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  • Mepolizumab or Placebo for Eosinophilic Granulomatosis with Polyangiitis
    Posted on May 18, 2017 at 12:00 am

    Eosinophilic granulomatosis with polyangiitis (formerly known as the Churg–Strauss syndrome) is characterized by asthma, sinusitis, pulmonary infiltrates, neuropathy, and eosinophilic vasculitis of one or more end-organs. Eosinophils are thought to induce pathogenic effects in patients wit […]

  • Targeting Eosinophils in Eosinophilic Granulomatosis with Polyangiitis
    Posted on May 18, 2017 at 12:00 am

    Eosinophilic granulomatosis with polyangiitis, first described in the early 1950s by Dr. Jacob Churg and Dr. Lotte Strauss (hence the original name, the Churg–Strauss syndrome), is a rare condition that can affect many organ systems, most commonly the lung, with the majority of patients presenting […]

  • Case 15-2017 — A 27-Year-Old Woman with Anemia, Thrombocytosis, and Skin Lesions after Travel Abroad
    Posted on May 18, 2017 at 12:00 am

    Presentation of Case. Dr. Alyssa R. Letourneau: A 27-year-old woman was evaluated in the infectious disease clinic of this hospital because of skin lesions, anemia, thrombocytosis, and an elevated blood alkaline phosphatase level. Eleven months before this presentation, the patient traveled abroad […]

  • Case 14-2017: A 20-Year-Old Man with Pain and Swelling of the Left Calf and a Purpuric Rash
    Posted on May 11, 2017 at 12:00 am

    Presentation of Case. Dr. Lauren R. Zeitels (Medicine): A 20-year-old man was seen in an outpatient clinic of this hospital because of pain and swelling of the left calf and a purpuric rash. The patient had been well until 3 weeks before presentation to this hospital, when sore throat, […]

  • GGPS1 Mutation and Atypical Femoral Fractures with Bisphosphonates
    Posted on May 4, 2017 at 12:00 am

    To the Editor: Atypical femoral fractures have been associated with long-term bisphosphonate treatment. However, the underlying mechanisms remain obscure. We studied three sisters who had atypical femoral fractures after receiving various oral bisphosphonates for 6 years. Two of the sisters had a […]

  • Back to the History
    Posted on May 4, 2017 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. An 82-year-old man presented to […]

  • Adalimumab plus Methotrexate for Uveitis in Juvenile Idiopathic Arthritis
    Posted on April 27, 2017 at 12:00 am

    Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children. Children with JIA are at risk for inflammation of the uvea (uveitis). Uveitis develops in approximately 12 to 38% of patients with JIA within 7 years after the onset of arthritis. Despite current screening and […]

  • Overexpression of the Cytokine BAFF and Autoimmunity Risk
    Posted on April 27, 2017 at 12:00 am

    Multiple sclerosis and systemic lupus erythematosus (SLE) are autoimmune diseases caused by largely unknown environmental factors acting in genetically susceptible persons. Genomewide association studies have provided statistical support for more than 110 independent signals for multiple sclerosis […]

  • Adalimumab in the Treatment of Uveitis in Juvenile Idiopathic Arthritis
    Posted on April 27, 2017 at 12:00 am

    Uveitis encompasses a collection of ocular diseases that are characterized by intraocular inflammation and categorized according to the anatomical location of the inflammation in the eye. In the United States, uveitis is estimated to be the fifth or sixth leading cause of blindness and affects a […]

  • A Bare-Bones Approach
    Posted on April 6, 2017 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 60-year-old woman with type 1 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • Under Our Noses
    Posted by Wicks I. on June 20, 2017 at 12:00 am

    Right under our noses,in the breath-swept vestibules crowd the olfactory neurons,individual, in their invisible millions— wait for the volatile odorantsto arrive, like a fix on the breeze. […]

  • Typographical and Data Errors
    Posted on June 20, 2017 at 12:00 am

    In the Original Investigation entitled “Effect of Oral Iron Repletion on Exercise Capacity in Patients With Heart Failure With Reduced Ejection Fraction and Iron Deficiency: the IRONOUT HF Randomized Clinical Trial,” published in the May 16, 2017, issue of JAMA, there were typographical errors in the text and errors in the data. In the Primary End Point section of the text, the fourth sentence should read “Between-group differences in change in peak Vo2….” In footnote f of Table 1, the reference range for ferritin should read “100-300 ng/mL.” In the […]

  • Chronic Pain in the Aftermath of the Opioid Backlash
    Posted by Kroenke K, Cheville A. on June 20, 2017 at 12:00 am

