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  • Psoriatic Arthritis
    Posted on March 9, 2017 at 12:00 am

    Psoriasis is a common skin disease that is associated with multiple coexisting conditions. The most prevalent coexisting condition, psoriatic arthritis, develops in up to 30% of patients with psoriasis and is characterized by diverse clinical features, often resulting in delayed diagnosis and […]

  • Inhibiting Plasma Kallikrein for Hereditary Angioedema Prophylaxis
    Posted on February 23, 2017 at 12:00 am

    Hereditary angioedema with C1 inhibitor deficiency is a rare genetic disease that is characterized by recurrent swelling episodes, typically affecting the subcutaneous or submucosal tissues of the hands and feet, abdomen, face, larynx, or genitourinary tract. Swelling of the larynx can b […]

  • Case 6-2017: A 57-Year-Old Woman with Fatigue, Sweats, Weight Loss, Headache, and Skin Lesions
    Posted on February 23, 2017 at 12:00 am

    Presentation of Case. Dr. Kevin J. Heaton (Medicine): A 57-year-old woman was seen in the outpatient rheumatology clinic of this hospital because of fatigue, night sweats, weight loss, headache, diffuse abdominal pain, and skin lesions. The patient had been well until approximately 24 months befor […]

  • Kallikrein Inhibition for Hereditary Angioedema
    Posted on February 23, 2017 at 12:00 am

    Management of hereditary angioedema due to C1 inhibitor deficiency has evolved. During the past 10 years, those affected have progressed from underrecognized disability and premature death, through evidence-based hospital treatment, toward self-administration and independence from unscheduled […]

  • Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis
    Posted on February 16, 2017 at 12:00 am

    Rheumatoid arthritis is a systemic autoimmune disease characterized by inflammatory synovitis and progressive joint destruction, which are associated with severe disability and increased mortality. Progress in treatment with the use of conventional synthetic disease-modifying antirheumatic drugs […]

  • AA Amyloidosis and IgG4-Related Disease
    Posted on February 9, 2017 at 12:00 am

    To the Editor: Here, we describe a patient with renal amyloid A (AA) amyloidosis that was apparently associated with IgG4-related disease. A 53-year-old man with long-standing malaise and fatigue had a slow-growing mesenteric mass (5 cm in diameter) that had been present 16 years earlier on t […]

  • Safety of Nonsteroidal Antiinflammatory Drugs
    Posted on December 29, 2016 at 12:00 am

    Nonsteroidal antiinflammatory drugs (NSAIDs), one of the most widely used classes of drugs in the world, are effective antiinflammatory, analgesic, and antipyretic agents. Although they differ from one another in chemical class, all inhibit the synthesis of prostaglandins. Because prostaglandins […]

  • Cardiovascular Safety of Celecoxib, Naproxen, or Ibuprofen for Arthritis
    Posted on December 29, 2016 at 12:00 am

    Nonsteroidal antiinflammatory drugs (NSAIDs) were introduced in the 1960s and became the most widely prescribed class of drugs in the world, with more than 100 million prescriptions issued annually in the United States alone. NSAIDs inhibit cyclooxygenase (COX), which reduces pain and inflammation […]

  • Acute Rheumatic Fever with Erythema Marginatum
    Posted on December 22, 2016 at 12:00 am

    Figure 1. […]

  • Fulminant Myocarditis with Combination Immune Checkpoint Blockade
    Posted on November 3, 2016 at 12:00 am

    Immune checkpoint inhibitors have transformed the treatment of several cancers by releasing restrained antitumor immune responses. Ipilimumab, an anti–cytotoxic T-lymphocyte–associated antigen 4 (CTLA-4) antibody, and nivolumab, an anti–programmed death-1 (PD-1) antibody, have individually improved […]

  • Dissecting a Case of Abdominal Pain
    Posted on October 27, 2016 at 12:00 am

    A 43-year-old man with no notable medical history presented to the emergency department within 1 hour after the abrupt onset of abdominal pain. The patient stated that he had been dressing for work when severe, "crampy" abdominal pain occurred in the left upper quadrant. On a scale of 0 to 10, wit […]

  • Cutaneous Lupus — "The Pimple That Never Went Away"
    Posted on October 20, 2016 at 12:00 am

    Figure 1. […]

  • Case 31-2016: A 53-Year-Old Man with Diplopia, Polydipsia, and Polyuria
    Posted on October 13, 2016 at 12:00 am

    Presentation of Case. Dr. Thomas N. Byrne: A 53-year-old man was seen in the neurology, neurosurgery, and neuroendocrinology clinics of this hospital because of diplopia, polydipsia, and polyuria. The patient had been well until approximately 1 year before this evaluation, when nasal congestion and […]

  • Takayasu’s Arteritis
    Posted on August 18, 2016 at 12:00 am

    Figure 1. […]

  • Raynaud’s Phenomenon
    Posted on August 11, 2016 at 12:00 am

    In his 1862 thesis, Maurice Raynaud describes the condition afflicting a 26-year-old female patient: "Under the influence of a very moderate cold . . . she sees her fingers become ex-sanguine, completely insensible, and of a whitish yellow color. This phenomenon happens often without reason, lasts […]

  • Case 22-2016: A 65-Year-Old Man with Syncope, Dyspnea, and Leg Edema
    Posted on July 21, 2016 at 12:00 am

