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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 […]

  • 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 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 […]

  • 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 […]

  • Redefining Acute Coronary Syndrome Therapy
    Posted by Slomski A. on May 23, 2017 at 12:00 am

    Patients with acute coronary syndromes who received a low dose of the oral anticoagulant rivaroxaban, when substituted for aspirin in dual antiplatelet therapy (DAPT), had a similar risk of clinically significant bleeding as patients receiving standard DAPT in a phase 2 trial published in The Lancet. Nearly 10% of patients treated with standard DAPT therapy—aspirin combined with P2Y12 inhibitors clopidogrel or ticagrelor—still experience major cardiovascular events. Research is addressing the possibility of adding antithrombotic agents such as rivaroxaban to aspirin and […]

  • Race vs Burden in Understanding Health Equity
    Posted by Hardeman RR, Medina EM, Kozhimannil KB. on May 23, 2017 at 12:00 am

    To the Editor Dr Kindig discussed the concepts of rate and burden in terms of population health equity. We question several of the concepts put forth in his Viewpoint. […]

  • Moving Beyond Medication Reconcilliation to Correct Medication Lists
    Posted by Rose AJ, Fischer SH, Paasche-Orlow MK. on May 23, 2017 at 12:00 am

    This Viewpoint argues that conventional definitions of medication reconciliation overlook the need to identify the correct list of medicines for patients, and discusses the challenges involved in defining who should be involved in defining and maintaining that list.. […]

  • Missed Appointment
    Posted by Butka B. on May 23, 2017 at 12:00 am

    supposed to comeat one, did not but his chart said surfing accidentmexico, broken neck,unmoving, a young manthe story is never really new […]

  • FDA Approval of Desmopressin for Nocturia
    Posted by Fralick M, Kesselheim AS. on May 23, 2017 at 12:00 am

    This Viewpoint uses the example of the US FDA’s 2017 approval of desmopressin for treatment of nocturia to discuss the risks of approving a drug for symptoms rather than disease and the ways that the drug approval process is influenced by manufacturers and by overreliance on statistical vs clinical significance. […]

  • Missing Author Middle Initial
    Posted on May 23, 2017 at 12:00 am

    In the Preliminary Communication entitled “Effect of Moderate-Intensity Exercise Training on Peak Oxygen Consumption in Patients With Hypertrophic Cardiomyopathy: A Randomized Clinical Trial” published in the April 4, 2017, issue of JAMA, an author’s middle initial was omitted. In the byline, “Jonathan Herrera” should have appeared as “Jonathan J. Herrera.” This article has been corrected online. […]

  • Single IRBs in Multisite Trials
    Posted by Klitzman R, Pivovarova E, Lidz CW. on May 23, 2017 at 12:00 am

    This Viewpoint describes measures needed for an effective NIH policy in which a single IRB would work with multiple local IRBs to ensure protection of participants in multisite trials. […]

  • Increase in Diabetes Cases Among Youth
    Posted by Abbasi J. on May 23, 2017 at 12:00 am

    The incidence of both type 1 and type 2 diabetes in US youth younger than 20 years increased between 2002 and 2012, according to a new analysis from the ongoing SEARCH for Diabetes in Youth study, which is funded by the Centers for Disease Control and Prevention and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) at the National Institutes of Health. […]

  • Changing Mindsets to Enhance Treatment Effectiveness
    Posted by Crum A, Zuckerman B. on May 23, 2017 at 12:00 am

    This Viewpoint defines mindsets—frames of mind that orient beliefs or expectations—discusses how they can influence patients’ perceptions about treatment and self-efficacy, and proposes ways physicians might shape patients’ mindsets during clinical encounters to enhance treatment effectiveness. […]

  • Highlights for May 23, 2017
    Posted on May 23, 2017 at 12:00 am

    […]

  • Finding Joy in Practice
    Posted by Kirkland KB. on May 23, 2017 at 12:00 am

    Four years ago, after nearly 20 years in practice, I walked out of the familiar world of infectious disease and into the world of palliative care. In the world I left, I cared for hundreds of patients, educated countless learners, led dozens of infection prevention efforts. But that world felt increasingly superficial, fragmented, isolated, a hard place to find joy and meaning in my work. […]

  • Error in Text
    Posted on May 23, 2017 at 12:00 am

    In the Reply Letter entitled “Estimating the Prevalence of Sexual Minority Adolescents,” published in the April 25, 2017, issue of JAMA, there were errors in the text. The first sentence in the final paragraph reads “The sampling frame for the national YRBS consists of grades 9 through 12 of all public and private schools in the United States and….” This is not accurate and should read “The sampling frame for the national YRBS consists of all public and private schools in the United States with any of grades 9 through 12, and….” There were […]

  • Treatment of Macular Edema Due to Central Retinal Vein Occlusion
    Posted by Bressler NM. on May 23, 2017 at 12:00 am

