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  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

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

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

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

    Figure 1. […]

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

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

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

    Figure 1. […]

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

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

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

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

  • Geographic Disparities in US Suicide Rates
    Posted on April 25, 2017 at 12:00 am

    As the overall US suicide rate increases, a CDC study showed that the trend toward higher rates in less populated parts of the country and lower rates in large urban areas has become more pronounced. […]

  • Presidential Immigration Policies—Endangering Health?
    Posted by Gostin LO, Ó Cathaoir K. on April 25, 2017 at 12:00 am

    This Viewpoint discusses President Trump’s executive orders on US immigration policy and how they could affect health care, health systems, and public and global health. […]

  • Little Evidence to Guide Recommendation of Medical Marijuana
    Posted by Rubin R. on April 25, 2017 at 12:00 am

    This Medical News article discusses the challenges physicians face in recommending medical marijuana. […]

  • Lessons From Canada About Medicaid Block Grants
    Posted by Sommers BD, Naylor C. on April 25, 2017 at 12:00 am

    This Viewpoint discusses Canada’s experience with government funding of health care through block grants and what it could mean for the United States as Republican leaders propose the same for Medicaid financing. […]

  • Evolocumab Plus Statins and Progression of Coronary Atherosclerosis—Reply
    Posted by Nicholls SJ, Somaratne R, Nissen SE. on April 25, 2017 at 12:00 am

    In Reply The GLAGOV trial found that administration of evolocumab with statin therapy produced a favorable effect on coronary atherosclerosis, characterized by plaque regression, compared with statin monotherapy. Dr Murray questions the magnitude of a reduction of PAV of 0.95% in relation to the precision of the measurement tool. This parameter actually reflects changes in plaque burden as a proportion of the entire vessel wall volume. Given that the majority of this volume is occupied by the lumen, normal arterial wall, and nonmodifiable components of plaque, including fibrous and calcific […]

  • Enhancing Transparency at the US Food and Drug Administration
    Posted by Sharfstein JM, Stebbins M. on April 25, 2017 at 12:00 am

    This Viewpoint summarizes recommendations made in a 2017 Blueprint for Transparency at the US Food and Drug Administration developed to encourage increased public access to FDA analyses and regulatory decisions. […]

  • Epidemic Tracking Tool Wins Open Science Prize
    Posted by Abbasi J. on April 25, 2017 at 12:00 am

    A tool for tracking viral epidemics developed by Trevor Bedford, PhD, at the Fred Hutchinson Cancer Research Center, and Richard Neher, PhD, at the University of Basel in Switzerland, was awarded the second annual Open Science Prize, selected from almost 100 other projects from 45 countries submitted for the award. The researchers will receive $230 000 from the National Institutes of Health (NIH), the UK-based Wellcome Trust, and the Howard Hughes Medical Institute to further develop a prototype of their online platform nextstrain.org. […]

  • The Promises and Perils of Medical Care Crowdfunding
    Posted by Young MJ, Scheinberg E. on April 25, 2017 at 12:00 am

    This Viewpoint discusses the emergence and popularity of crowdfunding campaigns to cover individuals’ direct health care costs, and outlines steps to make crowdfunding more equitable and ethically sustainable. […]

  • Screening for Preeclampsia During Pregnancy
    Posted by Jin J. on April 25, 2017 at 12:00 am

    […]

  • Navigating Transitions and Charting New Paths
    Posted by Pizzo PA. on April 25, 2017 at 12:00 am

    A career in medicine creates an identity and a defining sense of purpose in life. I love being a physician and relish the planned and unexpected challenges and opportunities that have unfolded over time—which for many years seemed endless. But I also observed early in my career what can happen if one doesn’t anticipate transitions, especially in midlife and beyond. While I have come to know this as a physician, I have learned it is also true for individuals in other walks of life, as choices, options, and opportunities become altered and sometimes appear constrained and truncated […]

  • Estimating the Prevalence of Sexual Minority Adolescents—Reply
    Posted by Kann L, Barrios LC. on April 25, 2017 at 12:00 am

    In Reply Sexual orientation is defined by sexual attraction, sexual identity, and sex of sexual contacts. The national YRBS currently measures sexual identity and sex of sexual contacts and, consistent with National Academy of Medicine (formerly the Institute of Medicine) recommendations, each construct is measured separately. Sexual orientation typically develops during adolescence and may progress in such a way that sexual identity and sex of sexual contacts may not be concordant. This dissonance between sexual identity and sex of sexual contacts is well documented and, as national YRBS […]