    Presentation of Case. Dr. David K. Rhee (Cardiology): A 65-year-old man was admitted to this hospital because of syncope, dyspnea, and leg edema. The patient had been in his usual health until approximately 1 month before admission, when cough occurred. One week later, his legs became swollen and […]

  • Milk of Urate Bulla
    Posted on July 14, 2016 at 12:00 am

    Figure 1. […]

  • A Bruising Loss
    Posted on July 7, 2016 at 12:00 am

    Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows. Stage. A 32-year-old woman presented to […]

  • Ankylosing Spondylitis and Axial Spondyloarthritis
    Posted on June 30, 2016 at 12:00 am

    Chronic back pain is common worldwide and is cared for by a variety of providers, but specific, satisfactory treatment is often lacking. Ankylosing spondylitis, an inflammatory disorder that in its extreme form can lead to the bony fusion of vertebral joints, is an uncommon but well-established […]

  • Calcium Pyrophosphate Deposition Disease
    Posted on June 30, 2016 at 12:00 am

    Calcium pyrophosphate deposition (CPPD) disease is arthritis caused by calcium pyrophosphate (CPP) crystals (Figure 1). Until recently, CPPD disease has been referred to as pseudogout. This term stems from an early description of this disease in patients with an acute goutlike arthritis whos […]

  • New Peanut Introduction Guidance
    Posted by Abbasi J. on March 28, 2017 at 12:00 am

    To prevent the development of peanut allergies, peanut-containing foods should be introduced to at-risk children within the first 6 months of life—but exactly when in that 6-month period depends on the individual child’s risk. Those are the conclusions of an expert panel sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), which recently issued new clinical guidelines for clinicians on the topic. […]

  • Incorrect Value in Figure
    Posted on March 28, 2017 at 12:00 am

    In the US Preventive Services Task Force Evidence Report entitled “Screening for Obstructive Sleep Apnea in Adults: Evidence Report and Systematic Review for the US Preventive Services Task Force” published in the January 24/31, 2017, issue of JAMA, a value was incorrectly reported in a figure. In Figure 2, the top left box should have reported 1206 citations identified, rather than 1205. This article has been corrected online. […]

  • The Emergence of For-Profit Medical Schools
    Posted by Adashi EY, Krishna GR, Gruppuso PA. on March 28, 2017 at 12:00 am

    This Viewpoint discusses the emergence of for-profit medical schools and the implications of the new business model for the physician workforce and the quality of medical education and practice. […]

  • Highlights for March 28, 2017
    Posted on March 28, 2017 at 12:00 am

    […]

  • Reforming Federal Public Health Powers
    Posted by Gostin LO, Hodge JG, Jr. on March 28, 2017 at 12:00 am

    This Viewpoint highlights potential effects of recent finalized changes to the Public Health Service Act. […]

  • Bezlotoxumab for Recurrent C difficile Infections
    Posted by Slomski A. on March 28, 2017 at 12:00 am

    A single intravenous dose of bezlotoxumab in combination with standard-of-care antibiotic treatment for primary or recurrent Clostridium difficile infection was associated with a 38% lower rate of recurrent infection than was antibiotic treatment alone, found 2 phase 3 trials. According to the findings published in NEJM, bezlotoxumab—a human monoclonal antibody against C difficile toxin B—had a safety profile similar to that of placebo. […]

  • The Lisboa Café
    Posted by Taran S. on March 28, 2017 at 12:00 am

    The Lisboa Café is an unusual little place in one of Toronto’s artsy districts, a charming but run-down restaurant with a hipster vibe that has survived both modernization and gentrification. It is located far from the bustle of downtown hospitals, at the intersection of two important thoroughfares that carry work-worn commuters out of the city. The Café’s clientele is a strange mix of the familiar and the bizarre: on any given night, self-conscious couples may share aisle space with large parties of 10 or 12 who sit, for the entire duration of dinner, in hushed […]

  • What We Are
    Posted by Halberstadt C. on March 28, 2017 at 12:00 am

    In the beginningis a dream of being.This is real:What the earthwormand slug do in their becomingwhat cells and galaxies dowhat the atoms in lichen and microbes are—the glue and the forcesthat hold us together—the armature of bones and stones.How the mountains and trees and oceans breathe.What the whale knows.We don't know whyonly glimpses of how and whatfrom the source of compassion—life making life and becomingas it turns again and again. […]

  • Laparoscopic Hysterectomy for Endometrial Cancer
    Posted by Wright JD. on March 28, 2017 at 12:00 am

    Laparoscopy allows for completion of an operative procedure through multiple small incisions as opposed to 1 larger incision. Over the last 30 years, laparoscopic procedures have been developed, tested, and validated for a number of surgical interventions. Laparoscopic hysterectomy was first performed in the early 1990s. For women undergoing hysterectomy for benign gynecologic diseases, the procedure has been shown to be safe and is associated with improved perioperative outcomes compared with abdominal hysterectomy performed via laparotomy. Despite the apparent benefits of laparoscopic […]

  • Priorities for Public Health Spending
    Posted by Cahill S, Mayer K, Boswell S. on March 28, 2017 at 12:00 am

    To the Editor In an Editorial on how the United States should spend its health care dollars, Dr Emanuel called for a shift of public health funding away from human immunodeficiency virus (HIV) toward other diseases. Although we support the allocation of greater resources for all current vital health issues, shifting support away from HIV prevention, treatment, and research is not smart public health policy. […]