    Central retinal or hemiretinal vein occlusion, due to a thrombus at an arteriovenous crossing within the optic nerve, is a common disease of the retinal vasculature, the blood supply to the inner layers of the retina that are closest to the vitreous cavity. Central retinal vein occlusion sometimes has been described as a “blood and thunder” appearance due to extensive flame-shaped hemorrhages throughout 2 (hemiretinal) or 4 quadrants of the retina and causes sudden vision loss in one eye when venous flow is acutely compromised. The vision loss at first may be due in part to blood […]

  • The Paternal Epigenome Makes Its Mark
    Posted by Abbasi J. on May 23, 2017 at 12:00 am

    This Medical News article discusses how epigentic changes in a father’s sperm may influence his descendants’ health. […]

  • Empirical MRSA Coverage for Nonpurulent Cellulitis
    Posted by Shuman EK, Malani PN. on May 23, 2017 at 12:00 am

    Cellulitis is an infection of the deep dermis and subcutaneous tissue, manifesting as expanding erythema, edema, and warmth of the skin. In most instances of cellulitis, the causative microorganism cannot be definitively determined. However, based on studies using blood cultures, other laboratory markers (anti–streptolysin O and anti–DNase B antibodies), and clinical response to β-lactam antimicrobials, the vast majority of cellulitis is thought to be caused by β-hemolytic streptococci. Staphylococci, including methicillin-resistant Staphylococcus aureus (MRSA), are a […]

  • Vitamin E and Selenium Fail to Prevent Dementia in Men
    Posted by Slomski A. on May 23, 2017 at 12:00 am

    Antioxidant supplementation with vitamin E and selenium, taken alone or in combination, was not associated with a decreased incidence of dementia in asymptomatic older men, according to a study published by JAMA Neurology. Oxidative stress has been implicated as an important mechanism in Alzheimer disease, spurring interest in the use of antioxidants to modify risk of cognitive decline and dementia. […]

  • Bevacizumab vs Aflibercept for Macular Edema Due to Retinal Vein Occlusion
    Posted by Scott IU, VanVeldhuisen PC, Ip MS, et al. on May 23, 2017 at 12:00 am

    This randomized clinical trial compares the effects of bevacizumab vs aflibercept on visual acuity among patients with macular edema due to central retinal or hemiretinal vein occlusion. […]

  • Effect of Crohn Disease Biologics
    Posted on May 23, 2017 at 12:00 am

    Biologics that were introduced in the mid-1990s to treat Crohn disease haven’t had the hoped-for effect of reducing remissions or hospitalizations, according to a new study. But the investigators suggested that the drugs might have reduced Crohn severity for many patients, leading to a decrease in small bowel resections from 2003 to 2013. […]

  • Cephalexin Plus Trimethoprim-Sulfamethoxazole for Clinical Cure of Cellulitis
    Posted by Moran GJ, Krishnadasan A, Mower WR, et al. on May 23, 2017 at 12:00 am

    This randomized trial compares the effects of cephalexin plus trimethoprim-sulfamethoxazole vs cephalexin alone on clinical cure rate among patients with uncomplicated cellulitis. […]

  • Cellulitis
    Posted by Linder KA, Malani PN. on May 23, 2017 at 12:00 am

    […]

  • Effects of Ferric Carboxymaltose On Postgastrectomy Anemia
    Posted by Kim Y, Bae J, Park Y, et al. on May 23, 2017 at 12:00 am

    This randomized clinical trial compares the efficacy and safety of ferric carboxymaltose vs saline to treat acute isovolemic anemia following gastrectomy. […]

  • Etelcalcetide vs Cinacalcet for Hyperparathyroidism
    Posted by Block GA, Chertow GM. on May 23, 2017 at 12:00 am

    In Reply Dr Hai and colleagues are concerned that the starting dose of etelcalcetide was 5 mg (not the lowest dose) whereas the starting dose of cinacalcet was 30 mg (the lowest dose). This clinical trial, using a double-dummy active control, dosed cinacalcet in strict accordance with the approved package insert and in a manner consistent with previous clinical trials of similar duration using similar biochemical end points. Our finding of a mean decrease in PTH of approximately 40% over 26 weeks in patients treated with cinacalcet is similar to findings of the phase 3 trials with cinacalcet […]

  • Association Between US Hospital Teaching Status and Mortality
    Posted by Burke LG, Frakt AB, Khullar D, et al. on May 23, 2017 at 12:00 am

    This study uses national Medicare data to compare 30-day mortality among patients hospitalized or undergoing surgical procedures in teaching vs nonteaching hospitals between 2012 and 2014. […]

  • Race vs Burden in Understanding Health EquityReply
    Posted by Kindig DA. on May 23, 2017 at 12:00 am

    In Reply I appreciate the attention Dr Hardeman and colleagues have given to my Viewpoint, but I do not believe that my position can be seen as pitting black individuals against white individuals, nor did I suggest that burden should be favored over rate differences. I agree that racism is a socially defined determinant of health and that structural racism needs to be seriously addressed as a component of population health policy. But considering burden along with rate uncovers the parallel structural classism that Isenberg chronicled in her book, White Trash: The 400-Year Untold History of […]