    This Viewpoint argues that abandoning opioids on principal may be premature and could harm patients successfully treating their chronic pain with opioids. […]

  • Temporal Changes in Later Cancers Among Childhood Cancer Survivors
    Posted by Tanimoto T, Tsuda K, Mori J. on June 20, 2017 at 12:00 am

    To the Editor Dr Turcotte and colleagues found that cumulative incidence rates of subsequent malignancies at 15 years after initial childhood cancer diagnosis were lower among survivors treated in more recent treatment eras and that lower risk was associated with reduced therapeutic radiation dose. […]

  • The Primary Care of Patients With Chronic Pain
    Posted by Schneiderhan J, Clauw D, Schwenk TL. on June 20, 2017 at 12:00 am

    This Viewpoint advocates for reducing opioid misuse among primary care patients with chronic pain through a comprehensive approach emphasizing shared decision making, nonpharmacological treatments, nonopioid therapy, and a focus on functional improvement rather than pain elimination. […]

  • Podoconiosis Is the Diagnosis
    Posted by Friedrich MJ. on June 20, 2017 at 12:00 am

    An uptick in foot and leg deformities thought to be caused by elephantiasis in western Uganda was actually the result of podoconiosis, a noninfectious form of elephantiasis that is caused by walking barefoot in volcanic soils, report a team of Ugandan researchers. […]

  • What Is Permitted in Text Messaging About Protected Health Information?
    Posted by Drolet BC. on June 20, 2017 at 12:00 am

    This Viewpoint discusses the best use of texting clinical information, noting that neither Health Insurance Portability and Accountability Act nor the Health Information Technology for Economic and Clinical Health Act offer specific guidelines. […]

  • Highlights for June 20, 2017
    Posted on June 20, 2017 at 12:00 am

    […]

  • The Next Generation of Episode-Based Payments
    Posted by Navathe AS, Song Z, Emanuel EJ. on June 20, 2017 at 12:00 am

    This Viewpoint discusses bundled payment models and suggests ways in which the next generation of episode-based payments can better align with population health. […]

  • Nonreproducibility of Preclinical Research
    Posted by Goldschmidt PG. on June 20, 2017 at 12:00 am

    To the Editor In his Viewpoint, Dr Ioannidis highlighted the seriousness of the nonreproducibility of preclinical research and suggested various ways to improve the situation. Two points are of concern. First, he wrote that “Overall, basic and preclinical research probably have a much larger challenge of nonreproducibility than clinical research.” The reverse is more likely to be true. Clinical research may be infeasible to reproduce for at least 2 reasons: the cost of doing so may be prohibitive and both background and foreground conditions may be impossible to replicate […]

  • Speak Up
    Posted by Merrill DG. on June 20, 2017 at 12:00 am

    When is the last time that your clinic was running behind and you met a patient by apologizing that you were late, only to have her angrily tell you that this delay occurred “because you are not an American”? […]

  • Blood-clotting Drug Saves Lives During Childbirth
    Posted by Friedrich MJ. on June 20, 2017 at 12:00 am

    An inexpensive generic blood-clotting drug called tranexamic acid (TXA) reduced death due to postpartum hemorrhage—the leading cause of maternal death worldwide—with no adverse effects, according to a report from an international team of researchers. […]

  • Losing Weight During the Postpartum Period
    Posted by Tsai A, Nicholson WK. on June 20, 2017 at 12:00 am

    The postpartum period is one of the critical time points in a woman’s life that often places her at risk for obesity and obesity-related health conditions. Postpartum weight retention (defined as a retained weight of 4.5 kg at 6-12 months after delivery) affects an estimated 25% of the 4 million women in the United States who give birth each year. Although all women are at risk for postpartum weight retention, those who are African American, Hispanic, receive a lower income, or live in certain geographical regions (South and Midwest) are at particularly high risk for weight retention […]

  • Immunotherapy for Bladder Cancer
    Posted by Voelker R. on June 20, 2017 at 12:00 am

    Several weeks after approving avelumab to treat a rare form of skin cancer, the FDA authorized its use for patients with locally advanced or metastatic urothelial cancer who haven’t responded to platinum-based chemotherapy. […]

  • Cetuximab or Bevacizumab With First-Line Chemotherapy in Advanced KRAS Wild-Type Colorectal Cancer No Difference, but Not the Same
    Posted by Lieu CH, Messersmith WA. on June 20, 2017 at 12:00 am