  • Vitamin D, Calcium, and Cancer
    Posted by Manson JE, Bassuk SS, Buring JE. on March 28, 2017 at 12:00 am

    Vitamin D and calcium, long recognized as important for bone health, have attracted clinical interest in recent years for their potential nonskeletal benefits, including cancer prevention. Despite this enthusiasm, however, few completed randomized clinical trials of supplemental vitamin D administered with or without calcium have examined cancer end points, and no previously completed trial has reported cancer as a primary prespecified outcome. Moreover, few randomized trials have tested high doses of vitamin D (ie, at least twice as high as the current recommended dietary allowance of […]

  • Professionalism in Health Care Organizations
    Posted by Mason DJ. on March 28, 2017 at 12:00 am

    Health care organizations have been under enormous pressure for the past 8 years, and it might get worse. The Affordable Care Act (ACA) sought to alter the course of a huge ship. Soon the ship may be turning in another direction into uncertain waters. How should these organizations navigate the turbulence while maintaining the “quadruple aim” of improving people’s experience with care, improving the health of the population, reducing health care cost, and fostering job satisfaction among health care workers? […]

  • Childhood Lead Exposure and Adult Outcomes
    Posted by Bellinger DC. on March 28, 2017 at 12:00 am

    The discovery that the water in Flint, Michigan, was contaminated with lead shows that excessive exposure to this toxic metal remains a threat to human health. The episode resulted from a series of poor decisions by politicians that allowed lead to leach from pipes and fixtures into the water flowing into residents’ homes. But Flint is by no means unique with regard to lead hazards. A 2016 report identified 3000 US communities in which the percentage of children with a blood lead concentration greater than 5 μg/dL, the current Centers for Disease Control and Prevention (CDC) […]

  • Germline Editing OK With Caveats
    Posted by Abbasi J. on March 28, 2017 at 12:00 am

    In a new report, an expert international committee appointed by the National Academy of Sciences and the National Academy of Medicine said human trials of germline genome editing may be permitted in the future. The committee stipulated that genome changes to human sperm or egg cells or early embryos—which can be inherited by future generations—should only be tested to prevent serious diseases or conditions when no reasonable alternatives exist and only with strict oversight and follow-up and ample public input. […]

  • Screening for Asymptomatic Celiac Disease
    Posted by Choung R, Murray JA. on March 28, 2017 at 12:00 am

    In this issue of JAMA, the US Preventive Services Task Force (USPSTF) critically examines screening for celiac disease in asymptomatic adults, adolescents, and children. Celiac disease, one of the most common lifelong disorders in the United States, exhibits a broad spectrum of clinical presentations from subtle or no symptoms to severe malabsorption. The rate of diagnosis of celiac disease has substantially increased over the past 30 years, in part explained by increased awareness but perhaps also by a true increase in the disease. The current prevalence of celiac disease is estimated at […]

  • Less Noise, Better Health
    Posted on March 28, 2017 at 12:00 am

    Recent research showing that 21 million US residents have hearing damage not from loud on-the-job noise but from blaring everyday sounds—honking car horns, sirens, and leaf blowers, not to mention rock concerts and sporting events—prompted the CDC to advise that primary care clinicians give greater attention to patients’ hearing during routine examinations. […]

  • Laparoscopic vs Abdominal Hysterectomy for Stage I Endometrial Cancer
    Posted by Janda M, Gebski V, Davies LC, et al. on March 28, 2017 at 12:00 am

    This randomized clinical trial compares the effects on disease-free survival of total laparoscopic vs abdominal hysterectomy among women with stage I endometrial cancer treated at tertiary gynecological cancer centers in Australia, New Zealand, and Hong Kong. […]

  • Screening for Celiac Disease
    Posted by Jin J. on March 28, 2017 at 12:00 am

    […]

  • Effect of Vitamin D and Calcium Supplementation on Cancer Incidence in Older Women
    Posted by Lappe J, Watson P, Travers-Gustafson D, et al. on March 28, 2017 at 12:00 am

    This randomized clinical trial compares the effects of dietary supplementation with vitamin D3 and calcium vs placebo on cancer incidence in postmenopausal older women. […]

  • Assessing Performance of Internal Medicine Residents
    Posted by Hauer KE, Holmboe ES, McDonald FS. on March 28, 2017 at 12:00 am

    In Reply Dr Monach raises concern about whether ratings are in fact capturing a developmental trajectory. Subcompetency milestone ratings are completed by program directors working with clinical competency committees to review and synthesize a broad data set into determinations of each resident’s progress. Although it is possible that evaluators are completing evaluations too quickly, as Monach fears, the introduction of milestones was accompanied by a new requirement for committees to engage in group decision making using a range of information. This can include written evaluations and […]

  • Childhood Blood Lead Levels, Cognitive Function, and Socioeconomic Status in Adulthood
    Posted by Reuben A, Caspi A, Belsky DW, et al. on March 28, 2017 at 12:00 am

    This cohort study evaluated the association between childhood lead exposure cognitive function and socioeconomic status in adulthood, and changes in IQ and socioeconomic status between ages 11 and 28 years. […]

  • Priorities for Public Health Spending—Reply
    Posted by Emanuel EJ. on March 28, 2017 at 12:00 am

