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  • Salt-and-Pepper Skin Changes
    Posted on July 13, 2017 at 12:00 am

    Figure 1. […]

  • Achenbach’s Syndrome
    Posted on June 29, 2017 at 12:00 am

    Figure 1. […]

  • Decision Aids and Elective Joint Replacement — How Knowledge Affects Utilization
    Posted on June 29, 2017 at 12:00 am

    The health care market is undergoing rapid transformation, spurred in part by the Affordable Care Act (ACA) and recent payment reforms introduced by the Centers for Medicare and Medicaid Services (CMS). The industry is shifting from a business-to-business model involving insurers, health car […]

  • 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 […]

  • 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 […]

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

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

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

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

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

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

  • Back to the History
    Posted on May 4, 2017 at 12:00 am

    Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors’ commentary follows. Stage. An 82-year-old man presented to […]

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

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

  • 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 […]

  • 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 […]

  • 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 […]

  • Strategy to Increases Colorectal Cancer Screening
    Posted by Slomski A. on July 25, 2017 at 12:00 am

    A colorectal cancer (CRC) screening decision aid in combination with guidance to follow through with screening significantly increased CRC screening in a vulnerable primary care population, according to a trial published in JAMA Internal Medicine. […]

  • Parent-Based Therapy Helps Children Lose Weight
    Posted by Slomski A. on July 25, 2017 at 12:00 am

    Overweight children lost weight through a treatment program attended only by a parent, who learns about behavior modification, nutrition, and physical activity reports a JAMA Pediatricsstudy. Family-based weight-loss treatment (FBT) is the gold standard for childhood obesity, but this clinical trial finds that parent-based treatment (PBT) is equally effective and likely easier to disseminate. […]

  • Is Hearing Restoration Near?
    Posted by Lyon J. on July 25, 2017 at 12:00 am

    This Medical News article discusses how new inner ear research may lead to treatments that reverse hearing loss. […]

  • Blended CBT Controls Anxiety in Cancer Survivors
    Posted by Slomski A. on July 25, 2017 at 12:00 am

    Long after treatment ends, many cancer survivors are plagued by fears that their cancer will recur. The recent SWORD trial, published in the Journal of Clinical Oncology, finds that blended cognitive behavior therapy (CBT)—a combination of face-to-face and online therapy sessions—significantly reduces cancer anxiety. […]

  • Power Morcellators, Postmarketing Surveillance, and the FDA
    Posted by Redberg RF, Jacoby AF, Sharfstein JM. on July 25, 2017 at 12:00 am

    This Viewpoint uses the example of power morcellator devices to discuss the wider scope of US Food and Drug Administration regulations and postmarketing surveillance necessary to ensure patient safety. […]

  • Deep Brain Stimulation for Obsessive-Compulsive Disorder
    Posted by Kohl S, Kuhn J. on July 25, 2017 at 12:00 am

    To the Editor The review by Dr Hirschtritt and colleagues gave a comprehensive overview of diagnosis and treatment of obsessive-compulsive disorder (OCD). The authors proposed deep-brain stimulation as a treatment option for severely affected and treatment-resistant patients. They referred to a meta-analysis stating that 60% of patients respond to deep-brain stimulation with a mean symptom reduction of 45.1%. We agree that these results suggest promise but we would like to highlight further important challenging aspects of the treatment. […]

  • Interventions to Improve Infant Safe Sleep Practices
    Posted by Shapiro-Mendoza CK. on July 25, 2017 at 12:00 am

    In 2013, there were nearly 3500 deaths among infants from sudden infant death syndrome (SIDS) and other sleep-related events (eg, accidental suffocation) in the United States. Although the cause of SIDS is unknown, several modifiable risk factors have been identified, including prone and side sleep position, bed sharing, and use of potentially hazardous soft bedding in the sleep environment. SIDS rates declined by more than 50% following the Back to Sleep campaign in the 1990s, but since then, rates of sudden unexpected infant deaths have declined less rapidly and SIDS remains the leading […]

  • All Ears
    Posted by Wicks I. on July 25, 2017 at 12:00 am

    Twin auricles—rimmed helix, canted antihelix, curving togetherabove the deep hollow of the concha.Each hung with a pendant lobe,like question marks, pinned in mirror image. The external ear, catch all for sound, deftly entraining its passing score behind the baffle of the tragus,down dark auditory canals, sinking deepinto the skull’s interior. […]

  • Practical Improvements for Medical Device Evaluation
    Posted by Kramer DB, Yeh RW. on July 25, 2017 at 12:00 am