  • Follow-up of Positive Fecal Test Results
    Posted by Rutter CM, Inadomi JM. on April 25, 2017 at 12:00 am

    A large body of research demonstrates that colorectal cancer screening is an effective method for reducing colorectal cancer mortality. Screening can detect cancer at an earlier stage, before it becomes symptomatic, and the detection and removal of adenomas can prevent cancer. Rates of colorectal cancer screening had increased until 2010, at which time approximately 60% of eligible US adults participated in colorectal cancer screening; however, screening has not increased since that time. Colonoscopy is the most commonly used colorectal cancer screening test, but it is an invasive procedure […]

  • Bariatric Surgery Has Durable Effects in Controlling Diabetes
    Posted by Slomski A. on April 25, 2017 at 12:00 am

    Obese patients with type 2 diabetes had superior glycemic control following bariatric surgery compared with patients who received only intensive medical therapy, according to 5-year data from the Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently (STAMPEDE) trial published in The New England Journal of Medicine. Patients who had surgical therapy also used fewer diabetes medications and had greater weight reduction and improvement in lipid levels and quality of life. […]

  • Screening for the Preeclampsia and the USPSTF Recommendations
    Posted by Sperling JD, Gossett DR. on April 25, 2017 at 12:00 am

    Preeclampsia is a condition characterized by the new onset of hypertension after 20 weeks of gestation, with proteinuria, evidence of organ dysfunction, or both in a previously normotensive woman. Preeclampsia and eclampsia complicate up to 10% of pregnancies and remain a leading cause of maternal and neonatal morbidity and mortality in the United States. The complications of preeclampsia in part shaped the development of prenatal care in the United States. The timing and frequency of visits were chosen to improve detection of preeclampsia through the measurement of blood pressure at routine […]

  • Consortium to Develop Dementia Biomarkers
    Posted by Abbasi J. on April 25, 2017 at 12:00 am

    A new National Institutes of Health (NIH)–funded consortium will work to identify and validate trial-ready biomarkers for small vessel diseases in the brain that contribute to cognitive impairment and dementia. Seven participating research sites across the country will develop their own imaging and fluid-based biomarkers and scale them up across the consortium, explained neurologist Steven M. Greenberg, MD, PhD, who will lead the project’s coordinating center at Massachusetts General Hospital. […]

  • Association Between Time to Colonoscopy After FIT and CRC Risk
    Posted by Corley DA, Jensen CD, Quinn VP, et al. on April 25, 2017 at 12:00 am

    This cohort study evaluates the association between time to colonoscopy after a positive fecal immunochemical test result and risk of colorectal cancer and advanced-stage disease at diagnosis. […]

  • Harvesting
    Posted by Brooks W. on April 25, 2017 at 12:00 am

    We harvested over the weekend.Artichokes and grapes. Too many beans to eat. Chard still going strong. The kitchen reeked of basil’s best.Ripe apples soon.The pumpkins turning orange. A colorful collage of carnival squashes. The dry summer hadn’t affected our harvest much.Fences had kept intruders out. […]

  • Postoperative Troponin T and Mortality and Myocardial Injury After Noncardiac Surgery
    Posted by , Devereaux PJ, Biccard BM, et al. on April 25, 2017 at 12:00 am

    This cohort study investigated the association between perioperative high-sensitivity troponin T levels and 30-day mortality and myocardial injury among patients undergoing noncardiac surgery. […]

  • Highlights for April 25, 2017
    Posted on April 25, 2017 at 12:00 am

    […]

  • Infective Endocarditis Trends in California and New York, 1998-2013
    Posted by Toyoda N, Chikwe J, Itagaki S, et al. on April 25, 2017 at 12:00 am

    This population epidemiology study describes trends in incidence and etiologies of infective endocarditis in California and New York State from 1998 through 2013. […]

  • Estimating the Prevalence of Sexual Minority Adolescents
    Posted by Lunn MR, Obedin-Maliver J, Bibbins-Domingo K. on April 25, 2017 at 12:00 am

    To The Editor The Viewpoint by Dr Zaza and colleagues on US lesbian, gay, or bisexual (ie, sexual minority) high school students and their health-related behaviors represents “an important starting point” by describing understudied communities at risk for poor health. However, there are limitations in the Youth Risk Behavior Surveys (YRBS) worthy of comment. […]

