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In cognitive radio (CR) networks, the perceived reduction of application layer quality of service (QoS), such as multimedia distortion, by secondary users may impede the success of CR technologies. Most previous work in CR networks ignores application layer QoS. In this paper we take an integrated design approach to jointly optimize multimedia intra refreshing rate, an application layer parameter, together with access strategy, and spectrum sensing for multimedia transmission in a CR system with time varying wireless channels. We formulate the QoS optimization problem as a partially observable Markov decision process (POMDP). Numerical results show the effectiveness of the proposed scheme.