    Passage of the Medical Device Amendments Act in 1976 confirmed the US Food and Drug Administration’s (FDA’s) primary responsibility for evaluating the safety and effectiveness of medical devices in the United States. Although there have been modest legislative updates in the ensuing decades, the broad structure of the FDA’s risk-based framework for premarket evaluation has remained largely unchanged. High-risk (“class III”) devices (such as pacemakers and insulin pumps) are subject to stringent premarket requirements including demonstration of clinical […]

  • Targeted Temperature Management After Cardiac Arrests
    Posted by Callaway CW. on July 25, 2017 at 12:00 am

    Many clinical trials in critically ill patients do not detect important differences in outcomes between groups receiving different treatments. The trial by Kirkegaard et al in this issue of JAMA compared 24 hours vs 48 hours of targeted temperature management (TTM) with cooling to 33°C among 355 patients who were comatose after out-of-hospital cardiac arrest. The investigators found no significant difference in favorable functional neurologic outcome (defined as Cerebral Performance Categories score of 1 or 2) at 6 months for patients treated for 24 hours (n = 176; 64% with […]

  • Picture Archiving and Computer
    Posted by Hise J. on July 25, 2017 at 12:00 am

    I graduated from medical school in 1984 and entered a diagnostic radiology residency. No internship was required for radiology, so I began my medical training without a clinical year. This was long before the implementation of PACS (the picture archiving and computer system); therefore, clinical training occurred every morning. The referring physicians would arrive without fail inquiring about the x-rays of their patients. If one was even a marginally astute radiologist, you quickly learned that this exchange was the highlight of the day and key to a good radiology report. […]

  • Contact Precautions for Endemic MRSA and VRE
    Posted by Morgan DJ, Wenzel RP, Bearman G. on July 25, 2017 at 12:00 am

    This Viewpoint argues for rescission of legal mandates requiring contact precautions for any patient with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) infection in favor and more selective and cost-effective infection control measures. […]

  • Improving Medical Device Safety
    Posted by Ibrahim AM, Dimick JB. on July 25, 2017 at 12:00 am

    This Viewpoint uses the example of gastric band failures to discuss how available data may be used more appropriately to detect problems in the safety and effectiveness of medical devices. […]

  • Chikungunya Vaccine Trials Begin
    Posted by Lyon J. on July 25, 2017 at 12:00 am

    A phase 1 and 2 clinical trial of an experimental vaccine against the viral disease chikungunya has begun enrolling a planned 180 healthy adult volunteers aged 18 to 45 years with funding by the National Institute of Allergy and Infectious Diseases (NIAID). The vaccine, known as MV-CHIKV, is a recombinant live-attenuated measles vaccine virus expressing chikungunya proteins that induce antibody production. […]

  • Understanding Chronic Traumatic Encephalopathy
    Posted by Rabinovici GD. on July 25, 2017 at 12:00 am

    Traumatic brain injury (TBI) is a major public health concern, affecting an estimated 10 million people worldwide per year and more than 40% of US residents over the course of a lifetime. Mild TBI, also referred to as concussion, is defined as blunt, nonpenetrating head trauma associated with transient symptoms (eg, headache, nausea, dizziness, visual changes, confusion, or difficulty concentrating) and accounts for more than 80% of all TBI cases. Beyond the morbidity of the immediate trauma, patients who experience mild TBI are at increased risk of developing neurological and psychiatric […]

  • Deceptive Lyme Disease Diagnosis Linked With Serious Infections
    Posted on July 25, 2017 at 12:00 am

    The CDC is fielding reports of serious bacterial infections resulting from treatments prescribed for “chronic Lyme disease”—a misleading diagnosis sometimes given for vague symptoms such as fatigue, generalized pain, or neurologic disorders. […]

  • Targeted Temperature Management and Outcomes After Cardiac Arrest
    Posted by Kirkegaard H, Søreide E, de Haas I, et al. on July 25, 2017 at 12:00 am

    This randomized clinical trial tested the effect of targeted temperature management to 33°C for 48 hours vs 24 hours on neurologic outcomes at 6 months in survivors of out-of-hospital cardiac arrest. […]

  • Plantar Fasciitis
    Posted by Muth CC. on July 25, 2017 at 12:00 am

    […]

  • Effect of Quality Improvement and Mobile Health Interventions on Infant Sleep
    Posted by Moon RY, Hauck FR, Colson ER, et al. on July 25, 2017 at 12:00 am

    This randomized clinical trial assesses the effectiveness of a nursing quality improvement intervention and a mobile health messaging intervention separately and combined to promote infant safe sleep practices compared with control breastfeeding interventions in mothers of healthy term newborns at 16 US hospitals. […]

  • Nonclinical Factors Affecting Shared Decision Making—Reply
    Posted by Spatz ES, Moulton BW, Krumholz HM. on July 25, 2017 at 12:00 am