  • USPSTF Recommendation: Screening for Preeclampsia
    Posted by , Bibbins-Domingo K, Grossman DC, et al. on April 25, 2017 at 12:00 am

    This Recommendation Statement from the US Preventive Services Task Force concludes that pregnant women should be screened for preeclampsia using blood pressure measurements throughout pregnancy. […]

  • Errors in Data Analysis
    Posted on April 25, 2017 at 12:00 am

    In the Research Letter entitled “Pain at 12 Months After Surgery for Breast Cancer” published in the January 1, 2014, issue of JAMA, an error in the original analysis led to the psychological factors (Beck Depression Inventory and Spielberger State and Trait Anxiety Questionnaires) being derived from the 12-month questionnaires rather than from preoperatively acquired scores. Reanalysis for a different project resulted in changes in Tables 1 and 2, including mean values (Table 1) and Spearman correlations (Table 2) for the BDI and State and Trait anxiety sum scores, as well as […]

  • USPSTF Evidence Report: Preeclampsia Screening
    Posted by Henderson JT, Thompson JH, Burda BU, et al. on April 25, 2017 at 12:00 am

    This Evidence Report and systematic review to support the 2017 US Preventive Services Task Force Recommendation Statement on preeclampsia screening summarizes the benefits, accuracy, and harms of screening for preeclampsia. […]

  • Acupuncture Effective for Migraine Prophylaxis
    Posted by Slomski A. on April 25, 2017 at 12:00 am

    Acupuncture significantly reduced the frequency and severity of migraines without aura, according to a Chinese trial that compared true acupuncture (TA) with 2 control groups—sham acupuncture (SA) and no intervention. The authors of the study, published in JAMA Internal Medicine, report that the clinical benefit persisted over the 24-week trial. […]

  • Mechanical Nasal Dilators to Treat Nasal Valve Compromise
    Posted by Pawar SS. on April 25, 2017 at 12:00 am

    This commentary discusses a narrative review published in JAMA Facial Plastic Surgery that summarized the efficacy of over-the-counter mechanical nasal dilators to improve airflow through the internal nasal valve. […]

  • Low-intensity Weight-Maintenance Program Keeps Pounds Off
    Posted by Slomski A. on April 25, 2017 at 12:00 am

    A weight-loss program that incorporates a maintenance intervention may help people avoid regaining the 2 to 4 pounds a year that is typical after weight loss. Results of a trial published in Annals of Internal Medicine found that a primarily telephone-based maintenance program modestly slowed participants’ weight regain. […]

  • Immunogenicity of 2 vs 3 Doses of the HPV Vaccine in Girls After 60 Months
    Posted by Ogilvie G, Sauvageau C, Dionne M, et al. on April 25, 2017 at 12:00 am

    This study uses long-term follow-up clinical trial data to compare antibody response 60 months after girls younger than 15 years were randomized to 2 vs 3 doses of quadrivalent human papillomavirus vaccine. […]

  • VA’s Burn Pit Registry Flawed
    Posted by Abbasi J. on April 25, 2017 at 12:00 am

    Collectively, burn sites at large US military bases in Iraq and Afghanistan incinerated 60 000 to 85 000 pounds of waste—including plastics, chemicals, petroleum, and human refuse—daily during the 2000s. The practice was banned due to health concerns in 2009. […]

  • Urban-Rural Differences in Diabetes in China
    Posted by Wang H, Lai Y. on April 25, 2017 at 12:00 am

    To the Editor The study by Dr Bragg and colleagues reported a 5.9% prevalence of diabetes in China that differs from previous results reported by Yang and colleagues (9.7%) and Xu and colleagues (11.6%). This study concluded that although diabetes was more prevalent in urban areas of China, rural areas demonstrated higher diabetes-related mortality. […]

  • Prescribing Patterns and Long-term Opioid Use
    Posted on April 25, 2017 at 12:00 am

    Taking an opioid pain reliever for more than just a few days increases the probability of long-term use, according to a recent study that examined prescribing patterns most likely to result in opioid use for a year or longer. […]

  • Urban-Rural Differences in Diabetes-Associated Mortality in China—Reply
    Posted by Bragg F, Li L, Chen Z. on April 25, 2017 at 12:00 am