  • The Management of Depression in Older Adults
    Posted by Kok RM, Reynolds CF, III. on May 23, 2017 at 12:00 am

    This review offers guidance on medical and psychotherapeutic treatment options available for older frail patients with depression and who are taking several types of medications. […]

  • Incorrect Surgery Identified
    Posted on May 23, 2017 at 12:00 am

    In the Originial Investigation entitled “Association Between Radiation Therapy, Surgery, or Observation for Localized Prostate Cancer and Patient-Reported Outcomes After 3 Years” published in the March 21, 2017, issue of JAMA, the type of surgery patients had undergone was incorrectly identified. In the third paragraph of the Results section, the phrase that read “and of the 1032 (85%) who had complete reporting of the surgical approach, 1002 (77%) had bilateral nerve-sparing surgery” should have read “had robotic surgery.” This article was corrected online. […]

  • Evaluating Alternative Payment Models in Oncology
    Posted by Basch E. on May 23, 2017 at 12:00 am

    This commentary discusses a study published in JAMA Oncology that compared quality and cost outcomes for breast cancer care in Taiwan with a pay-for-performance bundled-payment program vs fee-for-service payment programs. […]

  • Percentage Error in Article
    Posted on May 23, 2017 at 12:00 am

    In the Original Investigation entitled “Effect of Palliative Care-Led Meetings for Families of Patients With Chronic Critical Illness: A Randomized Clinical Trial” published in the July 5, 2016, issue of JAMA, there was a percentage error in the article. In the Results section, third paragraph, the first sentence should read “Patient prognosis was discussed in 89% of the first support and information team meetings and 91% of the second meetings.” In addition, in eTable 2 in Supplement 2, the data for the patient’s condition and prognosis for the SIT-1 meeting […]

  • Facial Rash, Fever, and Anemia in a Newborn
    Posted by Shiiya C, Ota M. on May 23, 2017 at 12:00 am

    A 19-day-old Japanese male infant presented with a 12-day history of low-grade fevers and erythematous plaques with central atrophy and raised margins on the forehead and periorbital areas. Laboratory testing showed mild anemia and an elevated C-reactive protein level. What would you do next? […]

  • Is the Affordable Care Act Imploding?
    Posted by Levitt L. on May 23, 2017 at 12:00 am

    President Trump has said on various occasions that the Affordable Care Act (ACA) is imploding, exploding, or collapsing. […]

  • Hospital-Level Variation in Postpartum Readmissions
    Posted by Clapp MA, Little SE, Zheng J, et al. on May 23, 2017 at 12:00 am

    This study uses obstetric readmission rates from the 2013 National Readmission Database to describe hospital variance in postpartum readmissions and the percentage of variance attributed to hospital factors. […]

  • Therapies That Target PCSK9 Effective at Reducing LDL
    Posted by Slomski A. on May 23, 2017 at 12:00 am

    In a trial published recently in the New England Journal of Medicine (NEJM), evolocumab, a monoclonal antibody that inhibits circulating PCSK9 (proprotein convertase subtilisin-kexin type 9) by preventing it from binding to the low-density lipoprotein (LDL) receptor, was found to reduce LDL cholesterol and cardiovascular risk in patients with elevated cholesterol despite high-intensity statin therapy. […]

  • Intubation With Video Laryngoscopy vs Direct Laryngoscopy
    Posted by Loh N, Tan J. on May 23, 2017 at 12:00 am

    To the Editor The randomized clinical trial comparing video laryngoscopy with direct laryngoscopy found no between-group difference in successful first-pass intubation rates in patients in the intensive care unit (ICU), but concluded that use of video laryngoscopy was associated with higher rates of severe life-threatening complications. There are several issues we would like to highlight about the methods used and the statistical analysis. […]

  • Cancer Death Rates Decrease
    Posted by Abbasi J. on May 23, 2017 at 12:00 am

    Overall death rates from cancer are decreasing in the United States, according to the “Annual Report to the Nation on the Status of Cancer” issued by the Centers for Disease Control and Prevention, the National Cancer Institute, the American Cancer Society, and the North American Association of Central Cancer Registries. […]

  • Intubation With Video Laryngoscopy vs Direct Laryngoscopy
    Posted by Xue FS, Liu YY, Li HX. on May 23, 2017 at 12:00 am

    To the Editor In the recent study by Dr Lascarrou and colleagues comparing successful first-pass orotracheal intubation with video laryngoscopy vs direct laryngoscopy in patients in the ICU, we note several issues that were not well addressed. […]

  • National Academies Tackle Hepatitis B and C
    Posted by Abbasi J. on May 23, 2017 at 12:00 am