    In Reply We agree with Drs Smith and Volk that shared decision making should include discussions about the social and economic burdens of care associated with different treatment options. A multidisciplinary team can help enrich these discussions and ensure that patients are given meaningful information around which to base their decisions. […]

  • Evaluation of Chronic Traumatic Encephalopathy in Football Players
    Posted by Mez J, Daneshvar DH, Kiernan PT, et al. on July 25, 2017 at 12:00 am

    This case series investigated the neuropathological and clinical features of deceased football players with chronic traumatic encephalopathy whose brains were donated for research. […]

  • Deep Brain Stimulation for Obsessive-Compulsive Disorder—Reply
    Posted by Hirschtritt ME, Bloch MH, Mathews CA. on July 25, 2017 at 12:00 am

    In Reply In our clinical review, we presented deep-brain stimulation as an investigational method to address treatment-refractory OCD in adults. The majority of studies involving deep-brain stimulation among patients with OCD have been limited to open-label designs and relatively small sample sizes, both of which constrain generalizability and examination of robust predictors of clinical treatment response. Nonetheless, the growing literature on this method suggests that deep-brain stimulation may be an effective modality for patients who continue to suffer from debilitating OCD symptoms […]

  • Genetic Variants in Serum Calcium and Coronary Artery Disease
    Posted by Larsson SC, Burgess S, Michaëlsson K. on July 25, 2017 at 12:00 am

    This analysis evaluates the potential causal association between genetic variants related to elevated serum calcium levels and risk of coronary artery disease and myocardial infarction using mendelian randomization. […]

  • Why Is US Maternal Mortality Rising?
    Posted by Carroll AE. on July 25, 2017 at 12:00 am

    In 2005, 23 US mothers per 100 000 live births died from complications related to pregnancy or childbirth. In 2015, that number rose to 25. In the United Kingdom, the number was less than 9. In Canada, it was less than 7. […]

  • Cascade Screening for Familial Hypercholesterolemia and the Use of Genetic Testing
    Posted by Knowles JW, Rader DJ, Khoury MJ. on July 25, 2017 at 12:00 am

    This JAMA Insights article explains process of cascade screening for familial hypercholesterolemia and its efficacy in reducing risk of atherosclerotic cardiovascular disease. […]

  • Combination Therapy Shrinks Melanoma Brain Metastases
    Posted by Slomski A. on July 25, 2017 at 12:00 am

    The COMBI-MB phase 2 trial is the first to evaluate a combination of precision medicine therapies in patients with melanoma metastasized to the brain—a group typically excluded from trials. The results, reported in Lancet Oncology, showed a significant, if short-lived, benefit. […]

  • Epistaxis, Ecchymoses, and an Abnormal White Blood Cell Count
    Posted by Sellers MH, Dinner SN. on July 25, 2017 at 12:00 am

    A 42-year-old man had epistaxis and spontaneous ecchymoses of the extremities. A complete blood cell count and coagulation profile showed abnormalities, and a peripheral blood smear showing promyelocytes with bilobed nuclei and azurophilic cytoplasmic granules. What would you do next? […]

  • Fewer Seizures With Cannabidiol in Catastrophic Epilepsy
    Posted by Slomski A. on July 25, 2017 at 12:00 am

    Cannabidiol reduced the frequency of convulsive seizures compared with placebo in Dravet syndrome, a childhood epilepsy disorder with a high mortality rate and no approved treatment in the United States, reported a clinical trial in the New England Journal of Medicine. […]

  • Metanephrines for Evaluating Palpitations and Flushing
    Posted by Hannah-Shmouni F, Pacak K, Stratakis CA. on July 25, 2017 at 12:00 am

    A 29-year-old woman with chronic paroxysmal palpitations, flushing, paleness, and diaphoresis had a blood pressure of 112/74 mm Hg, a heart rate of 82 beats/min, normal physical examination, and normal plasma metanephrines with elevated normetanephrines. How do you interpret the results? […]

  • Cancer Project Speeding Along
    Posted by Lyon J. on July 25, 2017 at 12:00 am

    According to reports, the National Cancer Institute (NCI) is nearly 2 years ahead of schedule in sequencing the tumors of 6000 patients called for under the NCI-Molecular Analysis for Therapy Choice (NCI-MATCH), its precision-medicine protocol. What researchers are calling an “unprecedented” rate of patient enrollment, spurred by wide acceptance of the program’s aims by more than 1100 academic cancer centers and community hospitals, led to the shortened time frame. […]

  • Neglected Tropical Disease Treatment Development Before and After an FDA Incentive Program
    Posted by Jain N, Hwang T, Franklin JM, et al. on July 25, 2017 at 12:00 am

    This study uses commercial pharmaceutical database data to evaluate the number of new drugs and vaccines for neglected tropical diseases entering phase 1 clinical trials before and after introduction in 2007 of a priority review voucher program to incentivize development. […]