    In the United States in 2017, there are projected to be 135 430 individuals newly diagnosed with colorectal cancer and 50 260 deaths from the disease with 18% to 22% having distant metastatic diseases at the time of diagnosis. Over the past decade or more, significant effort has been devoted to optimize first-line treatment for advanced and metastatic colorectal cancer. It has been established that overall survival is similar if patients are initially treated with FOLFOX (the combination of fluororuacil with leucovorin and oxaliplatin) or FOLFIRI (the combination of fluororuacil […]

  • Screening for Obesity in Children and Adolescents
    Posted by Jin J. on June 20, 2017 at 12:00 am

    […]

  • Context for the USPSTF Recommendation for Childhood Obesity Treatment
    Posted by Thornton RJ, Hernandez RG, Cheng TL. on June 20, 2017 at 12:00 am

    In this issue of JAMA, the US Preventive Services Task Force (USPSTF) recommends that clinicians screen for obesity in children and adolescents aged 6 to 18 years and refer those with an age- and sex-specific body mass index at the 95th percentile or greater to comprehensive, intensive behavioral interventions (B grade). This recommendation confirms what pediatric primary care clinicians and others do in the everyday care of children: monitor growth, counsel on healthy lifestyles, and refer when appropriate. Well-child care began with maternal education and use of child weighing stations in […]

  • Changes in Coronary Artery Plaque With Testosterone Therapy—Reply
    Posted by Budoff MJ, Ellenberg SS, Snyder PJ. on June 20, 2017 at 12:00 am

    In Reply We do not agree with Dr Dhindsa and colleagues that the increase in noncalcified plaque volume was confined to the fibrous component. Changes in that component did reach statistical significance, but changes in the other noncalcified plaque components were also greater in the testosterone group, although they did not reach statistical significance (P values of .11 and .14). Thus, the results for all 3 components were consistent. […]

  • Effect of an Internet-Based Weight Loss Program for Low-Income Postpartum Women
    Posted by Phelan S, Hagobian T, Brannen A, et al. on June 20, 2017 at 12:00 am

    This cluster randomized clinical trial assessed the effects of adding an internet-based weight loss intervention program to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC program) on weight loss over 12 months among low-income, postpartum women. […]

  • Temporal Changes in Later Cancers Among Childhood Cancer Survivors—Reply
    Posted by Turcotte LM, Yasui Y, Neglia JP. on June 20, 2017 at 12:00 am

    In Reply Dr Tanimoto and colleagues query whether treatment with HCT was considered in our analysis of temporal changes in subsequent neoplasms in the Childhood Cancer Survivor Study (CCSS). They raise the point that treatment modalities used in the context of HCT, such as the dose and intensity of chemotherapy, total body irradiation, or both, are unique and also point out the potential importance of chronic GVHD as a risk factor for subsequent neoplasms. […]

  • Effect of Adding Cetuximab vs Bevacizumab to Chemotherapy for KRAS Wild-Type Colorectal Cancer
    Posted by Venook AP, Niedzwiecki D, Lenz H, et al. on June 20, 2017 at 12:00 am

    This randomized clinical trial compares the effect of adding bevacizumab vs cetuximab to standard chemotherapy regimens on overall survival among patients with advanced or metastatic KRAS wild-type colorectal cancer. […]

  • Nonreproducibility of Preclinical Research—Reply
    Posted by Ioannidis JA. on June 20, 2017 at 12:00 am

    In Reply I agree with Dr Goldschmidt that basic and preclinical research, in principle, should be easier to reproduce than clinical research. When I said that “basic and preclinical research probably have a much larger challenge of nonreproducibility,” I meant that unfortunately they show an excess of nonreproducibility problems, not that they are justified to show such an excess. There can be exceptions; eg, some basic and preclinical questions and experimental systems are very complex and may pose special difficulties to reproduce. However, on average it should be easier to […]

  • Risks of Breast, Ovarian, and Contralateral Breast Cancer Among BRCA Mutation Carriers
    Posted by Kuchenbaecker KB, Hopper JL, Barnes DR, et al. on June 20, 2017 at 12:00 am

    This cohort study estimates age-specific risks of breast, ovarian, and contralateral breast cancer among carriers of BRCA1 and BRCA2 mutations and evaluates risk modification by family cancer history and location of the mutation within the BRCA gene. […]

  • Junk Food Ads and Child Obesity
    Posted by Abbasi J. on June 20, 2017 at 12:00 am

    This Medical News article reveals how the food industry markets unhealthful products to kids. […]

  • USPSTF Recommendation: Screening for Obesity in Children and Adolescents
    Posted by , Grossman DC, Bibbins-Domingo K, et al. on June 20, 2017 at 12:00 am