    Viral hepatitis accounts for more than 20 000 deaths annually in the United States. A new report from the National Academies of Sciences, Engineering, and Medicine provides a roadmap for ending these deaths and eliminating hepatitis B and C as public health problems by 2030. […]

  • Intubation With Video Laryngoscopy vs Direct Laryngoscopy
    Posted by Saddawi-Konefka D, Baker KH, Wiener-Kronish JP. on May 23, 2017 at 12:00 am

    To the Editor Dr Lascarrou and colleagues performed a randomized clinical trial comparing video laryngoscopy with direct laryngoscopy for first-pass success rates of orotracheal intubation in patients who were critically ill in the ICU. The first-pass success rate was not higher using video laryngoscopy. […]

  • Fentanyl-Fueled Overdoses
    Posted on May 23, 2017 at 12:00 am

    Data from 3 Massachusetts counties provide a glimpse into the role that the potent pain reliever fentanyl plays in the current opioid overdose epidemic. […]

  • Intubation With Video Laryngoscopy vs Direct Laryngoscopy—Reply
    Posted by Lascarrou J, Le Thuaut A, Reignier J. on May 23, 2017 at 12:00 am

    In Reply Drs Loh and Tan comment on the long duration of intubation using the video laryngoscope vs the laryngoscope. The time differed from previous studies because counting started at anesthesia induction. Duration of intubation is more accurately determined this way than at the beginning of laryngoscopy in which introduction of the (video) laryngoscope into the mouth is part of the intubation process and can be delayed or prolonged (eg, if mouth opening limitation is underestimated). The median intubation time of 3 minutes included the time needed for drugs to be injected and take action. […]

  • Anniversary of the National Nutrition Conference
    Posted on May 23, 2017 at 12:00 am

    The National Nutrition Conference called by President Roosevelt in May 1941 assembled diversified interests in the field of nutrition and stimulated the formulation of a national program. The responsibility for coordinating the programs and activities of public and private agencies, national, state and local, into a unified program for the promotion of better nutrition rests with the Office of Defense Health and Welfare Services, of which Federal Security Administrator Paul V. McNutt is director. M. L. Wilson is assistant director in charge of nutrition and Dr. W. H. Sebrell is deputy […]

  • Etelcalcetide and Cinacalcet for Hyperthyroidism
    Posted by Hai M, Guettier J, Rosebraugh CJ. on May 23, 2017 at 12:00 am

    To the Editor In the study by Dr Block and colleagues, the effect of etelcalcetide on reducing serum parathyroid hormone (PTH) levels in patients with secondary hyperparathyroidism receiving hemodialysis was compared with cinacalcet. This 26-week randomized, double-blind, double-dummy controlled trial was designed to demonstrate noninferiority between 2 calcimimetics for the primary end point of the proportion of patients achieving more than a 30% reduction in PTH levels from baseline. Demonstration of superiority on PTH reduction was a secondary end point. The authors concluded […]

  • JAMA
    Posted on May 23, 2017 at 12:00 am

    […]

  • Galloping Heart
    Posted on May 25, 2017 at 12:00 am

    Figure 1. […]

  • Case 16-2017 — A 69-Year-Old Woman with Urinary Incontinence
    Posted on May 25, 2017 at 12:00 am

    Presentation of Case. Dr. John O. Schorge: A 69-year-old woman was evaluated at the gynecologic oncology clinic of this hospital because of persistent urinary incontinence. Seven years before this evaluation, the patient had received a diagnosis of superficial bladder cancer (low grade), for whic […]

  • Medical Assistance in Dying — Implementing a Hospital-Based Program in Canada
    Posted on May 25, 2017 at 12:00 am

    An aging population and shifts in Western societies toward secularism, populism, and an emphasis on individual autonomy and personal control have fueled the movement to legalize assisted dying. It has now been legalized in some form in five European countries (the Netherlands, Belgium, Switzerland, […]

  • On the Cusp
    Posted on May 25, 2017 at 12:00 am

    A 27-year-old man presented to the emergency department with a 5-day history of fevers. One week before presentation, he began to have congestion, rhinorrhea, cough, and fatigue after exposure to a coworker who had an upper respiratory infection. At the same time, he noted an oral ulcer, whic […]

  • Auer Rods
    Posted on May 25, 2017 at 12:00 am

    Figure 1. […]

  • Acute Myocardial Infarction
    Posted on May 25, 2017 at 12:00 am

    Acute myocardial infarction with or without ST-segment elevation (STEMI or non-STEMI) is a common cardiac emergency, with the potential for substantial morbidity and mortality. The management of acute myocardial infarction has improved dramatically over the past three decades and continues to […]

  • Aerobic or Resistance Exercise, or Both, in Dieting Obese Older Adults
    Posted on May 18, 2017 at 12:00 am

    More than a third of persons 65 years of age or older in the United States are obese, and this group constitutes a population vulnerable to adverse outcomes, because obesity exacerbates the age-related decline in physical function and causes frailty. However, appropriate management of obesity in […]