  • New Medical Officer at Indian Health Service
    Posted by Lyon J. on July 25, 2017 at 12:00 am

    Capt. Michael Toedt, MD, a 23-year veteran of the US Indian Health Service, has been named chief medical officer of the agency, which provides a comprehensive health service delivery system for 2.2 million American Indians and Alaska Natives. He was previously chief medical officer for the IHS Nashville Area, which stretches from Maine to Florida, and is board certified in family medicine. […]

  • Increases in Thyroid Cancer Incidence and Mortality
    Posted by Davies L, Morris L, Hankey B. on July 25, 2017 at 12:00 am

    To the Editor Dr Lim and colleagues reported that there has been a true increase in thyroid cancer mortality in the United States between 1974 and 2013. Based on 1063 deaths over 20 years, they concluded that the change in mortality, in combination with increased incidence, is consistent with a true increase in thyroid cancer. We are concerned that this conclusion does not adequately consider alternative explanations and may lead to confusion about the current major public health issues posed by overdiagnosis of thyroid cancer in the United States. […]

  • Decline in Student Tobacco Use
    Posted on July 25, 2017 at 12:00 am

    Last year’s decline in tobacco use among US middle and high school students was driven primarily by a decrease in e-cigarette use, according to a recent CDC study. […]

  • Increases in Thyroid Cancer Incidence and Mortality—Reply
    Posted by Kitahara CM, Devesa SS, Sosa JA. on July 25, 2017 at 12:00 am

    In Reply Dr Davies and colleagues suggest that the increasing thyroid cancer mortality rates observed in our study are “likely” to be explained by increases in treatment-related deaths, attribution bias, or both, rather than reflecting a true increase in occurrence of the disease. However, thyroid cancer treatment-related deaths are extremely rare. Although attribution bias is a possible explanation for trends in prostate cancer mortality since the introduction of prostate-specific antigen testing, actual evidence that it played a substantial role remains inconclusive, and whether […]

  • Laboratory Work in Medical Schools
    Posted on July 25, 2017 at 12:00 am

    One of the most interesting papers presented at Detroit was Dr. Vaughan’s earnest plea for more laboratory work in our medical schools, read before the Association of Medical Colleges. The course of study is now lengthened to four years, and the term of nearly all medical schools is now more than six months. There is time for this work. The European medical education is superior to the American only by the facilities which it offers in laboratory instruction. It is for histology, pathology, bacteriology, clinical diagnosis and multiple dissections that our young medical men go to […]

  • Nonclinical Factors Affecting Shared Decision Making
    Posted by Smith GL, Volk RJ. on July 25, 2017 at 12:00 am

    To the Editor Dr Spatz and colleagues offered recommendations for effective shared decision making, highlighting clinician engagement. A major challenge for clinicians is addressing factors that significantly affect a patient’s decision beyond the commonly compared clinical benefits and harms of treatment options. Key nonclinical factors can influence a treatment’s accessibility and, subsequently, its preference. […]

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

    […]

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

    […]

  • Severe Plantar Warts in an Immunocompromised Patient
    Posted on July 20, 2017 at 12:00 am

    Figure 1. […]

  • Subarachnoid Hemorrhage
    Posted on July 20, 2017 at 12:00 am

    Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors’ clinical recommendations. Stage. A 17-year-old […]

  • Bronchoscopic Removal of an Obstructing Broncholith
    Posted on July 20, 2017 at 12:00 am

    Figure 1. […]

  • Certain about Dying with Uncertainty
    Posted on July 20, 2017 at 12:00 am

    Mrs. C. a woman with whom we’d had a long-standing patient–physician relationship, one of us for over 25 years, died recently in the 87th year of her life. A woman who had always maintained her cheerful spirit even in the midst of quite trying medical setbacks, she was one of our favorite patients. […]

  • Implementation of Medical Homes in Federally Qualified Health Centers
    Posted on July 20, 2017 at 12:00 am

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

  • Case 22-2017: A 21-Year-Old Woman with Fever, Headache, and Myalgias
    Posted on July 20, 2017 at 12:00 am

    Presentation of Case. Dr. Nkemdilim Mgbojikwe (Medicine): A 21-year-old woman was admitted to this hospital during the winter because of fever, headache, and myalgias. The patient had been well until 4 days before this admission, when fever, chills, fatigue, malaise, retro-orbital headache, and […]

  • Mobile Aortic Thrombi
    Posted on July 13, 2017 at 12:00 am

    Figure 1. […]

  • Salt-and-Pepper Skin Changes
    Posted on July 13, 2017 at 12:00 am

    Figure 1. […]

  • Case 21-2017: A 28-Year-Old Pregnant Woman with Endocervical Carcinoma
    Posted on July 13, 2017 at 12:00 am