    This Recommendation Statement from the US Preventive Services Task Force recommends that clinicians screen for obesity in children and adolescents 6 years and older and offer or refer them to comprehensive, intensive behavioral interventions to promote improvements in weight (B recommendation). […]

  • Cholera Vaccine Safe During Pregnancy
    Posted by Friedrich MJ. on June 20, 2017 at 12:00 am

    Women in Malawi who received a cholera vaccine during pregnancy did not have a higher risk of pregnancy loss or neonatal mortality, according to an observational cohort study carried out by researchers from the United States and Malawi. […]

  • USPSTF Evidence Report: Screening for Obesity in Children and Youth
    Posted by O’Connor EA, Evans CV, Burda BU, et al. on June 20, 2017 at 12:00 am

    This Evidence Report and systematic review to support the 2017 US Preventive Services Task Force Recommendation Statement on screening for obesity summarizes current evidence on the benefits and harms of screening and treatment for obesity and overweight in children and adolescents. […]

  • Antioxidant Drug Approved for ALS
    Posted by Voelker R. on June 20, 2017 at 12:00 am

    A drug that was approved 2 years ago in Japan and South Korea for patients with amyotrophic lateral sclerosis (ALS) now is FDA approved for the same indication. Edaravone is the first ALS drug to gain approval since the agency sanctioned riluzole in 1995. […]

  • Phenytoin Toxicity—A Significant Adverse Drug Event
    Posted by Gupta A, Yek C, Hendler RS. on June 20, 2017 at 12:00 am

    This JAMA Performance Improvement article uses the case of a patient with iatrogenic phenytoin toxicity due to an excess prescribed dosage to discuss proper handling and reporting of significant adverse drug events. […]

  • Warnings for Anesthetic Drugs
    Posted by Voelker R. on June 20, 2017 at 12:00 am

    The FDA recently approved label changes warning of risks when general anesthetic and sedation medications are used in young children and pregnant women during their third trimester. […]

  • Trends in Use of High-Dose Vitamin D Supplements, 1999-2014
    Posted by Rooney MR, Harnack L, Michos ED, et al. on June 20, 2017 at 12:00 am

    This study uses NHANES data to assess trends in supplemental vitamin D intake of 1000 IU or more and 4000 IU or more daily between 1999 and 2014. […]

  • The Patent Laws and Patent Office Practice
    Posted on June 20, 2017 at 12:00 am

    The inequity of our patent laws, or possibly it would be more correct to say, of the interpretation of our patent laws, has been commented on many times in The Journal. The Journal also has had occasion to call attention to patents that have been issued for obviously unscientific and quackish devices and preparations. The cases of the preposterous gas-pipe fake “Oxydonor” and the creatinin mixture for the alleged conferring of immunity against diphtheria, pneumonia, scarlet fever, syphilis, tuberculosis, etc., are cases in point. […]

  • Changes in Coronary Artery Plaque With Testosterone Therapy
    Posted by Dhindsa S, Wilson MF, Dandona P. on June 20, 2017 at 12:00 am

    To the Editor Dr Budoff and colleagues demonstrated that testosterone therapy compared with placebo in elderly men for 1 year increased noncalcified plaque volume in coronary arteries as measured by computed tomographic angiography. An analysis of the individual components revealed that the increase was confined to the fibrous component of the plaque, which provides for plaque stability. Fatty and necrotic portions, characterized by low attenuation and indicative of a vulnerable plaque, as well as calcified plaque volume did not alter. Thus, testosterone therapy may have resulted in […]

  • JAMA
    Posted on June 20, 2017 at 12:00 am

    […]

  • Coronary-Artery Vasospasm
    Posted on June 22, 2017 at 12:00 am

    Figure 1. […]

  • Post-Traumatic Stress Disorder
    Posted on June 22, 2017 at 12:00 am

    Reports of violence, injury, and death appear daily on headline news. More than 70% of adults worldwide experience a traumatic event at some time in their lives, and 31% experience four or more events. Post-traumatic stress disorder (PTSD) is the most prevalent psychopathological consequence of […]

  • Case 19-2017 — A 53-Year-Old Woman with Leg Numbness and Weakness
    Posted on June 22, 2017 at 12:00 am

    Presentation of Case. Dr. Kristyn M. Spera (Neurology): A 53-year-old woman with rheumatoid arthritis was admitted to this hospital because of progressive asymmetric hypoesthesia and weakness in the legs. The patient had been in her usual health until 4 months before this admission, when […]