  • Scarlet Fever
    Posted on May 18, 2017 at 12:00 am

    Figure 1. […]

  • Letter to a Young Female Physician
    Posted on May 18, 2017 at 12:00 am

    This past June, I participated in an orientation session during which new interns were asked to write self-addressed letters expressing their hopes and anxieties. The sealed envelopes were collected and then returned 6 months later, when I’m sure the interns felt encouraged to see how far they’d […]

  • 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 […]

  • Tuberous Sclerosis Complex
    Posted on May 18, 2017 at 12:00 am

    Figure 1. […]

  • Arteriovenous Malformations of the Brain
    Posted on May 11, 2017 at 12:00 am

    Arteriovenous malformations of the brain are congenital anomalies of the blood vessels that are derived from maldevelopment of the capillary network, allowing direct connections between cerebral arteries and veins. The most common presenting symptoms are cerebral hemorrhage and seizures. Foca […]

  • Melanoma of the Foot
    Posted on May 11, 2017 at 12:00 am

    Figure 1. […]

  • Binaural Tympanic-Membrane Perforations after Blast Injury
    Posted on May 11, 2017 at 12:00 am

    Figure 1. […]

  • 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, […]

  • Traumatic Spondylolisthesis of the Axis
    Posted on May 4, 2017 at 12:00 am

    Figure 1. […]

  • Fluorescein Guidance in Glioblastoma Resection
    Posted on May 4, 2017 at 12:00 am

    Figure 1. […]

  • 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 […]

  • Case 13-2017: A 41-Year-Old Man with Hearing Loss, Seizures, Weakness, and Cognitive Decline
    Posted on April 27, 2017 at 12:00 am

    Presentation of Case. Dr. Haatem M. Reda: A 41-year-old man was seen in the neurology clinic of this hospital because of seizures, weakness, and cognitive decline. The patient had a history of migraine headaches, sensorineural hearing loss, and chronic proteinuria. He had been in his usual healt […]

  • Physical Abuse of Children
    Posted on April 27, 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 author’s clinical recommendations. Stage. A 4-month-old […]

  • Redefining Acute Coronary Syndrome Therapy
    Posted by Slomski A. on May 23, 2017 at 12:00 am

    Patients with acute coronary syndromes who received a low dose of the oral anticoagulant rivaroxaban, when substituted for aspirin in dual antiplatelet therapy (DAPT), had a similar risk of clinically significant bleeding as patients receiving standard DAPT in a phase 2 trial published in The Lancet. Nearly 10% of patients treated with standard DAPT therapy—aspirin combined with P2Y12 inhibitors clopidogrel or ticagrelor—still experience major cardiovascular events. Research is addressing the possibility of adding antithrombotic agents such as rivaroxaban to aspirin and […]

  • Race vs Burden in Understanding Health Equity
    Posted by Hardeman RR, Medina EM, Kozhimannil KB. on May 23, 2017 at 12:00 am

    To the Editor Dr Kindig discussed the concepts of rate and burden in terms of population health equity. We question several of the concepts put forth in his Viewpoint. […]

  • Moving Beyond Medication Reconcilliation to Correct Medication Lists
    Posted by Rose AJ, Fischer SH, Paasche-Orlow MK. on May 23, 2017 at 12:00 am

    This Viewpoint argues that conventional definitions of medication reconciliation overlook the need to identify the correct list of medicines for patients, and discusses the challenges involved in defining who should be involved in defining and maintaining that list.. […]

  • Missed Appointment
    Posted by Butka B. on May 23, 2017 at 12:00 am

    supposed to comeat one, did not but his chart said surfing accidentmexico, broken neck,unmoving, a young manthe story is never really new […]

  • FDA Approval of Desmopressin for Nocturia
    Posted by Fralick M, Kesselheim AS. on May 23, 2017 at 12:00 am

    This Viewpoint uses the example of the US FDA’s 2017 approval of desmopressin for treatment of nocturia to discuss the risks of approving a drug for symptoms rather than disease and the ways that the drug approval process is influenced by manufacturers and by overreliance on statistical vs clinical significance. […]

  • Missing Author Middle Initial
    Posted on May 23, 2017 at 12:00 am

    In the Preliminary Communication entitled “Effect of Moderate-Intensity Exercise Training on Peak Oxygen Consumption in Patients With Hypertrophic Cardiomyopathy: A Randomized Clinical Trial” published in the April 4, 2017, issue of JAMA, an author’s middle initial was omitted. In the byline, “Jonathan Herrera” should have appeared as “Jonathan J. Herrera.” This article has been corrected online. […]

  • Single IRBs in Multisite Trials
    Posted by Klitzman R, Pivovarova E, Lidz CW. on May 23, 2017 at 12:00 am

    This Viewpoint describes measures needed for an effective NIH policy in which a single IRB would work with multiple local IRBs to ensure protection of participants in multisite trials. […]