    Presentation of Case. Dr. Mariam Naqvi (Obstetrics and Gynecology): A 28-year-old pregnant woman with Rh isoimmunization and endocervical carcinoma was seen in the maternal–fetal outpatient clinic of this hospital at 34.1 weeks of gestation. The patient was gravida 3, para 2001 (the first delivery […]

  • Amyotrophic Lateral Sclerosis
    Posted on July 13, 2017 at 12:00 am

    Amyotrophic lateral sclerosis (ALS) is a progressive, paralytic disorder characterized by degeneration of motor neurons in the brain and spinal cord. It begins insidiously with focal weakness but spreads relentlessly to involve most muscles, including the diaphragm. Typically, death due to […]

  • Unmasking Ptosis in Both Eyes
    Posted on July 6, 2017 at 12:00 am

    Figure 1. […]

  • Cerebral Cavernous Malformations
    Posted on July 6, 2017 at 12:00 am

    Figure 1. […]

  • Beating, Fast and Slow
    Posted on July 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 52-year-old man presented to his […]

  • Eye Injury from a Firecracker
    Posted on June 29, 2017 at 12:00 am

    Figure 1. […]

  • Achenbach’s Syndrome
    Posted on June 29, 2017 at 12:00 am

    Figure 1. […]

  • A Placebo-Controlled Trial of Antibiotics for Smaller Skin Abscesses
    Posted on June 29, 2017 at 12:00 am

    More than 4 in 100 people seek treatment for skin infections annually in the United States. Abscesses are the most common of these infections, and the majority of patients are treated as outpatients. Serious complications, such as bacteremia, occur in rare cases. Staphylococcus aureus, including […]

  • Subclinical Hypothyroidism
    Posted on June 29, 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 71-year-old […]

  • Irritable Bowel Syndrome
    Posted on June 29, 2017 at 12:00 am

    The irritable bowel syndrome (IBS) is a chronic and sometimes disabling functional bowel disorder. Traditionally, this functional diagnostic label has been applied when no obvious structural or biochemical abnormalities are found, but emerging evidence suggests that distinct pathophysiologica […]

  • Case 20-2017 — A 48-Year-Old Man with Weight Loss, Confusion, Skin Lesions, and Pancytopenia
    Posted on June 29, 2017 at 12:00 am

    Presentation of Case. Dr. Robert H. Goldstein (Medicine): A 48-year-old man was seen in the emergency department of this hospital because of confusion. The week before this presentation, the patient, who was a lawyer, had traveled alone to Mexico for vacation. His family reported that he seemed to […]

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

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

  • Strategy to Increases Colorectal Cancer Screening
    Posted by Slomski A. on July 25, 2017 at 12:00 am

    A colorectal cancer (CRC) screening decision aid in combination with guidance to follow through with screening significantly increased CRC screening in a vulnerable primary care population, according to a trial published in JAMA Internal Medicine. […]

  • Parent-Based Therapy Helps Children Lose Weight
    Posted by Slomski A. on July 25, 2017 at 12:00 am

    Overweight children lost weight through a treatment program attended only by a parent, who learns about behavior modification, nutrition, and physical activity reports a JAMA Pediatricsstudy. Family-based weight-loss treatment (FBT) is the gold standard for childhood obesity, but this clinical trial finds that parent-based treatment (PBT) is equally effective and likely easier to disseminate. […]

  • Is Hearing Restoration Near?
    Posted by Lyon J. on July 25, 2017 at 12:00 am

    This Medical News article discusses how new inner ear research may lead to treatments that reverse hearing loss. […]

  • Blended CBT Controls Anxiety in Cancer Survivors
    Posted by Slomski A. on July 25, 2017 at 12:00 am

    Long after treatment ends, many cancer survivors are plagued by fears that their cancer will recur. The recent SWORD trial, published in the Journal of Clinical Oncology, finds that blended cognitive behavior therapy (CBT)—a combination of face-to-face and online therapy sessions—significantly reduces cancer anxiety. […]

  • Power Morcellators, Postmarketing Surveillance, and the FDA
    Posted by Redberg RF, Jacoby AF, Sharfstein JM. on July 25, 2017 at 12:00 am

    This Viewpoint uses the example of power morcellator devices to discuss the wider scope of US Food and Drug Administration regulations and postmarketing surveillance necessary to ensure patient safety. […]

  • Deep Brain Stimulation for Obsessive-Compulsive Disorder
    Posted by Kohl S, Kuhn J. on July 25, 2017 at 12:00 am