  • Efficacy of Recombinant Influenza Vaccine in Adults 50 Years of Age or Older
    Posted on June 22, 2017 at 12:00 am

    Reducing the burden of influenza disease requires improved vaccines, and a recombinant influenza vaccine may contribute to this public-health goal. This vaccine contains recombinant hemagglutinin (HA) proteins produced in a serum-free medium by expresSF+ cells. These cells contain recombinant […]

  • Perirenal Extramedullary Hematopoiesis
    Posted on June 22, 2017 at 12:00 am

    Figure 1. […]

  • Implementation of Medical Homes in Federally Qualified Health Centers
    Posted on June 21, 2017 at 12:00 am

    A strong primary care delivery system is critical to improving population health and controlling health care spending. The use of the patient-centered medical home — a care-delivery model that emphasizes enhanced access along with comprehensive and coordinated primary care — has spread widely […]

  • Strongyloides stercoralis Hyperinfection
    Posted on June 15, 2017 at 12:00 am

    Figure 1. […]

  • Case 18-2017 — An 11-Year-Old Girl with Difficulty Eating after a Choking Incident
    Posted on June 15, 2017 at 12:00 am

    Presentation of Case. Dr. Lazaro V. Zayas (Psychiatry): An 11-year-old girl was seen in an outpatient clinic of this hospital because of difficulty eating solid food and associated weight loss after an acute choking incident. The patient had been in her usual health until 14 days before this […]

  • Diabetic Foot Ulcers and Their Recurrence
    Posted on June 15, 2017 at 12:00 am

    Complications of diabetes that affect the lower extremities are common, complex, and costly. Foot ulceration is the most frequently recognized complication. In a community-based study in the northwestern United Kingdom, the prevalence of active foot ulcers identified at screening among persons wit […]

  • A Tale of Two Doctors — Structural Inequalities and the Culture of Medicine
    Posted on June 15, 2017 at 12:00 am

    I recently had two doctor’s appointments in the same week, one in general medicine and the other in orthopedics, both at the same highly ranked medical institution. Occurring so close together, these visits quickly morphed in my mind from personal experiences with individual doctors into metaphors […]

  • The Waiting Game — Why Providers May Fail to Reduce Wait Times
    Posted on June 15, 2017 at 12:00 am

    When patients wait weeks or months for physician’s appointments, bad things happen. Some adverse consequences are emotional: patients become anxious and even angry. Some are clinical, such as medical issues that worsen, especially if patients don’t show up when their appointments finally ro […]

  • Seesaw Nystagmus
    Posted on June 15, 2017 at 12:00 am

    Figure 1. […]

  • Case 17-2017: A 14-Year-Old Boy with Acute Fear of Choking while Swallowing
    Posted on June 8, 2017 at 12:00 am

    Presentation of Case. Dr. Juliana Mariani (Pediatrics): A 14-year-old boy was seen in the emergency department of this hospital because of fear of choking while swallowing. The patient had been well until 2 days before admission, when he choked while eating a piece of chicken during dinner. H […]

  • Management of Septic Shock
    Posted on June 8, 2017 at 12:00 am

    Ms. Jones has been admitted to the ICU with septic shock and is receiving vasopressors to elevate her mean arterial pressure. Shortly after her arrival, her condition deteriorates, and intubation and mechanical ventilation are initiated because of acute lung injury. The increased lactate level and […]

  • Large Arachnoid Cyst
    Posted on June 8, 2017 at 12:00 am

    Figure 1. […]

  • Social Anxiety Disorder
    Posted on June 8, 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 26-year-old […]

  • Health Effects of Dramatic Societal Events — Ramifications of the Recent Presidential Election
    Posted on June 8, 2017 at 12:00 am

    A small but growing body of evidence suggests that election campaigns can have both positive and negative effects on health. Campaigns that give voice to the disenfranchised have been shown to have positive but short-term effects on health. Such associations have been observed among black Sout […]

  • Mondor’s Disease
    Posted on June 8, 2017 at 12:00 am

    Figure 1. […]

  • Spiraling Out of Control
    Posted on June 1, 2017 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 22-year-old man presented to t […]

  • The Other Victims of the Opioid Epidemic
    Posted on June 1, 2017 at 12:00 am

    I’d seen Jerry in pain before, but never like this. He lay prostrate on the gurney in the emergency department, his hands clenched in silent prayer. I laid an apologetic hand on his shoulder and told him we would do what we could to help. Then I logged in to the bedside computer to order his pain […]