    In Reply The China Kadoorie Biobank (CKB) was not designed to be nationally representative, and the 10 study areas were selected from different provinces to capture the diversity of populations in China. Diabetes prevalence in the CKB (5.9%) was lower than in some more recent studies, possibly reflecting increasing temporal trends in diabetes prevalence in China and also the different methods used for diagnosing diabetes in different studies. […]

  • ART AIDS AMERICA
    Posted by Palella FJ, Jr. on April 25, 2017 at 12:00 am

    This Arts and Medicine essay reviews the 2017 ArtAIDSAmerica Chicago exhibit, which highlights work that expresses the suffering, grief, and anger caused by the AIDS crisis in the pre-ZDV era. […]

  • Evolocumab Plus Statins and Progression of Coronary Atherosclerosis
    Posted by Murray SW. on April 25, 2017 at 12:00 am

    To the Editor Dr Nicholls and colleagues found that adding evolocumab vs placebo to statin treatment among patients with coronary disease resulted in a 1% greater decrease in percent atheroma volume (PAV), measured by serial intravascular ultrasonography (IVUS) imaging, after 76 weeks. Unfortunately, IVUS examinations have inherent variability. Even in the best of laboratories, there are always measurement reproducibility errors but also intraoperator and interoperator variability in the actual plaque measurements. […]

  • The Placebo Effect in Psychotherapy
    Posted on April 25, 2017 at 12:00 am

    Historically, the concepts of the placebo and the placebo effect have been quite broad; only recently have these concepts been narrowed to become virtually synonymous with the administration of inert medications. In the last three decades, investigators have sought to define the conditions under which the placebo effect operates. The 1950’s saw the widespread use of placebo medication as controls in the evaluation of drug effects. A major conclusion from these studies was not only that placebos are indispensable as controls in scientific drug evaluation, but also that placebos are […]

  • Evolocumab Plus Statins and Progression of Coronary Atherosclerosis
    Posted by Alkhalil M, Choudhury RP. on April 25, 2017 at 12:00 am

    To the Editor The Global Assessment of Plaque Regression With a PCSK9 Antibody as Measured by Intravascular Ultrasound (GLAGOV) trial was designed to determine the effects of proprotein convertase subtilisin kexin type 9 (PCSK9) inhibition with evolocumab (in statin-treated patients) on progression of coronary atherosclerosis, calculated as the change in PAV. […]

  • JAMA
    Posted on April 25, 2017 at 12:00 am

    […]

  • Board Review and the Middle-Aged Doctor
    Posted on April 27, 2017 at 12:00 am

    Last fall, along with thousands of other internists all over the country, I hunched in front of a computer screen and endured 8 hours and 240 multiple-choice questions on the American Board of Internal Medicine (ABIM) decennial recertification exam. The day was grueling. By midmorning, deep in […]

  • Pyogenic Granuloma of the Conjunctiva
    Posted on April 27, 2017 at 12:00 am

    Figure 1. […]

  • 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 […]

  • Extramammary Paget’s Disease
    Posted on April 27, 2017 at 12:00 am

    Figure 1. […]

  • Osteopetrosis
    Posted on April 20, 2017 at 12:00 am

    Figure 1. […]

  • Case 12-2017 — A 34-Year-Old Man with Nephropathy
    Posted on April 20, 2017 at 12:00 am

    Presentation of Case. Dr. Daniel H. Katz (Medicine): A 34-year-old man with hearing impairment was admitted to this hospital because of worsening renal function. The patient had been well until approximately 11 weeks before this admission, when subjective fevers with sweats, fatigue, decreased […]

  • Addressing the Opioid Epidemic — Opportunities in the Postmarketing Setting
    Posted on April 20, 2017 at 12:00 am

    The Food and Drug Administration (FDA) recently developed a multipart action plan in response to the opioid epidemic. As part of that initiative, it invited recommendations from the National Academy of Medicine about a regulatory framework that might allow public health considerations to b […]

  • Candida Esophagitis
    Posted on April 20, 2017 at 12:00 am

    Figure 1. […]

  • Primary Hyperoxaluria
    Posted on April 13, 2017 at 12:00 am

    Figure 1. […]

  • Dyskeratosis Congenita
    Posted on April 13, 2017 at 12:00 am

    Figure 1. […]

  • Case 11-2017 — A 61-Year-Old Woman with Leg Swelling, Back Pain, and Hydronephrosis
    Posted on April 13, 2017 at 12:00 am