    To the Editor The review by Dr Hirschtritt and colleagues gave a comprehensive overview of diagnosis and treatment of obsessive-compulsive disorder (OCD). The authors proposed deep-brain stimulation as a treatment option for severely affected and treatment-resistant patients. They referred to a meta-analysis stating that 60% of patients respond to deep-brain stimulation with a mean symptom reduction of 45.1%. We agree that these results suggest promise but we would like to highlight further important challenging aspects of the treatment. […]

  • Interventions to Improve Infant Safe Sleep Practices
    Posted by Shapiro-Mendoza CK. on July 25, 2017 at 12:00 am

    In 2013, there were nearly 3500 deaths among infants from sudden infant death syndrome (SIDS) and other sleep-related events (eg, accidental suffocation) in the United States. Although the cause of SIDS is unknown, several modifiable risk factors have been identified, including prone and side sleep position, bed sharing, and use of potentially hazardous soft bedding in the sleep environment. SIDS rates declined by more than 50% following the Back to Sleep campaign in the 1990s, but since then, rates of sudden unexpected infant deaths have declined less rapidly and SIDS remains the leading […]

  • All Ears
    Posted by Wicks I. on July 25, 2017 at 12:00 am

    Twin auricles—rimmed helix, canted antihelix, curving togetherabove the deep hollow of the concha.Each hung with a pendant lobe,like question marks, pinned in mirror image. The external ear, catch all for sound, deftly entraining its passing score behind the baffle of the tragus,down dark auditory canals, sinking deepinto the skull’s interior. […]

  • Practical Improvements for Medical Device Evaluation
    Posted by Kramer DB, Yeh RW. on July 25, 2017 at 12:00 am

    Passage of the Medical Device Amendments Act in 1976 confirmed the US Food and Drug Administration’s (FDA’s) primary responsibility for evaluating the safety and effectiveness of medical devices in the United States. Although there have been modest legislative updates in the ensuing decades, the broad structure of the FDA’s risk-based framework for premarket evaluation has remained largely unchanged. High-risk (“class III”) devices (such as pacemakers and insulin pumps) are subject to stringent premarket requirements including demonstration of clinical […]

  • Targeted Temperature Management After Cardiac Arrests
    Posted by Callaway CW. on July 25, 2017 at 12:00 am

    Many clinical trials in critically ill patients do not detect important differences in outcomes between groups receiving different treatments. The trial by Kirkegaard et al in this issue of JAMA compared 24 hours vs 48 hours of targeted temperature management (TTM) with cooling to 33°C among 355 patients who were comatose after out-of-hospital cardiac arrest. The investigators found no significant difference in favorable functional neurologic outcome (defined as Cerebral Performance Categories score of 1 or 2) at 6 months for patients treated for 24 hours (n = 176; 64% with […]

  • Picture Archiving and Computer
    Posted by Hise J. on July 25, 2017 at 12:00 am

    I graduated from medical school in 1984 and entered a diagnostic radiology residency. No internship was required for radiology, so I began my medical training without a clinical year. This was long before the implementation of PACS (the picture archiving and computer system); therefore, clinical training occurred every morning. The referring physicians would arrive without fail inquiring about the x-rays of their patients. If one was even a marginally astute radiologist, you quickly learned that this exchange was the highlight of the day and key to a good radiology report. […]

  • Contact Precautions for Endemic MRSA and VRE
    Posted by Morgan DJ, Wenzel RP, Bearman G. on July 25, 2017 at 12:00 am

    This Viewpoint argues for rescission of legal mandates requiring contact precautions for any patient with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) infection in favor and more selective and cost-effective infection control measures. […]

  • Improving Medical Device Safety
    Posted by Ibrahim AM, Dimick JB. on July 25, 2017 at 12:00 am

    This Viewpoint uses the example of gastric band failures to discuss how available data may be used more appropriately to detect problems in the safety and effectiveness of medical devices. […]

  • Chikungunya Vaccine Trials Begin
    Posted by Lyon J. on July 25, 2017 at 12:00 am

    A phase 1 and 2 clinical trial of an experimental vaccine against the viral disease chikungunya has begun enrolling a planned 180 healthy adult volunteers aged 18 to 45 years with funding by the National Institute of Allergy and Infectious Diseases (NIAID). The vaccine, known as MV-CHIKV, is a recombinant live-attenuated measles vaccine virus expressing chikungunya proteins that induce antibody production. […]

  • Understanding Chronic Traumatic Encephalopathy
    Posted by Rabinovici GD. on July 25, 2017 at 12:00 am

    Traumatic brain injury (TBI) is a major public health concern, affecting an estimated 10 million people worldwide per year and more than 40% of US residents over the course of a lifetime. Mild TBI, also referred to as concussion, is defined as blunt, nonpenetrating head trauma associated with transient symptoms (eg, headache, nausea, dizziness, visual changes, confusion, or difficulty concentrating) and accounts for more than 80% of all TBI cases. Beyond the morbidity of the immediate trauma, patients who experience mild TBI are at increased risk of developing neurological and psychiatric […]

