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JAMA. 2007;297(23):2557. doi:10.1001/jama.297.23.2557.
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FAMILY STRUCTURE AND PREDICTION OF

In the identification of appropriate candidates for genetic cancer risk assessment, an individual's risk may be masked by small family size. Wietzel and colleaguesArticle assessed whether BRCA mutations are more prevalent among single cases of early onset breast cancer in families with limited (fewer than 2 first- or second-degree female relatives surviving beyond 45 years in either the maternal or paternal lineage) vs adequate family structure and evaluated the performance of several currently available risk assessment probability models. The authors found that the probability of a BRCA mutation was greater when family structure was limited vs adequate, and commonly used models for estimating BRCA mutation probability were insensitive to family structure as a predictive factor. In an editorial, Kauff and OffitArticle discuss the role of genetic risk assessment-models in the evaluation of patients with cancer.

COVERED DRUGS IN MEDICARE PART D FORMULARIES

Medicare Part D formularies vary widely, which can result in clinicians unknowingly prescribing drugs that are either not covered or require a high co-payment. Tseng and colleagues reviewed Part D formularies in California and Hawaii to determine how often 75 drugs in 8 treatment classes were “widely covered” by 90% or more of formularies at co-payments of $35 or less without prior authorization. The authors report that coverage for the 75 drugs ranged from 7% to 100% (mean, 69%). With the exception of angiotensin II receptor blockers, each drug class was represented by 1 or more widely covered drugs at a low co-payment in each formulary. Ninety-four percent of widely covered drugs were generic.

MALARIA CONTROL IN PREGNANCY

In malaria-endemic regions, insecticide-treated nets and intermittent preventive therapy (IPT)—single-dose preventive therapy with sulfadoxine-pyrimethamine—are key components of malaria control in pregnancy. However, increasing resistance to sulfadoxine-pyrimethamine raises concerns about the efficacy of this strategy. In a systematic review of clinical trials of sulfadoxine-pyrimethamine in Africa, ter Kuile and colleagues assessed the efficacy of IPT with sulfadoxine-pyrimethamine on placental and peripheral malaria, birth weight, low birth weight, and maternal anemia (hemoglobin level) in relation to regional sulfadoxine-pyrimethamine resistance. The authors found that in areas of Africa with sulfadoxine-pyrimethamine resistance as high as 39%, 1 dose of IPT sulfadoxine-pyrimethamine given in trimesters 2 and 3 provided substantial benefit to HIV-negative women. Among HIV-positive women, more frequent dosing appeared necessary.

CLINICIAN'S CORNER

Tibbles and colleagues assessed the sensitivity of history and physical examination characteristics for the diagnosis of erythema migrans and found that the clinical presentation varies widely with no single element in a patient's history, physical examination, or laboratory assessment as highly sensitive for the diagnosis.

A PIECE OF MY MIND

“For our patients to thrive, they need some intangible things that we physicians are certainly able to give. . . acceptance, appreciation, affirmation, and assurance.” From “A Tissue Diagnosis.”

MEDICAL NEWS & PERSPECTIVES

The Robert Wood Johnson Clinical Scholars Program gives young physicians the opportunity to diverge from traditional careers in medicine and create innovations in health services research.

HEAD AND NECK MELANOMA

An article in the Archives of Otolaryngology–Head & Neck Surgery reports the epidemiology and mortality-associated factors of cutaneous head and neck melanoma. Bradford and Levine discuss the increasing incidence of melanoma and identification of prognostic characteristics.

CHRONIC KIDNEY DISEASE

A lack of interventional studies compromises the care of patients with chronic kidney disease.

LOCALITY RULE

Implications of the locality rule in malpractice cases.

Theme Issue on Chronic Diseases of Children

JAMA PATIENT PAGE

For your patients: Information about Lyme disease.

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