    In Reply There is always a scarcity of resources for public health initiatives. Inevitably, choices need to be made. Choosing to spend money on one option means the benefits that might have been accrued from the alternatives must be foregone. Those lost benefits are the opportunity cost of going with one option. Because the world will always have a scarcity of resources, including for public health measures, there are always opportunity costs. […]

  • USPSTF Recommendation: Screening for Celiac Disease
    Posted by , Bibbins-Domingo K, Grossman DC, et al. on March 28, 2017 at 12:00 am

    This Recommendation Statement from the US Preventive Services Task Force concludes that current evidence is insufficient to assess the balance of benefits and harms of screening for celiac disease in asymptomatic adults, adolescents, and children. […]

  • Oral Bacteria Linked to Rheumatoid Arthritis
    Posted by Abbasi J. on March 28, 2017 at 12:00 am

    This Medical News article discusses the discovery of a microbe that may trigger rheumatoid arthritis. […]

  • USPSTF Evidence Report: Screening for Celiac Disease
    Posted by Chou R, Bougatsos C, Blazina I, et al. on March 28, 2017 at 12:00 am

    This Evidence Report to inform the 2017 US Preventive Services Task Force Recommendation Statement on screening for celiac disease summarizes evidence on the benefits and harms of screening for celiac disease in asymptomatic adults, adolescents, and children 3 years and older. […]

  • Avoiding Unnecessary Prostate Biopsies With MRI
    Posted by Slomski A. on March 28, 2017 at 12:00 am

    Multiparametric magnetic resonance imaging (MP-MRI) used as a triage test for men with suspected prostate cancer may reduce unnecessary first biopsies and improve the detection of clinically significant cancer, according to results of a new study published in the Lancet. The MP-MRI, which provides information about prostate volume, cellularity, and vascularity, has significantly better sensitivity and negative predictive value for clinically important prostate cancer than standard transrectal ultrasound-guided (TRUS) biopsy. […]

  • Retained Lumbar Catheter Tip—A Lesson in Patient Safety
    Posted by DeLancey JO, Barnard C, Bilimoria KY. on March 28, 2017 at 12:00 am

    This JAMA Performance Improvement article uses the case of a patient with a retained lumbar catheter tip to discuss strategies for patient communication, clinician education, and reporting of procedure-related adverse events. […]

  • Waiting to Clamp Cords Reduces Anemia in Infants
    Posted by Slomski A. on March 28, 2017 at 12:00 am

    Delaying umbilical cord clamping after birth by 3 or more minutes reduced the prevalence of anemia in infants at ages 8 and 12 months in a clinical trial in Nepal. Delayed cord clamping could be a low-cost intervention to reduce the risk of iron deficiency anemia, which is associated with impaired neurodevelopment in children. […]

  • Age-Specific Contribution of ART to Overall US Births, 2012-2014
    Posted by Levine AD, Boulet SL, Kissin DM. on March 28, 2017 at 12:00 am

    This study uses US Centers for Disease Control and Prevention surveillance data to estimate the proportion of live births attributable to assisted reproductive technology by maternal age in the United States between 2012 and 2014. […]

  • Increases in Premature Mortality
    Posted by Abbasi J. on March 28, 2017 at 12:00 am

    A recent study on premature mortality in the United States highlights both new challenges and hard-won successes in halting early deaths among different racial and ethnic groups. […]

  • Comparison of Live Births Among IVF Patients With vs Without Insurance
    Posted by Jungheim ES, Leung M, Macones GA, et al. on March 28, 2017 at 12:00 am

    This study compares the cumulative probability of live birth among women with and without in vitro fertilization insurance coverage at a university-affiliated reproductive medicine center. […]

  • Decline in Postpartum Depression
    Posted on March 28, 2017 at 12:00 am

    Improved screening and treatment for postpartum depression apparently are paying off. The condition’s prevalence rate has declined by about 25% in 27 states that report such data, yet CDC researchers caution that postpartum depression remains common among new mothers. […]

  • Inpatient Palliative Care After Hematopoietic Stem Cell Transplantation
    Posted by Chhabra S, Lai Z. on March 28, 2017 at 12:00 am

    To the Editor Dr El-Jawahri and colleagues assessed the effect of inpatient palliative care on patient- and caregiver-reported outcomes after hematopoietic stem cell transplantation (HCT). They reported that the intervention group had better quality-of-life scores and secondary outcomes such as depression and anxiety. […]

  • The Female Beautiful Face
    Posted by Pastorek NJ. on March 28, 2017 at 12:00 am

    In this Arts and Medicine essay, a facial plastic surgeon surveys the evolution of standards of female beauty on women’s interest magazine covers and implications of the shifting standards for facial plastic procedures. […]

  • Inpatient Palliative Care After Hematopoietic Stem Cell Transplantation—Reply
    Posted by El-Jawahri A, Temel JS. on March 28, 2017 at 12:00 am

    In Reply Ms Chhabra and Mr Lai comment on the use of antipsychotics and antidepressants as a potential confounder of the effect of the intervention on psychological outcomes at 2 weeks and 3 months posttransplantation and potential bias due to the lack of blinding leading to higher patient-reported anxiety symptoms in patients randomized to the control group. […]

  • Notification of Infectious Diseases
    Posted on March 28, 2017 at 12:00 am

    The public has so long been accustomed to the good-nature of physicians, and has so long expected from them work without compensation, that perhaps it is not surprising that they fail to recognize the financial rights of the medical man in the matter of notification of infectious diseases. […]