  • Under Our Noses
    Posted by Wicks I. on June 20, 2017 at 12:00 am

    Right under our noses,in the breath-swept vestibules crowd the olfactory neurons,individual, in their invisible millions— wait for the volatile odorantsto arrive, like a fix on the breeze. […]

  • Typographical and Data Errors
    Posted on June 20, 2017 at 12:00 am

    In the Original Investigation entitled “Effect of Oral Iron Repletion on Exercise Capacity in Patients With Heart Failure With Reduced Ejection Fraction and Iron Deficiency: the IRONOUT HF Randomized Clinical Trial,” published in the May 16, 2017, issue of JAMA, there were typographical errors in the text and errors in the data. In the Primary End Point section of the text, the fourth sentence should read “Between-group differences in change in peak Vo2….” In footnote f of Table 1, the reference range for ferritin should read “100-300 ng/mL.” In the […]

  • Chronic Pain in the Aftermath of the Opioid Backlash
    Posted by Kroenke K, Cheville A. on June 20, 2017 at 12:00 am

    This Viewpoint argues that abandoning opioids on principal may be premature and could harm patients successfully treating their chronic pain with opioids. […]

  • Temporal Changes in Later Cancers Among Childhood Cancer Survivors
    Posted by Tanimoto T, Tsuda K, Mori J. on June 20, 2017 at 12:00 am

    To the Editor Dr Turcotte and colleagues found that cumulative incidence rates of subsequent malignancies at 15 years after initial childhood cancer diagnosis were lower among survivors treated in more recent treatment eras and that lower risk was associated with reduced therapeutic radiation dose. […]

  • The Primary Care of Patients With Chronic Pain
    Posted by Schneiderhan J, Clauw D, Schwenk TL. on June 20, 2017 at 12:00 am

    This Viewpoint advocates for reducing opioid misuse among primary care patients with chronic pain through a comprehensive approach emphasizing shared decision making, nonpharmacological treatments, nonopioid therapy, and a focus on functional improvement rather than pain elimination. […]

  • Podoconiosis Is the Diagnosis
    Posted by Friedrich MJ. on June 20, 2017 at 12:00 am

    An uptick in foot and leg deformities thought to be caused by elephantiasis in western Uganda was actually the result of podoconiosis, a noninfectious form of elephantiasis that is caused by walking barefoot in volcanic soils, report a team of Ugandan researchers. […]

  • What Is Permitted in Text Messaging About Protected Health Information?
    Posted by Drolet BC. on June 20, 2017 at 12:00 am

    This Viewpoint discusses the best use of texting clinical information, noting that neither Health Insurance Portability and Accountability Act nor the Health Information Technology for Economic and Clinical Health Act offer specific guidelines. […]

  • Highlights for June 20, 2017
    Posted on June 20, 2017 at 12:00 am

    […]

  • The Next Generation of Episode-Based Payments
    Posted by Navathe AS, Song Z, Emanuel EJ. on June 20, 2017 at 12:00 am

    This Viewpoint discusses bundled payment models and suggests ways in which the next generation of episode-based payments can better align with population health. […]

  • Nonreproducibility of Preclinical Research
    Posted by Goldschmidt PG. on June 20, 2017 at 12:00 am

    To the Editor In his Viewpoint, Dr Ioannidis highlighted the seriousness of the nonreproducibility of preclinical research and suggested various ways to improve the situation. Two points are of concern. First, he wrote that “Overall, basic and preclinical research probably have a much larger challenge of nonreproducibility than clinical research.” The reverse is more likely to be true. Clinical research may be infeasible to reproduce for at least 2 reasons: the cost of doing so may be prohibitive and both background and foreground conditions may be impossible to replicate […]

  • Speak Up
    Posted by Merrill DG. on June 20, 2017 at 12:00 am

    When is the last time that your clinic was running behind and you met a patient by apologizing that you were late, only to have her angrily tell you that this delay occurred “because you are not an American”? […]

  • Blood-clotting Drug Saves Lives During Childbirth
    Posted by Friedrich MJ. on June 20, 2017 at 12:00 am

    An inexpensive generic blood-clotting drug called tranexamic acid (TXA) reduced death due to postpartum hemorrhage—the leading cause of maternal death worldwide—with no adverse effects, according to a report from an international team of researchers. […]

  • Losing Weight During the Postpartum Period
    Posted by Tsai A, Nicholson WK. on June 20, 2017 at 12:00 am