  • Increase in Diabetes Cases Among Youth
    Posted by Abbasi J. on May 23, 2017 at 12:00 am

    The incidence of both type 1 and type 2 diabetes in US youth younger than 20 years increased between 2002 and 2012, according to a new analysis from the ongoing SEARCH for Diabetes in Youth study, which is funded by the Centers for Disease Control and Prevention and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) at the National Institutes of Health. […]

  • Changing Mindsets to Enhance Treatment Effectiveness
    Posted by Crum A, Zuckerman B. on May 23, 2017 at 12:00 am

    This Viewpoint defines mindsets—frames of mind that orient beliefs or expectations—discusses how they can influence patients’ perceptions about treatment and self-efficacy, and proposes ways physicians might shape patients’ mindsets during clinical encounters to enhance treatment effectiveness. […]

  • Highlights for May 23, 2017
    Posted on May 23, 2017 at 12:00 am

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  • Finding Joy in Practice
    Posted by Kirkland KB. on May 23, 2017 at 12:00 am

    Four years ago, after nearly 20 years in practice, I walked out of the familiar world of infectious disease and into the world of palliative care. In the world I left, I cared for hundreds of patients, educated countless learners, led dozens of infection prevention efforts. But that world felt increasingly superficial, fragmented, isolated, a hard place to find joy and meaning in my work. […]

  • Error in Text
    Posted on May 23, 2017 at 12:00 am

    In the Reply Letter entitled “Estimating the Prevalence of Sexual Minority Adolescents,” published in the April 25, 2017, issue of JAMA, there were errors in the text. The first sentence in the final paragraph reads “The sampling frame for the national YRBS consists of grades 9 through 12 of all public and private schools in the United States and….” This is not accurate and should read “The sampling frame for the national YRBS consists of all public and private schools in the United States with any of grades 9 through 12, and….” There were […]

  • Treatment of Macular Edema Due to Central Retinal Vein Occlusion
    Posted by Bressler NM. on May 23, 2017 at 12:00 am

    Central retinal or hemiretinal vein occlusion, due to a thrombus at an arteriovenous crossing within the optic nerve, is a common disease of the retinal vasculature, the blood supply to the inner layers of the retina that are closest to the vitreous cavity. Central retinal vein occlusion sometimes has been described as a “blood and thunder” appearance due to extensive flame-shaped hemorrhages throughout 2 (hemiretinal) or 4 quadrants of the retina and causes sudden vision loss in one eye when venous flow is acutely compromised. The vision loss at first may be due in part to blood […]

  • The Paternal Epigenome Makes Its Mark
    Posted by Abbasi J. on May 23, 2017 at 12:00 am

    This Medical News article discusses how epigentic changes in a father’s sperm may influence his descendants’ health. […]

  • Empirical MRSA Coverage for Nonpurulent Cellulitis
    Posted by Shuman EK, Malani PN. on May 23, 2017 at 12:00 am

    Cellulitis is an infection of the deep dermis and subcutaneous tissue, manifesting as expanding erythema, edema, and warmth of the skin. In most instances of cellulitis, the causative microorganism cannot be definitively determined. However, based on studies using blood cultures, other laboratory markers (anti–streptolysin O and anti–DNase B antibodies), and clinical response to β-lactam antimicrobials, the vast majority of cellulitis is thought to be caused by β-hemolytic streptococci. Staphylococci, including methicillin-resistant Staphylococcus aureus (MRSA), are a […]

  • Vitamin E and Selenium Fail to Prevent Dementia in Men
    Posted by Slomski A. on May 23, 2017 at 12:00 am

    Antioxidant supplementation with vitamin E and selenium, taken alone or in combination, was not associated with a decreased incidence of dementia in asymptomatic older men, according to a study published by JAMA Neurology. Oxidative stress has been implicated as an important mechanism in Alzheimer disease, spurring interest in the use of antioxidants to modify risk of cognitive decline and dementia. […]

  • Bevacizumab vs Aflibercept for Macular Edema Due to Retinal Vein Occlusion
    Posted by Scott IU, VanVeldhuisen PC, Ip MS, et al. on May 23, 2017 at 12:00 am

    This randomized clinical trial compares the effects of bevacizumab vs aflibercept on visual acuity among patients with macular edema due to central retinal or hemiretinal vein occlusion. […]

  • Effect of Crohn Disease Biologics
    Posted on May 23, 2017 at 12:00 am

    Biologics that were introduced in the mid-1990s to treat Crohn disease haven’t had the hoped-for effect of reducing remissions or hospitalizations, according to a new study. But the investigators suggested that the drugs might have reduced Crohn severity for many patients, leading to a decrease in small bowel resections from 2003 to 2013. […]

  • Cephalexin Plus Trimethoprim-Sulfamethoxazole for Clinical Cure of Cellulitis
    Posted by Moran GJ, Krishnadasan A, Mower WR, et al. on May 23, 2017 at 12:00 am