  • Assessing Performance of Internal Medicine Residents
    Posted by Monach PA. on March 28, 2017 at 12:00 am

    To the Editor Dr Hauer and colleagues compared ratings of internal medicine residents on the resident annual evaluation summary (RAES) and internal medicine milestones. Greater variability was seen in scores using milestones compared with the RAES. I disagree that this variability is evidence that milestones have greater capacity to identify deficiencies. […]

  • JAMA
    Posted on March 28, 2017 at 12:00 am

    […]

  • Trial of Pregabalin for Acute and Chronic Sciatica
    Posted on March 23, 2017 at 12:00 am

    Sciatica is characterized by radiating posterior or posterolateral leg pain, which is sometimes accompanied by back pain, sensory loss, weakness, or reflex abnormalities. Few clinical guidelines for the treatment of sciatica exist, and evidence regarding effective medical treatments is limited. […]

  • Fournier’s Gangrene
    Posted on March 23, 2017 at 12:00 am

    Figure 1. […]

  • Treatment of Benzodiazepine Dependence
    Posted on March 23, 2017 at 12:00 am

    Traditionally, various terms have been used to define substance use–related disorders. These include "addiction," "misuse" (in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition [DSM-IV]), "harmful use" (in the International Classification of Diseases, 10th Revision […]

  • Management of Sciatica
    Posted on March 23, 2017 at 12:00 am

    Mr. Winston’s case represents a common scenario in the management of symptomatic lumbar disk herniation. In this particular case, the patient’s symptoms and the physical examination are consistent with nerve-root compression and inflammation directly from an L4–L5 herniated disk on his left side. […]

  • Is Pregabalin Ineffective in Acute or Chronic Sciatica?
    Posted on March 23, 2017 at 12:00 am

    Sciatica with or without low back pain is not easily managed, and few treatments have established efficacy for these conditions. Although the antiepileptic drug pregabalin has been recommended for the treatment of neuropathic pain (i.e. the broad category of pain associated with a lesion or diseas […]

  • Adopting Innovations in Care Delivery — The Case of Shared Medical Appointments
    Posted on March 23, 2017 at 12:00 am

    Transformative innovations in care delivery often fail to spread. Consider shared medical appointments, in which patients receive one-on-one physician consultations in the presence of others with similar conditions. Shared appointments are used for routine care of chronic conditions, patient […]

  • Incidental Finding of Oleothorax
    Posted on March 23, 2017 at 12:00 am

    Figure 1. […]

  • Case 9-2017: A 27-Year-Old Woman with Nausea, Vomiting, Confusion, and Hyponatremia
    Posted on March 23, 2017 at 12:00 am

    Presentation of Case. Dr. Meaghan E. Colling (Medicine): A 27-year-old woman was admitted to this hospital because of nausea, vomiting, confusion, and hyponatremia. The patient had been well until 1 week before admission, when she had nausea and nonbloody, nonbilious emesis. She did not seek […]

  • Lessons from Oregon in Embracing Complexity in End-of-Life Care
    Posted on March 16, 2017 at 12:00 am

    Under the incentives of fee-for-service Medicare, the utilization trends among persons with chronic progressive medical illness include more care in the intensive care unit (ICU), more hospitalizations, and often late or no referrals to hospice care (Figure 1). These utilization patterns ar […]

  • Protruding Iris Collarette
    Posted on March 16, 2017 at 12:00 am

    Figure 1. […]

  • Acute Lower Gastrointestinal Bleeding
    Posted on March 16, 2017 at 12:00 am

    Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors’ clinical recommendations. Stage. A 71-year-old […]

  • Plasmacytomas and Plasma-Cell Leukemia
    Posted on March 16, 2017 at 12:00 am

    Figure 1. […]

  • Another Senseless Death — The Case for Supervised Injection Facilities
    Posted on March 16, 2017 at 12:00 am

    Frankie liked to tell people "we made our bones together." He must have said that a hundred times, to every new medical student I introduced to him, to every nurse, and during every one of our many visits. I had a general sense of what he meant, but on the morning I heard that he’d died from an […]

  • Case 7-2017: A 73-Year-Old Man with Confusion and Recurrent Epistaxis
    Posted on March 9, 2017 at 12:00 am

    Presentation of Case. Dr. Jeffrey L. Greenwald: A 73-year-old man with multiple chronic medical illnesses was admitted to this hospital because of confusion and irritability. Two days before this admission, increasing weakness, lethargy, chills, and diarrhea developed. The patient became less […]

  • Psoriatic Arthritis
    Posted on March 9, 2017 at 12:00 am

    Psoriasis is a common skin disease that is associated with multiple coexisting conditions. The most prevalent coexisting condition, psoriatic arthritis, develops in up to 30% of patients with psoriasis and is characterized by diverse clinical features, often resulting in delayed diagnosis and […]

  • Realizing the Potential of Cancer Prevention — The Role of Implementation Science
    Posted on March 9, 2017 at 12:00 am

    In the past two decades, we and others have estimated that more than half of cancers could have been prevented by applying knowledge that we already have. Tobacco use, inactivity, and obesity are modifiable causes of cancer, and evidence now suggests that vaccination against the human […]

  • At Risk for Serious Mental Illness — Screening Children of Patients with Mood Disorders or Schizophrenia
    Posted on March 9, 2017 at 12:00 am