  • Deceptive Lyme Disease Diagnosis Linked With Serious Infections
    Posted on July 25, 2017 at 12:00 am

    The CDC is fielding reports of serious bacterial infections resulting from treatments prescribed for “chronic Lyme disease”—a misleading diagnosis sometimes given for vague symptoms such as fatigue, generalized pain, or neurologic disorders. […]

  • Targeted Temperature Management and Outcomes After Cardiac Arrest
    Posted by Kirkegaard H, Søreide E, de Haas I, et al. on July 25, 2017 at 12:00 am

    This randomized clinical trial tested the effect of targeted temperature management to 33°C for 48 hours vs 24 hours on neurologic outcomes at 6 months in survivors of out-of-hospital cardiac arrest. […]

  • Plantar Fasciitis
    Posted by Muth CC. on July 25, 2017 at 12:00 am

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  • Effect of Quality Improvement and Mobile Health Interventions on Infant Sleep
    Posted by Moon RY, Hauck FR, Colson ER, et al. on July 25, 2017 at 12:00 am

    This randomized clinical trial assesses the effectiveness of a nursing quality improvement intervention and a mobile health messaging intervention separately and combined to promote infant safe sleep practices compared with control breastfeeding interventions in mothers of healthy term newborns at 16 US hospitals. […]

  • Nonclinical Factors Affecting Shared Decision Making—Reply
    Posted by Spatz ES, Moulton BW, Krumholz HM. on July 25, 2017 at 12:00 am

    In Reply We agree with Drs Smith and Volk that shared decision making should include discussions about the social and economic burdens of care associated with different treatment options. A multidisciplinary team can help enrich these discussions and ensure that patients are given meaningful information around which to base their decisions. […]

  • Evaluation of Chronic Traumatic Encephalopathy in Football Players
    Posted by Mez J, Daneshvar DH, Kiernan PT, et al. on July 25, 2017 at 12:00 am

    This case series investigated the neuropathological and clinical features of deceased football players with chronic traumatic encephalopathy whose brains were donated for research. […]

  • Deep Brain Stimulation for Obsessive-Compulsive Disorder—Reply
    Posted by Hirschtritt ME, Bloch MH, Mathews CA. on July 25, 2017 at 12:00 am

    In Reply In our clinical review, we presented deep-brain stimulation as an investigational method to address treatment-refractory OCD in adults. The majority of studies involving deep-brain stimulation among patients with OCD have been limited to open-label designs and relatively small sample sizes, both of which constrain generalizability and examination of robust predictors of clinical treatment response. Nonetheless, the growing literature on this method suggests that deep-brain stimulation may be an effective modality for patients who continue to suffer from debilitating OCD symptoms […]

  • Genetic Variants in Serum Calcium and Coronary Artery Disease
    Posted by Larsson SC, Burgess S, Michaëlsson K. on July 25, 2017 at 12:00 am

    This analysis evaluates the potential causal association between genetic variants related to elevated serum calcium levels and risk of coronary artery disease and myocardial infarction using mendelian randomization. […]

  • Why Is US Maternal Mortality Rising?
    Posted by Carroll AE. on July 25, 2017 at 12:00 am

    In 2005, 23 US mothers per 100 000 live births died from complications related to pregnancy or childbirth. In 2015, that number rose to 25. In the United Kingdom, the number was less than 9. In Canada, it was less than 7. […]

  • Cascade Screening for Familial Hypercholesterolemia and the Use of Genetic Testing
    Posted by Knowles JW, Rader DJ, Khoury MJ. on July 25, 2017 at 12:00 am

    This JAMA Insights article explains process of cascade screening for familial hypercholesterolemia and its efficacy in reducing risk of atherosclerotic cardiovascular disease. […]

  • Combination Therapy Shrinks Melanoma Brain Metastases
    Posted by Slomski A. on July 25, 2017 at 12:00 am

    The COMBI-MB phase 2 trial is the first to evaluate a combination of precision medicine therapies in patients with melanoma metastasized to the brain—a group typically excluded from trials. The results, reported in Lancet Oncology, showed a significant, if short-lived, benefit. […]

  • Epistaxis, Ecchymoses, and an Abnormal White Blood Cell Count
    Posted by Sellers MH, Dinner SN. on July 25, 2017 at 12:00 am

    A 42-year-old man had epistaxis and spontaneous ecchymoses of the extremities. A complete blood cell count and coagulation profile showed abnormalities, and a peripheral blood smear showing promyelocytes with bilobed nuclei and azurophilic cytoplasmic granules. What would you do next? […]