    Presentation of Case. Dr. Areej El-Jawahri (Hematology–Oncology): A 61-year-old woman was seen in the emergency department of this hospital because of leg swelling and back pain. The patient had been in her usual health until approximately 3 months before this presentation, when mild swelling of […]

  • Lessons from Standing Rock — Of Water, Racism, and Solidarity
    Posted on April 13, 2017 at 12:00 am

    "I heard you were in Standing Rock." So began a visit with Mr. Y. and we leaned in toward one another. In the past, I’d felt off balance with Mr. Y. who often seemed to push me away. "Why can’t you just fix this?" he asked, referring to his diabetes. Mr. Y. is a traditional Navajo, or Diné. In t […]

  • Diagnosis and Differential Diagnosis of Cushing’s Syndrome
    Posted on April 13, 2017 at 12:00 am

    More than a century ago, Harvey Cushing introduced the term "pluriglandular syndrome" to describe a disorder characterized by rapid development of central obesity, arterial hypertension, proximal muscle weakness, diabetes mellitus, oligomenorrhea, hirsutism, thin skin, and ecchymoses. Cushing knew […]

  • Acute Spinal Cord Compression
    Posted on April 6, 2017 at 12:00 am

    Acute compression of the spinal cord is a devastating but treatable disorder. Diseases that cause acute spinal cord compression constitute a special category because they originate in the spinal column and narrow the spinal canal. This review addresses the disorders that account for most instances […]

  • Use of Pressure Transducers
    Posted on April 6, 2017 at 12:00 am

    […]

  • 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 […]

  • Physicians, Not Conscripts — Conscientious Objection in Health Care
    Posted on April 6, 2017 at 12:00 am

    "Conscience clause" legislation has proliferated in recent years, extending the legal rights of health care professionals to cite their personal religious or moral beliefs as a reason to opt out of performing specific procedures or caring for particular patients. Physicians can refuse to perform […]

  • Regression of Coronary Atherosclerosis with Medical Therapy
    Posted on April 6, 2017 at 12:00 am

    Figure 1. […]

  • Gartner’s Duct Cyst
    Posted on April 6, 2017 at 12:00 am

    Figure 1. […]

  • Geographic Disparities in US Suicide Rates
    Posted on April 25, 2017 at 12:00 am

    As the overall US suicide rate increases, a CDC study showed that the trend toward higher rates in less populated parts of the country and lower rates in large urban areas has become more pronounced. […]

  • Presidential Immigration Policies—Endangering Health?
    Posted by Gostin LO, Ó Cathaoir K. on April 25, 2017 at 12:00 am

    This Viewpoint discusses President Trump’s executive orders on US immigration policy and how they could affect health care, health systems, and public and global health. […]

  • Little Evidence to Guide Recommendation of Medical Marijuana
    Posted by Rubin R. on April 25, 2017 at 12:00 am

    This Medical News article discusses the challenges physicians face in recommending medical marijuana. […]

  • Lessons From Canada About Medicaid Block Grants
    Posted by Sommers BD, Naylor C. on April 25, 2017 at 12:00 am

    This Viewpoint discusses Canada’s experience with government funding of health care through block grants and what it could mean for the United States as Republican leaders propose the same for Medicaid financing. […]

  • Evolocumab Plus Statins and Progression of Coronary Atherosclerosis—Reply
    Posted by Nicholls SJ, Somaratne R, Nissen SE. on April 25, 2017 at 12:00 am

    In Reply The GLAGOV trial found that administration of evolocumab with statin therapy produced a favorable effect on coronary atherosclerosis, characterized by plaque regression, compared with statin monotherapy. Dr Murray questions the magnitude of a reduction of PAV of 0.95% in relation to the precision of the measurement tool. This parameter actually reflects changes in plaque burden as a proportion of the entire vessel wall volume. Given that the majority of this volume is occupied by the lumen, normal arterial wall, and nonmodifiable components of plaque, including fibrous and calcific […]

  • Enhancing Transparency at the US Food and Drug Administration
    Posted by Sharfstein JM, Stebbins M. on April 25, 2017 at 12:00 am

    This Viewpoint summarizes recommendations made in a 2017 Blueprint for Transparency at the US Food and Drug Administration developed to encourage increased public access to FDA analyses and regulatory decisions. […]

  • Epidemic Tracking Tool Wins Open Science Prize
    Posted by Abbasi J. on April 25, 2017 at 12:00 am