    A 10-year-old boy has cognitive deficits, and his school performance and social skills have been deteriorating gradually since he was 7. Neither his 12-year-old brother nor his 14-year-old sister has similar problems. Their mother, a 37-year-old schoolteacher, has been treated for bipolar disorder […]

  • Glucagonoma-Associated Rash
    Posted on March 9, 2017 at 12:00 am

    Figure 1. […]

  • Care for Autism and Other Disabilities — A Future in Jeopardy
    Posted on March 9, 2017 at 12:00 am

    The false belief that vaccines cause autism has been forcefully countered by the scientific community, which recognizes that vaccines are among the most valuable medical innovations of our time. President Donald Trump’s apparent openness to a long-debunked link between vaccines and autism risks […]

  • Grouped Pustules on an Erythematous Base
    Posted on March 9, 2017 at 12:00 am

    Figure 1. […]

  • New Peanut Introduction Guidance
    Posted by Abbasi J. on March 28, 2017 at 12:00 am

    To prevent the development of peanut allergies, peanut-containing foods should be introduced to at-risk children within the first 6 months of life—but exactly when in that 6-month period depends on the individual child’s risk. Those are the conclusions of an expert panel sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), which recently issued new clinical guidelines for clinicians on the topic. […]

  • Incorrect Value in Figure
    Posted on March 28, 2017 at 12:00 am

    In the US Preventive Services Task Force Evidence Report entitled “Screening for Obstructive Sleep Apnea in Adults: Evidence Report and Systematic Review for the US Preventive Services Task Force” published in the January 24/31, 2017, issue of JAMA, a value was incorrectly reported in a figure. In Figure 2, the top left box should have reported 1206 citations identified, rather than 1205. This article has been corrected online. […]

  • The Emergence of For-Profit Medical Schools
    Posted by Adashi EY, Krishna GR, Gruppuso PA. on March 28, 2017 at 12:00 am

    This Viewpoint discusses the emergence of for-profit medical schools and the implications of the new business model for the physician workforce and the quality of medical education and practice. […]

  • Highlights for March 28, 2017
    Posted on March 28, 2017 at 12:00 am

    […]

  • Reforming Federal Public Health Powers
    Posted by Gostin LO, Hodge JG, Jr. on March 28, 2017 at 12:00 am

    This Viewpoint highlights potential effects of recent finalized changes to the Public Health Service Act. […]

  • Bezlotoxumab for Recurrent C difficile Infections
    Posted by Slomski A. on March 28, 2017 at 12:00 am

    A single intravenous dose of bezlotoxumab in combination with standard-of-care antibiotic treatment for primary or recurrent Clostridium difficile infection was associated with a 38% lower rate of recurrent infection than was antibiotic treatment alone, found 2 phase 3 trials. According to the findings published in NEJM, bezlotoxumab—a human monoclonal antibody against C difficile toxin B—had a safety profile similar to that of placebo. […]

  • The Lisboa Café
    Posted by Taran S. on March 28, 2017 at 12:00 am

    The Lisboa Café is an unusual little place in one of Toronto’s artsy districts, a charming but run-down restaurant with a hipster vibe that has survived both modernization and gentrification. It is located far from the bustle of downtown hospitals, at the intersection of two important thoroughfares that carry work-worn commuters out of the city. The Café’s clientele is a strange mix of the familiar and the bizarre: on any given night, self-conscious couples may share aisle space with large parties of 10 or 12 who sit, for the entire duration of dinner, in hushed […]

  • What We Are
    Posted by Halberstadt C. on March 28, 2017 at 12:00 am

    In the beginningis a dream of being.This is real:What the earthwormand slug do in their becomingwhat cells and galaxies dowhat the atoms in lichen and microbes are—the glue and the forcesthat hold us together—the armature of bones and stones.How the mountains and trees and oceans breathe.What the whale knows.We don't know whyonly glimpses of how and whatfrom the source of compassion—life making life and becomingas it turns again and again. […]

  • Laparoscopic Hysterectomy for Endometrial Cancer
    Posted by Wright JD. on March 28, 2017 at 12:00 am

    Laparoscopy allows for completion of an operative procedure through multiple small incisions as opposed to 1 larger incision. Over the last 30 years, laparoscopic procedures have been developed, tested, and validated for a number of surgical interventions. Laparoscopic hysterectomy was first performed in the early 1990s. For women undergoing hysterectomy for benign gynecologic diseases, the procedure has been shown to be safe and is associated with improved perioperative outcomes compared with abdominal hysterectomy performed via laparotomy. Despite the apparent benefits of laparoscopic […]

  • Priorities for Public Health Spending
    Posted by Cahill S, Mayer K, Boswell S. on March 28, 2017 at 12:00 am

    To the Editor In an Editorial on how the United States should spend its health care dollars, Dr Emanuel called for a shift of public health funding away from human immunodeficiency virus (HIV) toward other diseases. Although we support the allocation of greater resources for all current vital health issues, shifting support away from HIV prevention, treatment, and research is not smart public health policy. […]

  • Vitamin D, Calcium, and Cancer
    Posted by Manson JE, Bassuk SS, Buring JE. on March 28, 2017 at 12:00 am

    Vitamin D and calcium, long recognized as important for bone health, have attracted clinical interest in recent years for their potential nonskeletal benefits, including cancer prevention. Despite this enthusiasm, however, few completed randomized clinical trials of supplemental vitamin D administered with or without calcium have examined cancer end points, and no previously completed trial has reported cancer as a primary prespecified outcome. Moreover, few randomized trials have tested high doses of vitamin D (ie, at least twice as high as the current recommended dietary allowance of […]