    This randomized trial compares the effects of cephalexin plus trimethoprim-sulfamethoxazole vs cephalexin alone on clinical cure rate among patients with uncomplicated cellulitis. […]

  • Cellulitis
    Posted by Linder KA, Malani PN. on May 23, 2017 at 12:00 am

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  • Effects of Ferric Carboxymaltose On Postgastrectomy Anemia
    Posted by Kim Y, Bae J, Park Y, et al. on May 23, 2017 at 12:00 am

    This randomized clinical trial compares the efficacy and safety of ferric carboxymaltose vs saline to treat acute isovolemic anemia following gastrectomy. […]

  • Etelcalcetide vs Cinacalcet for Hyperparathyroidism
    Posted by Block GA, Chertow GM. on May 23, 2017 at 12:00 am

    In Reply Dr Hai and colleagues are concerned that the starting dose of etelcalcetide was 5 mg (not the lowest dose) whereas the starting dose of cinacalcet was 30 mg (the lowest dose). This clinical trial, using a double-dummy active control, dosed cinacalcet in strict accordance with the approved package insert and in a manner consistent with previous clinical trials of similar duration using similar biochemical end points. Our finding of a mean decrease in PTH of approximately 40% over 26 weeks in patients treated with cinacalcet is similar to findings of the phase 3 trials with cinacalcet […]

  • Association Between US Hospital Teaching Status and Mortality
    Posted by Burke LG, Frakt AB, Khullar D, et al. on May 23, 2017 at 12:00 am

    This study uses national Medicare data to compare 30-day mortality among patients hospitalized or undergoing surgical procedures in teaching vs nonteaching hospitals between 2012 and 2014. […]

  • Race vs Burden in Understanding Health EquityReply
    Posted by Kindig DA. on May 23, 2017 at 12:00 am

    In Reply I appreciate the attention Dr Hardeman and colleagues have given to my Viewpoint, but I do not believe that my position can be seen as pitting black individuals against white individuals, nor did I suggest that burden should be favored over rate differences. I agree that racism is a socially defined determinant of health and that structural racism needs to be seriously addressed as a component of population health policy. But considering burden along with rate uncovers the parallel structural classism that Isenberg chronicled in her book, White Trash: The 400-Year Untold History of […]

  • The Management of Depression in Older Adults
    Posted by Kok RM, Reynolds CF, III. on May 23, 2017 at 12:00 am

    This review offers guidance on medical and psychotherapeutic treatment options available for older frail patients with depression and who are taking several types of medications. […]

  • Incorrect Surgery Identified
    Posted on May 23, 2017 at 12:00 am

    In the Originial Investigation entitled “Association Between Radiation Therapy, Surgery, or Observation for Localized Prostate Cancer and Patient-Reported Outcomes After 3 Years” published in the March 21, 2017, issue of JAMA, the type of surgery patients had undergone was incorrectly identified. In the third paragraph of the Results section, the phrase that read “and of the 1032 (85%) who had complete reporting of the surgical approach, 1002 (77%) had bilateral nerve-sparing surgery” should have read “had robotic surgery.” This article was corrected online. […]

  • Evaluating Alternative Payment Models in Oncology
    Posted by Basch E. on May 23, 2017 at 12:00 am

    This commentary discusses a study published in JAMA Oncology that compared quality and cost outcomes for breast cancer care in Taiwan with a pay-for-performance bundled-payment program vs fee-for-service payment programs. […]

  • Percentage Error in Article
    Posted on May 23, 2017 at 12:00 am

    In the Original Investigation entitled “Effect of Palliative Care-Led Meetings for Families of Patients With Chronic Critical Illness: A Randomized Clinical Trial” published in the July 5, 2016, issue of JAMA, there was a percentage error in the article. In the Results section, third paragraph, the first sentence should read “Patient prognosis was discussed in 89% of the first support and information team meetings and 91% of the second meetings.” In addition, in eTable 2 in Supplement 2, the data for the patient’s condition and prognosis for the SIT-1 meeting […]

  • Facial Rash, Fever, and Anemia in a Newborn
    Posted by Shiiya C, Ota M. on May 23, 2017 at 12:00 am

    A 19-day-old Japanese male infant presented with a 12-day history of low-grade fevers and erythematous plaques with central atrophy and raised margins on the forehead and periorbital areas. Laboratory testing showed mild anemia and an elevated C-reactive protein level. What would you do next? […]

  • Is the Affordable Care Act Imploding?
    Posted by Levitt L. on May 23, 2017 at 12:00 am

    President Trump has said on various occasions that the Affordable Care Act (ACA) is imploding, exploding, or collapsing. […]

  • Hospital-Level Variation in Postpartum Readmissions
    Posted by Clapp MA, Little SE, Zheng J, et al. on May 23, 2017 at 12:00 am

    This study uses obstetric readmission rates from the 2013 National Readmission Database to describe hospital variance in postpartum readmissions and the percentage of variance attributed to hospital factors. […]