    A tool for tracking viral epidemics developed by Trevor Bedford, PhD, at the Fred Hutchinson Cancer Research Center, and Richard Neher, PhD, at the University of Basel in Switzerland, was awarded the second annual Open Science Prize, selected from almost 100 other projects from 45 countries submitted for the award. The researchers will receive $230 000 from the National Institutes of Health (NIH), the UK-based Wellcome Trust, and the Howard Hughes Medical Institute to further develop a prototype of their online platform nextstrain.org. […]

  • The Promises and Perils of Medical Care Crowdfunding
    Posted by Young MJ, Scheinberg E. on April 25, 2017 at 12:00 am

    This Viewpoint discusses the emergence and popularity of crowdfunding campaigns to cover individuals’ direct health care costs, and outlines steps to make crowdfunding more equitable and ethically sustainable. […]

  • Screening for Preeclampsia During Pregnancy
    Posted by Jin J. on April 25, 2017 at 12:00 am

    […]

  • Navigating Transitions and Charting New Paths
    Posted by Pizzo PA. on April 25, 2017 at 12:00 am

    A career in medicine creates an identity and a defining sense of purpose in life. I love being a physician and relish the planned and unexpected challenges and opportunities that have unfolded over time—which for many years seemed endless. But I also observed early in my career what can happen if one doesn’t anticipate transitions, especially in midlife and beyond. While I have come to know this as a physician, I have learned it is also true for individuals in other walks of life, as choices, options, and opportunities become altered and sometimes appear constrained and truncated […]

  • Estimating the Prevalence of Sexual Minority Adolescents—Reply
    Posted by Kann L, Barrios LC. on April 25, 2017 at 12:00 am

    In Reply Sexual orientation is defined by sexual attraction, sexual identity, and sex of sexual contacts. The national YRBS currently measures sexual identity and sex of sexual contacts and, consistent with National Academy of Medicine (formerly the Institute of Medicine) recommendations, each construct is measured separately. Sexual orientation typically develops during adolescence and may progress in such a way that sexual identity and sex of sexual contacts may not be concordant. This dissonance between sexual identity and sex of sexual contacts is well documented and, as national YRBS […]

  • Follow-up of Positive Fecal Test Results
    Posted by Rutter CM, Inadomi JM. on April 25, 2017 at 12:00 am

    A large body of research demonstrates that colorectal cancer screening is an effective method for reducing colorectal cancer mortality. Screening can detect cancer at an earlier stage, before it becomes symptomatic, and the detection and removal of adenomas can prevent cancer. Rates of colorectal cancer screening had increased until 2010, at which time approximately 60% of eligible US adults participated in colorectal cancer screening; however, screening has not increased since that time. Colonoscopy is the most commonly used colorectal cancer screening test, but it is an invasive procedure […]

  • Bariatric Surgery Has Durable Effects in Controlling Diabetes
    Posted by Slomski A. on April 25, 2017 at 12:00 am

    Obese patients with type 2 diabetes had superior glycemic control following bariatric surgery compared with patients who received only intensive medical therapy, according to 5-year data from the Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently (STAMPEDE) trial published in The New England Journal of Medicine. Patients who had surgical therapy also used fewer diabetes medications and had greater weight reduction and improvement in lipid levels and quality of life. […]

  • Screening for the Preeclampsia and the USPSTF Recommendations
    Posted by Sperling JD, Gossett DR. on April 25, 2017 at 12:00 am

    Preeclampsia is a condition characterized by the new onset of hypertension after 20 weeks of gestation, with proteinuria, evidence of organ dysfunction, or both in a previously normotensive woman. Preeclampsia and eclampsia complicate up to 10% of pregnancies and remain a leading cause of maternal and neonatal morbidity and mortality in the United States. The complications of preeclampsia in part shaped the development of prenatal care in the United States. The timing and frequency of visits were chosen to improve detection of preeclampsia through the measurement of blood pressure at routine […]

  • Consortium to Develop Dementia Biomarkers
    Posted by Abbasi J. on April 25, 2017 at 12:00 am

    A new National Institutes of Health (NIH)–funded consortium will work to identify and validate trial-ready biomarkers for small vessel diseases in the brain that contribute to cognitive impairment and dementia. Seven participating research sites across the country will develop their own imaging and fluid-based biomarkers and scale them up across the consortium, explained neurologist Steven M. Greenberg, MD, PhD, who will lead the project’s coordinating center at Massachusetts General Hospital. […]