  • Fewer Seizures With Cannabidiol in Catastrophic Epilepsy
    Posted by Slomski A. on July 25, 2017 at 12:00 am

    Cannabidiol reduced the frequency of convulsive seizures compared with placebo in Dravet syndrome, a childhood epilepsy disorder with a high mortality rate and no approved treatment in the United States, reported a clinical trial in the New England Journal of Medicine. […]

  • Metanephrines for Evaluating Palpitations and Flushing
    Posted by Hannah-Shmouni F, Pacak K, Stratakis CA. on July 25, 2017 at 12:00 am

    A 29-year-old woman with chronic paroxysmal palpitations, flushing, paleness, and diaphoresis had a blood pressure of 112/74 mm Hg, a heart rate of 82 beats/min, normal physical examination, and normal plasma metanephrines with elevated normetanephrines. How do you interpret the results? […]

  • Cancer Project Speeding Along
    Posted by Lyon J. on July 25, 2017 at 12:00 am

    According to reports, the National Cancer Institute (NCI) is nearly 2 years ahead of schedule in sequencing the tumors of 6000 patients called for under the NCI-Molecular Analysis for Therapy Choice (NCI-MATCH), its precision-medicine protocol. What researchers are calling an “unprecedented” rate of patient enrollment, spurred by wide acceptance of the program’s aims by more than 1100 academic cancer centers and community hospitals, led to the shortened time frame. […]

  • Neglected Tropical Disease Treatment Development Before and After an FDA Incentive Program
    Posted by Jain N, Hwang T, Franklin JM, et al. on July 25, 2017 at 12:00 am

    This study uses commercial pharmaceutical database data to evaluate the number of new drugs and vaccines for neglected tropical diseases entering phase 1 clinical trials before and after introduction in 2007 of a priority review voucher program to incentivize development. […]

  • New Medical Officer at Indian Health Service
    Posted by Lyon J. on July 25, 2017 at 12:00 am

    Capt. Michael Toedt, MD, a 23-year veteran of the US Indian Health Service, has been named chief medical officer of the agency, which provides a comprehensive health service delivery system for 2.2 million American Indians and Alaska Natives. He was previously chief medical officer for the IHS Nashville Area, which stretches from Maine to Florida, and is board certified in family medicine. […]

  • Increases in Thyroid Cancer Incidence and Mortality
    Posted by Davies L, Morris L, Hankey B. on July 25, 2017 at 12:00 am

    To the Editor Dr Lim and colleagues reported that there has been a true increase in thyroid cancer mortality in the United States between 1974 and 2013. Based on 1063 deaths over 20 years, they concluded that the change in mortality, in combination with increased incidence, is consistent with a true increase in thyroid cancer. We are concerned that this conclusion does not adequately consider alternative explanations and may lead to confusion about the current major public health issues posed by overdiagnosis of thyroid cancer in the United States. […]

  • Decline in Student Tobacco Use
    Posted on July 25, 2017 at 12:00 am

    Last year’s decline in tobacco use among US middle and high school students was driven primarily by a decrease in e-cigarette use, according to a recent CDC study. […]

  • Increases in Thyroid Cancer Incidence and Mortality—Reply
    Posted by Kitahara CM, Devesa SS, Sosa JA. on July 25, 2017 at 12:00 am

    In Reply Dr Davies and colleagues suggest that the increasing thyroid cancer mortality rates observed in our study are “likely” to be explained by increases in treatment-related deaths, attribution bias, or both, rather than reflecting a true increase in occurrence of the disease. However, thyroid cancer treatment-related deaths are extremely rare. Although attribution bias is a possible explanation for trends in prostate cancer mortality since the introduction of prostate-specific antigen testing, actual evidence that it played a substantial role remains inconclusive, and whether […]

  • Laboratory Work in Medical Schools
    Posted on July 25, 2017 at 12:00 am

    One of the most interesting papers presented at Detroit was Dr. Vaughan’s earnest plea for more laboratory work in our medical schools, read before the Association of Medical Colleges. The course of study is now lengthened to four years, and the term of nearly all medical schools is now more than six months. There is time for this work. The European medical education is superior to the American only by the facilities which it offers in laboratory instruction. It is for histology, pathology, bacteriology, clinical diagnosis and multiple dissections that our young medical men go to […]

  • Nonclinical Factors Affecting Shared Decision Making
    Posted by Smith GL, Volk RJ. on July 25, 2017 at 12:00 am

    To the Editor Dr Spatz and colleagues offered recommendations for effective shared decision making, highlighting clinician engagement. A major challenge for clinicians is addressing factors that significantly affect a patient’s decision beyond the commonly compared clinical benefits and harms of treatment options. Key nonclinical factors can influence a treatment’s accessibility and, subsequently, its preference. […]

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

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

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