    The postpartum period is one of the critical time points in a woman’s life that often places her at risk for obesity and obesity-related health conditions. Postpartum weight retention (defined as a retained weight of 4.5 kg at 6-12 months after delivery) affects an estimated 25% of the 4 million women in the United States who give birth each year. Although all women are at risk for postpartum weight retention, those who are African American, Hispanic, receive a lower income, or live in certain geographical regions (South and Midwest) are at particularly high risk for weight retention […]

  • Immunotherapy for Bladder Cancer
    Posted by Voelker R. on June 20, 2017 at 12:00 am

    Several weeks after approving avelumab to treat a rare form of skin cancer, the FDA authorized its use for patients with locally advanced or metastatic urothelial cancer who haven’t responded to platinum-based chemotherapy. […]

  • Cetuximab or Bevacizumab With First-Line Chemotherapy in Advanced KRAS Wild-Type Colorectal Cancer No Difference, but Not the Same
    Posted by Lieu CH, Messersmith WA. on June 20, 2017 at 12:00 am

    In the United States in 2017, there are projected to be 135 430 individuals newly diagnosed with colorectal cancer and 50 260 deaths from the disease with 18% to 22% having distant metastatic diseases at the time of diagnosis. Over the past decade or more, significant effort has been devoted to optimize first-line treatment for advanced and metastatic colorectal cancer. It has been established that overall survival is similar if patients are initially treated with FOLFOX (the combination of fluororuacil with leucovorin and oxaliplatin) or FOLFIRI (the combination of fluororuacil […]

  • Screening for Obesity in Children and Adolescents
    Posted by Jin J. on June 20, 2017 at 12:00 am

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  • Context for the USPSTF Recommendation for Childhood Obesity Treatment
    Posted by Thornton RJ, Hernandez RG, Cheng TL. on June 20, 2017 at 12:00 am

    In this issue of JAMA, the US Preventive Services Task Force (USPSTF) recommends that clinicians screen for obesity in children and adolescents aged 6 to 18 years and refer those with an age- and sex-specific body mass index at the 95th percentile or greater to comprehensive, intensive behavioral interventions (B grade). This recommendation confirms what pediatric primary care clinicians and others do in the everyday care of children: monitor growth, counsel on healthy lifestyles, and refer when appropriate. Well-child care began with maternal education and use of child weighing stations in […]

  • Changes in Coronary Artery Plaque With Testosterone Therapy—Reply
    Posted by Budoff MJ, Ellenberg SS, Snyder PJ. on June 20, 2017 at 12:00 am

    In Reply We do not agree with Dr Dhindsa and colleagues that the increase in noncalcified plaque volume was confined to the fibrous component. Changes in that component did reach statistical significance, but changes in the other noncalcified plaque components were also greater in the testosterone group, although they did not reach statistical significance (P values of .11 and .14). Thus, the results for all 3 components were consistent. […]

  • Effect of an Internet-Based Weight Loss Program for Low-Income Postpartum Women
    Posted by Phelan S, Hagobian T, Brannen A, et al. on June 20, 2017 at 12:00 am

    This cluster randomized clinical trial assessed the effects of adding an internet-based weight loss intervention program to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC program) on weight loss over 12 months among low-income, postpartum women. […]

  • Temporal Changes in Later Cancers Among Childhood Cancer Survivors—Reply
    Posted by Turcotte LM, Yasui Y, Neglia JP. on June 20, 2017 at 12:00 am

    In Reply Dr Tanimoto and colleagues query whether treatment with HCT was considered in our analysis of temporal changes in subsequent neoplasms in the Childhood Cancer Survivor Study (CCSS). They raise the point that treatment modalities used in the context of HCT, such as the dose and intensity of chemotherapy, total body irradiation, or both, are unique and also point out the potential importance of chronic GVHD as a risk factor for subsequent neoplasms. […]

  • Effect of Adding Cetuximab vs Bevacizumab to Chemotherapy for KRAS Wild-Type Colorectal Cancer
    Posted by Venook AP, Niedzwiecki D, Lenz H, et al. on June 20, 2017 at 12:00 am

    This randomized clinical trial compares the effect of adding bevacizumab vs cetuximab to standard chemotherapy regimens on overall survival among patients with advanced or metastatic KRAS wild-type colorectal cancer. […]

  • Nonreproducibility of Preclinical Research—Reply
    Posted by Ioannidis JA. on June 20, 2017 at 12:00 am

    In Reply I agree with Dr Goldschmidt that basic and preclinical research, in principle, should be easier to reproduce than clinical research. When I said that “basic and preclinical research probably have a much larger challenge of nonreproducibility,” I meant that unfortunately they show an excess of nonreproducibility problems, not that they are justified to show such an excess. There can be exceptions; eg, some basic and preclinical questions and experimental systems are very complex and may pose special difficulties to reproduce. However, on average it should be easier to […]