  • Professionalism in Health Care Organizations
    Posted by Mason DJ. on March 28, 2017 at 12:00 am

    Health care organizations have been under enormous pressure for the past 8 years, and it might get worse. The Affordable Care Act (ACA) sought to alter the course of a huge ship. Soon the ship may be turning in another direction into uncertain waters. How should these organizations navigate the turbulence while maintaining the “quadruple aim” of improving people’s experience with care, improving the health of the population, reducing health care cost, and fostering job satisfaction among health care workers? […]

  • Childhood Lead Exposure and Adult Outcomes
    Posted by Bellinger DC. on March 28, 2017 at 12:00 am

    The discovery that the water in Flint, Michigan, was contaminated with lead shows that excessive exposure to this toxic metal remains a threat to human health. The episode resulted from a series of poor decisions by politicians that allowed lead to leach from pipes and fixtures into the water flowing into residents’ homes. But Flint is by no means unique with regard to lead hazards. A 2016 report identified 3000 US communities in which the percentage of children with a blood lead concentration greater than 5 μg/dL, the current Centers for Disease Control and Prevention (CDC) […]

  • Germline Editing OK With Caveats
    Posted by Abbasi J. on March 28, 2017 at 12:00 am

    In a new report, an expert international committee appointed by the National Academy of Sciences and the National Academy of Medicine said human trials of germline genome editing may be permitted in the future. The committee stipulated that genome changes to human sperm or egg cells or early embryos—which can be inherited by future generations—should only be tested to prevent serious diseases or conditions when no reasonable alternatives exist and only with strict oversight and follow-up and ample public input. […]

  • Screening for Asymptomatic Celiac Disease
    Posted by Choung R, Murray JA. on March 28, 2017 at 12:00 am

    In this issue of JAMA, the US Preventive Services Task Force (USPSTF) critically examines screening for celiac disease in asymptomatic adults, adolescents, and children. Celiac disease, one of the most common lifelong disorders in the United States, exhibits a broad spectrum of clinical presentations from subtle or no symptoms to severe malabsorption. The rate of diagnosis of celiac disease has substantially increased over the past 30 years, in part explained by increased awareness but perhaps also by a true increase in the disease. The current prevalence of celiac disease is estimated at […]

  • Less Noise, Better Health
    Posted on March 28, 2017 at 12:00 am

    Recent research showing that 21 million US residents have hearing damage not from loud on-the-job noise but from blaring everyday sounds—honking car horns, sirens, and leaf blowers, not to mention rock concerts and sporting events—prompted the CDC to advise that primary care clinicians give greater attention to patients’ hearing during routine examinations. […]

  • Laparoscopic vs Abdominal Hysterectomy for Stage I Endometrial Cancer
    Posted by Janda M, Gebski V, Davies LC, et al. on March 28, 2017 at 12:00 am

    This randomized clinical trial compares the effects on disease-free survival of total laparoscopic vs abdominal hysterectomy among women with stage I endometrial cancer treated at tertiary gynecological cancer centers in Australia, New Zealand, and Hong Kong. […]

  • Screening for Celiac Disease
    Posted by Jin J. on March 28, 2017 at 12:00 am

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  • Effect of Vitamin D and Calcium Supplementation on Cancer Incidence in Older Women
    Posted by Lappe J, Watson P, Travers-Gustafson D, et al. on March 28, 2017 at 12:00 am

    This randomized clinical trial compares the effects of dietary supplementation with vitamin D3 and calcium vs placebo on cancer incidence in postmenopausal older women. […]

  • Assessing Performance of Internal Medicine Residents
    Posted by Hauer KE, Holmboe ES, McDonald FS. on March 28, 2017 at 12:00 am

    In Reply Dr Monach raises concern about whether ratings are in fact capturing a developmental trajectory. Subcompetency milestone ratings are completed by program directors working with clinical competency committees to review and synthesize a broad data set into determinations of each resident’s progress. Although it is possible that evaluators are completing evaluations too quickly, as Monach fears, the introduction of milestones was accompanied by a new requirement for committees to engage in group decision making using a range of information. This can include written evaluations and […]

  • Childhood Blood Lead Levels, Cognitive Function, and Socioeconomic Status in Adulthood
    Posted by Reuben A, Caspi A, Belsky DW, et al. on March 28, 2017 at 12:00 am

    This cohort study evaluated the association between childhood lead exposure cognitive function and socioeconomic status in adulthood, and changes in IQ and socioeconomic status between ages 11 and 28 years. […]

  • Priorities for Public Health Spending—Reply
    Posted by Emanuel EJ. on March 28, 2017 at 12:00 am

    In Reply There is always a scarcity of resources for public health initiatives. Inevitably, choices need to be made. Choosing to spend money on one option means the benefits that might have been accrued from the alternatives must be foregone. Those lost benefits are the opportunity cost of going with one option. Because the world will always have a scarcity of resources, including for public health measures, there are always opportunity costs. […]

  • USPSTF Recommendation: Screening for Celiac Disease
    Posted by , Bibbins-Domingo K, Grossman DC, et al. on March 28, 2017 at 12:00 am

    This Recommendation Statement from the US Preventive Services Task Force concludes that current evidence is insufficient to assess the balance of benefits and harms of screening for celiac disease in asymptomatic adults, adolescents, and children. […]