  • Association Between Time to Colonoscopy After FIT and CRC Risk
    Posted by Corley DA, Jensen CD, Quinn VP, et al. on April 25, 2017 at 12:00 am

    This cohort study evaluates the association between time to colonoscopy after a positive fecal immunochemical test result and risk of colorectal cancer and advanced-stage disease at diagnosis. […]

  • Harvesting
    Posted by Brooks W. on April 25, 2017 at 12:00 am

    We harvested over the weekend.Artichokes and grapes. Too many beans to eat. Chard still going strong. The kitchen reeked of basil’s best.Ripe apples soon.The pumpkins turning orange. A colorful collage of carnival squashes. The dry summer hadn’t affected our harvest much.Fences had kept intruders out. […]

  • Postoperative Troponin T and Mortality and Myocardial Injury After Noncardiac Surgery
    Posted by , Devereaux PJ, Biccard BM, et al. on April 25, 2017 at 12:00 am

    This cohort study investigated the association between perioperative high-sensitivity troponin T levels and 30-day mortality and myocardial injury among patients undergoing noncardiac surgery. […]

  • Highlights for April 25, 2017
    Posted on April 25, 2017 at 12:00 am

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  • Infective Endocarditis Trends in California and New York, 1998-2013
    Posted by Toyoda N, Chikwe J, Itagaki S, et al. on April 25, 2017 at 12:00 am

    This population epidemiology study describes trends in incidence and etiologies of infective endocarditis in California and New York State from 1998 through 2013. […]

  • Estimating the Prevalence of Sexual Minority Adolescents
    Posted by Lunn MR, Obedin-Maliver J, Bibbins-Domingo K. on April 25, 2017 at 12:00 am

    To The Editor The Viewpoint by Dr Zaza and colleagues on US lesbian, gay, or bisexual (ie, sexual minority) high school students and their health-related behaviors represents “an important starting point” by describing understudied communities at risk for poor health. However, there are limitations in the Youth Risk Behavior Surveys (YRBS) worthy of comment. […]

  • USPSTF Recommendation: Screening for Preeclampsia
    Posted by , Bibbins-Domingo K, Grossman DC, et al. on April 25, 2017 at 12:00 am

    This Recommendation Statement from the US Preventive Services Task Force concludes that pregnant women should be screened for preeclampsia using blood pressure measurements throughout pregnancy. […]

  • Errors in Data Analysis
    Posted on April 25, 2017 at 12:00 am

    In the Research Letter entitled “Pain at 12 Months After Surgery for Breast Cancer” published in the January 1, 2014, issue of JAMA, an error in the original analysis led to the psychological factors (Beck Depression Inventory and Spielberger State and Trait Anxiety Questionnaires) being derived from the 12-month questionnaires rather than from preoperatively acquired scores. Reanalysis for a different project resulted in changes in Tables 1 and 2, including mean values (Table 1) and Spearman correlations (Table 2) for the BDI and State and Trait anxiety sum scores, as well as […]

  • USPSTF Evidence Report: Preeclampsia Screening
    Posted by Henderson JT, Thompson JH, Burda BU, et al. on April 25, 2017 at 12:00 am

    This Evidence Report and systematic review to support the 2017 US Preventive Services Task Force Recommendation Statement on preeclampsia screening summarizes the benefits, accuracy, and harms of screening for preeclampsia. […]

  • Acupuncture Effective for Migraine Prophylaxis
    Posted by Slomski A. on April 25, 2017 at 12:00 am

    Acupuncture significantly reduced the frequency and severity of migraines without aura, according to a Chinese trial that compared true acupuncture (TA) with 2 control groups—sham acupuncture (SA) and no intervention. The authors of the study, published in JAMA Internal Medicine, report that the clinical benefit persisted over the 24-week trial. […]

  • Mechanical Nasal Dilators to Treat Nasal Valve Compromise
    Posted by Pawar SS. on April 25, 2017 at 12:00 am

    This commentary discusses a narrative review published in JAMA Facial Plastic Surgery that summarized the efficacy of over-the-counter mechanical nasal dilators to improve airflow through the internal nasal valve. […]

  • Low-intensity Weight-Maintenance Program Keeps Pounds Off
    Posted by Slomski A. on April 25, 2017 at 12:00 am