  • Risks of Breast, Ovarian, and Contralateral Breast Cancer Among BRCA Mutation Carriers
    Posted by Kuchenbaecker KB, Hopper JL, Barnes DR, et al. on June 20, 2017 at 12:00 am

    This cohort study estimates age-specific risks of breast, ovarian, and contralateral breast cancer among carriers of BRCA1 and BRCA2 mutations and evaluates risk modification by family cancer history and location of the mutation within the BRCA gene. […]

  • Junk Food Ads and Child Obesity
    Posted by Abbasi J. on June 20, 2017 at 12:00 am

    This Medical News article reveals how the food industry markets unhealthful products to kids. […]

  • USPSTF Recommendation: Screening for Obesity in Children and Adolescents
    Posted by , Grossman DC, Bibbins-Domingo K, et al. on June 20, 2017 at 12:00 am

    This Recommendation Statement from the US Preventive Services Task Force recommends that clinicians screen for obesity in children and adolescents 6 years and older and offer or refer them to comprehensive, intensive behavioral interventions to promote improvements in weight (B recommendation). […]

  • Cholera Vaccine Safe During Pregnancy
    Posted by Friedrich MJ. on June 20, 2017 at 12:00 am

    Women in Malawi who received a cholera vaccine during pregnancy did not have a higher risk of pregnancy loss or neonatal mortality, according to an observational cohort study carried out by researchers from the United States and Malawi. […]

  • USPSTF Evidence Report: Screening for Obesity in Children and Youth
    Posted by O’Connor EA, Evans CV, Burda BU, et al. on June 20, 2017 at 12:00 am

    This Evidence Report and systematic review to support the 2017 US Preventive Services Task Force Recommendation Statement on screening for obesity summarizes current evidence on the benefits and harms of screening and treatment for obesity and overweight in children and adolescents. […]

  • Antioxidant Drug Approved for ALS
    Posted by Voelker R. on June 20, 2017 at 12:00 am

    A drug that was approved 2 years ago in Japan and South Korea for patients with amyotrophic lateral sclerosis (ALS) now is FDA approved for the same indication. Edaravone is the first ALS drug to gain approval since the agency sanctioned riluzole in 1995. […]

  • Phenytoin Toxicity—A Significant Adverse Drug Event
    Posted by Gupta A, Yek C, Hendler RS. on June 20, 2017 at 12:00 am

    This JAMA Performance Improvement article uses the case of a patient with iatrogenic phenytoin toxicity due to an excess prescribed dosage to discuss proper handling and reporting of significant adverse drug events. […]

  • Warnings for Anesthetic Drugs
    Posted by Voelker R. on June 20, 2017 at 12:00 am

    The FDA recently approved label changes warning of risks when general anesthetic and sedation medications are used in young children and pregnant women during their third trimester. […]

  • Trends in Use of High-Dose Vitamin D Supplements, 1999-2014
    Posted by Rooney MR, Harnack L, Michos ED, et al. on June 20, 2017 at 12:00 am

    This study uses NHANES data to assess trends in supplemental vitamin D intake of 1000 IU or more and 4000 IU or more daily between 1999 and 2014. […]

  • The Patent Laws and Patent Office Practice
    Posted on June 20, 2017 at 12:00 am

    The inequity of our patent laws, or possibly it would be more correct to say, of the interpretation of our patent laws, has been commented on many times in The Journal. The Journal also has had occasion to call attention to patents that have been issued for obviously unscientific and quackish devices and preparations. The cases of the preposterous gas-pipe fake “Oxydonor” and the creatinin mixture for the alleged conferring of immunity against diphtheria, pneumonia, scarlet fever, syphilis, tuberculosis, etc., are cases in point. […]

  • Changes in Coronary Artery Plaque With Testosterone Therapy
    Posted by Dhindsa S, Wilson MF, Dandona P. on June 20, 2017 at 12:00 am

    To the Editor Dr Budoff and colleagues demonstrated that testosterone therapy compared with placebo in elderly men for 1 year increased noncalcified plaque volume in coronary arteries as measured by computed tomographic angiography. An analysis of the individual components revealed that the increase was confined to the fibrous component of the plaque, which provides for plaque stability. Fatty and necrotic portions, characterized by low attenuation and indicative of a vulnerable plaque, as well as calcified plaque volume did not alter. Thus, testosterone therapy may have resulted in […]

  • JAMA
    Posted on June 20, 2017 at 12:00 am

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