  • Oral Bacteria Linked to Rheumatoid Arthritis
    Posted by Abbasi J. on March 28, 2017 at 12:00 am

    This Medical News article discusses the discovery of a microbe that may trigger rheumatoid arthritis. […]

  • USPSTF Evidence Report: Screening for Celiac Disease
    Posted by Chou R, Bougatsos C, Blazina I, et al. on March 28, 2017 at 12:00 am

    This Evidence Report to inform the 2017 US Preventive Services Task Force Recommendation Statement on screening for celiac disease summarizes evidence on the benefits and harms of screening for celiac disease in asymptomatic adults, adolescents, and children 3 years and older. […]

  • Avoiding Unnecessary Prostate Biopsies With MRI
    Posted by Slomski A. on March 28, 2017 at 12:00 am

    Multiparametric magnetic resonance imaging (MP-MRI) used as a triage test for men with suspected prostate cancer may reduce unnecessary first biopsies and improve the detection of clinically significant cancer, according to results of a new study published in the Lancet. The MP-MRI, which provides information about prostate volume, cellularity, and vascularity, has significantly better sensitivity and negative predictive value for clinically important prostate cancer than standard transrectal ultrasound-guided (TRUS) biopsy. […]

  • Retained Lumbar Catheter Tip—A Lesson in Patient Safety
    Posted by DeLancey JO, Barnard C, Bilimoria KY. on March 28, 2017 at 12:00 am

    This JAMA Performance Improvement article uses the case of a patient with a retained lumbar catheter tip to discuss strategies for patient communication, clinician education, and reporting of procedure-related adverse events. […]

  • Waiting to Clamp Cords Reduces Anemia in Infants
    Posted by Slomski A. on March 28, 2017 at 12:00 am

    Delaying umbilical cord clamping after birth by 3 or more minutes reduced the prevalence of anemia in infants at ages 8 and 12 months in a clinical trial in Nepal. Delayed cord clamping could be a low-cost intervention to reduce the risk of iron deficiency anemia, which is associated with impaired neurodevelopment in children. […]

  • Age-Specific Contribution of ART to Overall US Births, 2012-2014
    Posted by Levine AD, Boulet SL, Kissin DM. on March 28, 2017 at 12:00 am

    This study uses US Centers for Disease Control and Prevention surveillance data to estimate the proportion of live births attributable to assisted reproductive technology by maternal age in the United States between 2012 and 2014. […]

  • Increases in Premature Mortality
    Posted by Abbasi J. on March 28, 2017 at 12:00 am

    A recent study on premature mortality in the United States highlights both new challenges and hard-won successes in halting early deaths among different racial and ethnic groups. […]

  • Comparison of Live Births Among IVF Patients With vs Without Insurance
    Posted by Jungheim ES, Leung M, Macones GA, et al. on March 28, 2017 at 12:00 am

    This study compares the cumulative probability of live birth among women with and without in vitro fertilization insurance coverage at a university-affiliated reproductive medicine center. […]

  • Decline in Postpartum Depression
    Posted on March 28, 2017 at 12:00 am

    Improved screening and treatment for postpartum depression apparently are paying off. The condition’s prevalence rate has declined by about 25% in 27 states that report such data, yet CDC researchers caution that postpartum depression remains common among new mothers. […]

  • Inpatient Palliative Care After Hematopoietic Stem Cell Transplantation
    Posted by Chhabra S, Lai Z. on March 28, 2017 at 12:00 am

    To the Editor Dr El-Jawahri and colleagues assessed the effect of inpatient palliative care on patient- and caregiver-reported outcomes after hematopoietic stem cell transplantation (HCT). They reported that the intervention group had better quality-of-life scores and secondary outcomes such as depression and anxiety. […]

  • The Female Beautiful Face
    Posted by Pastorek NJ. on March 28, 2017 at 12:00 am

    In this Arts and Medicine essay, a facial plastic surgeon surveys the evolution of standards of female beauty on women’s interest magazine covers and implications of the shifting standards for facial plastic procedures. […]

  • Inpatient Palliative Care After Hematopoietic Stem Cell Transplantation—Reply
    Posted by El-Jawahri A, Temel JS. on March 28, 2017 at 12:00 am

    In Reply Ms Chhabra and Mr Lai comment on the use of antipsychotics and antidepressants as a potential confounder of the effect of the intervention on psychological outcomes at 2 weeks and 3 months posttransplantation and potential bias due to the lack of blinding leading to higher patient-reported anxiety symptoms in patients randomized to the control group. […]

  • Notification of Infectious Diseases
    Posted on March 28, 2017 at 12:00 am

    The public has so long been accustomed to the good-nature of physicians, and has so long expected from them work without compensation, that perhaps it is not surprising that they fail to recognize the financial rights of the medical man in the matter of notification of infectious diseases. […]

  • Assessing Performance of Internal Medicine Residents
    Posted by Monach PA. on March 28, 2017 at 12:00 am

    To the Editor Dr Hauer and colleagues compared ratings of internal medicine residents on the resident annual evaluation summary (RAES) and internal medicine milestones. Greater variability was seen in scores using milestones compared with the RAES. I disagree that this variability is evidence that milestones have greater capacity to identify deficiencies. […]

  • JAMA
    Posted on March 28, 2017 at 12:00 am

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