  • Therapies That Target PCSK9 Effective at Reducing LDL
    Posted by Slomski A. on May 23, 2017 at 12:00 am

    In a trial published recently in the New England Journal of Medicine (NEJM), evolocumab, a monoclonal antibody that inhibits circulating PCSK9 (proprotein convertase subtilisin-kexin type 9) by preventing it from binding to the low-density lipoprotein (LDL) receptor, was found to reduce LDL cholesterol and cardiovascular risk in patients with elevated cholesterol despite high-intensity statin therapy. […]

  • Intubation With Video Laryngoscopy vs Direct Laryngoscopy
    Posted by Loh N, Tan J. on May 23, 2017 at 12:00 am

    To the Editor The randomized clinical trial comparing video laryngoscopy with direct laryngoscopy found no between-group difference in successful first-pass intubation rates in patients in the intensive care unit (ICU), but concluded that use of video laryngoscopy was associated with higher rates of severe life-threatening complications. There are several issues we would like to highlight about the methods used and the statistical analysis. […]

  • Cancer Death Rates Decrease
    Posted by Abbasi J. on May 23, 2017 at 12:00 am

    Overall death rates from cancer are decreasing in the United States, according to the “Annual Report to the Nation on the Status of Cancer” issued by the Centers for Disease Control and Prevention, the National Cancer Institute, the American Cancer Society, and the North American Association of Central Cancer Registries. […]

  • Intubation With Video Laryngoscopy vs Direct Laryngoscopy
    Posted by Xue FS, Liu YY, Li HX. on May 23, 2017 at 12:00 am

    To the Editor In the recent study by Dr Lascarrou and colleagues comparing successful first-pass orotracheal intubation with video laryngoscopy vs direct laryngoscopy in patients in the ICU, we note several issues that were not well addressed. […]

  • National Academies Tackle Hepatitis B and C
    Posted by Abbasi J. on May 23, 2017 at 12:00 am

    Viral hepatitis accounts for more than 20 000 deaths annually in the United States. A new report from the National Academies of Sciences, Engineering, and Medicine provides a roadmap for ending these deaths and eliminating hepatitis B and C as public health problems by 2030. […]

  • Intubation With Video Laryngoscopy vs Direct Laryngoscopy
    Posted by Saddawi-Konefka D, Baker KH, Wiener-Kronish JP. on May 23, 2017 at 12:00 am

    To the Editor Dr Lascarrou and colleagues performed a randomized clinical trial comparing video laryngoscopy with direct laryngoscopy for first-pass success rates of orotracheal intubation in patients who were critically ill in the ICU. The first-pass success rate was not higher using video laryngoscopy. […]

  • Fentanyl-Fueled Overdoses
    Posted on May 23, 2017 at 12:00 am

    Data from 3 Massachusetts counties provide a glimpse into the role that the potent pain reliever fentanyl plays in the current opioid overdose epidemic. […]

  • Intubation With Video Laryngoscopy vs Direct Laryngoscopy—Reply
    Posted by Lascarrou J, Le Thuaut A, Reignier J. on May 23, 2017 at 12:00 am

    In Reply Drs Loh and Tan comment on the long duration of intubation using the video laryngoscope vs the laryngoscope. The time differed from previous studies because counting started at anesthesia induction. Duration of intubation is more accurately determined this way than at the beginning of laryngoscopy in which introduction of the (video) laryngoscope into the mouth is part of the intubation process and can be delayed or prolonged (eg, if mouth opening limitation is underestimated). The median intubation time of 3 minutes included the time needed for drugs to be injected and take action. […]

  • Anniversary of the National Nutrition Conference
    Posted on May 23, 2017 at 12:00 am

    The National Nutrition Conference called by President Roosevelt in May 1941 assembled diversified interests in the field of nutrition and stimulated the formulation of a national program. The responsibility for coordinating the programs and activities of public and private agencies, national, state and local, into a unified program for the promotion of better nutrition rests with the Office of Defense Health and Welfare Services, of which Federal Security Administrator Paul V. McNutt is director. M. L. Wilson is assistant director in charge of nutrition and Dr. W. H. Sebrell is deputy […]

  • Etelcalcetide and Cinacalcet for Hyperthyroidism
    Posted by Hai M, Guettier J, Rosebraugh CJ. on May 23, 2017 at 12:00 am

    To the Editor In the study by Dr Block and colleagues, the effect of etelcalcetide on reducing serum parathyroid hormone (PTH) levels in patients with secondary hyperparathyroidism receiving hemodialysis was compared with cinacalcet. This 26-week randomized, double-blind, double-dummy controlled trial was designed to demonstrate noninferiority between 2 calcimimetics for the primary end point of the proportion of patients achieving more than a 30% reduction in PTH levels from baseline. Demonstration of superiority on PTH reduction was a secondary end point. The authors concluded […]

  • JAMA
    Posted on May 23, 2017 at 12:00 am

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