved. Norris and colleaguesArticle collected dietary information for children at increased risk of celiac disease to determine whether the timing of dietary gluten introduction is related to development of celiac disease autoimmunity (CDA). They found that children with gluten exposure in the first 3 months of life or after 6 months had a significantly increased risk of CDA compared with children exposed to gluten at 4 to 6 months of age. In an editorial, FarrellArticle discusses the complexities of infant dietary practices and celiac disease risk.

THROMBOPHILIA AND RECURRENT VENOUS THROMBOSIS

The contribution of clinical factors, including thrombophilia, to the risk of recurrent thrombotic events is unclear. From follow-up of patients participating in the Leiden Thrombophilia Study, Christiansen and colleagues estimated the venous thrombosis recurrence rate and investigated associated factors. The incidence rate of recurrence was 25.9/1000 patient-years and was highest in the first 2 years after initial thrombosis. Factors associated with recurrence included male sex, idiopathic vs provoked first thrombosis, and use of oral contraceptives. Prothrombotic abnormalities, such as factor V Leiden or elevated levels of clotting factors, did not appear to play an important role in recurrence risk.

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CITATION IMPACT AND STUDY DESIGN

Two measures of the importance of information in the health sciences are the design of the study from which the information derives and the citation index of the article, but little is known about the relative citation impact of articles using different study designs. Patsopoulos and colleagues determined the citation count for 2646 articles representing various study designs that were published in 1991 and 2001. They found that meta-analyses received more citations than other types of study design. In 2001, randomized controlled trials were the second most cited study design and the citation impact of epidemiological studies declined compared with 1991, consistent with proposed hierarchies of evidence.

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SEPSIS ASSOCIATED WITH DOXORUBICIN PLUS DOCETAXEL

Brain and colleagues report serious adverse events leading to premature termination of a multicenter randomized trial comparing the effectiveness of doxorubicin plus docetaxel with doxorubicin plus cyclophosphamide as adjuvant chemotherapy for breast cancer. Women in the doxorubicin-docetaxel group had a significantly increased risk of febrile neutropenia (40.8% vs 7.1% in the doxorubicin-cyclophosphamide group); 2 women died and 1 required surgery for perforative peritonitis. Of 87 serious adverse events, 72 occurred in the doxorubicin-docetaxel group, the majority of which were associated with febrile neutropenia.

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NEONATAL EFFECTS OF IN UTERO SRI EXPOSURE

Knowledge of neonatal risks from late in utero exposure to serotonin reuptake inhibitors (SRIs) is important to guide maternal therapy during pregnancy and neonate care after delivery. Moses-Kolko and colleagues reviewed published evidence of neonatal symptoms associated with in utero exposure to SRIs. They review the associated signs and suggest strategies to prevent or treat the SRI-induced neonatal syndrome.

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A PIECE OF MY MIND

“The tears continue. What does she see? What does she know? Does she understand?” From “Saying Good-bye.”

MEDICAL NEWS & PERSPECTIVES

Despite the fact that 1 in 4 children and adolescents has a problem with sleep that warrants a physician’s attention, such problems often

PATIENT SAFETY

Leape and Berwick discuss progress and yet-to-be-realized improvements in patient safety 5 years after release of the report To Err Is Human.

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CLINICIAN’S CORNER

The Rational Clinical Examination
Accuracy and reliability of symptoms and examination findings in patients with suspected stroke or transient ischemic attack.

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COMMENTARY

The case of Theresa Marie Schiavo.

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JAMA PATIENT PAGE

For your patients: Information about celiac disease.

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