    A weight-loss program that incorporates a maintenance intervention may help people avoid regaining the 2 to 4 pounds a year that is typical after weight loss. Results of a trial published in Annals of Internal Medicine found that a primarily telephone-based maintenance program modestly slowed participants’ weight regain. […]

  • Immunogenicity of 2 vs 3 Doses of the HPV Vaccine in Girls After 60 Months
    Posted by Ogilvie G, Sauvageau C, Dionne M, et al. on April 25, 2017 at 12:00 am

    This study uses long-term follow-up clinical trial data to compare antibody response 60 months after girls younger than 15 years were randomized to 2 vs 3 doses of quadrivalent human papillomavirus vaccine. […]

  • VA’s Burn Pit Registry Flawed
    Posted by Abbasi J. on April 25, 2017 at 12:00 am

    Collectively, burn sites at large US military bases in Iraq and Afghanistan incinerated 60 000 to 85 000 pounds of waste—including plastics, chemicals, petroleum, and human refuse—daily during the 2000s. The practice was banned due to health concerns in 2009. […]

  • Urban-Rural Differences in Diabetes in China
    Posted by Wang H, Lai Y. on April 25, 2017 at 12:00 am

    To the Editor The study by Dr Bragg and colleagues reported a 5.9% prevalence of diabetes in China that differs from previous results reported by Yang and colleagues (9.7%) and Xu and colleagues (11.6%). This study concluded that although diabetes was more prevalent in urban areas of China, rural areas demonstrated higher diabetes-related mortality. […]

  • Prescribing Patterns and Long-term Opioid Use
    Posted on April 25, 2017 at 12:00 am

    Taking an opioid pain reliever for more than just a few days increases the probability of long-term use, according to a recent study that examined prescribing patterns most likely to result in opioid use for a year or longer. […]

  • Urban-Rural Differences in Diabetes-Associated Mortality in China—Reply
    Posted by Bragg F, Li L, Chen Z. on April 25, 2017 at 12:00 am

    In Reply The China Kadoorie Biobank (CKB) was not designed to be nationally representative, and the 10 study areas were selected from different provinces to capture the diversity of populations in China. Diabetes prevalence in the CKB (5.9%) was lower than in some more recent studies, possibly reflecting increasing temporal trends in diabetes prevalence in China and also the different methods used for diagnosing diabetes in different studies. […]

  • ART AIDS AMERICA
    Posted by Palella FJ, Jr. on April 25, 2017 at 12:00 am

    This Arts and Medicine essay reviews the 2017 ArtAIDSAmerica Chicago exhibit, which highlights work that expresses the suffering, grief, and anger caused by the AIDS crisis in the pre-ZDV era. […]

  • Evolocumab Plus Statins and Progression of Coronary Atherosclerosis
    Posted by Murray SW. on April 25, 2017 at 12:00 am

    To the Editor Dr Nicholls and colleagues found that adding evolocumab vs placebo to statin treatment among patients with coronary disease resulted in a 1% greater decrease in percent atheroma volume (PAV), measured by serial intravascular ultrasonography (IVUS) imaging, after 76 weeks. Unfortunately, IVUS examinations have inherent variability. Even in the best of laboratories, there are always measurement reproducibility errors but also intraoperator and interoperator variability in the actual plaque measurements. […]

  • The Placebo Effect in Psychotherapy
    Posted on April 25, 2017 at 12:00 am

    Historically, the concepts of the placebo and the placebo effect have been quite broad; only recently have these concepts been narrowed to become virtually synonymous with the administration of inert medications. In the last three decades, investigators have sought to define the conditions under which the placebo effect operates. The 1950’s saw the widespread use of placebo medication as controls in the evaluation of drug effects. A major conclusion from these studies was not only that placebos are indispensable as controls in scientific drug evaluation, but also that placebos are […]

  • Evolocumab Plus Statins and Progression of Coronary Atherosclerosis
    Posted by Alkhalil M, Choudhury RP. on April 25, 2017 at 12:00 am

    To the Editor The Global Assessment of Plaque Regression With a PCSK9 Antibody as Measured by Intravascular Ultrasound (GLAGOV) trial was designed to determine the effects of proprotein convertase subtilisin kexin type 9 (PCSK9) inhibition with evolocumab (in statin-treated patients) on progression of coronary atherosclerosis, calculated as the change in PAV. […]

  • JAMA
    Posted on April 25, 2017 at 12:00 am

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