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The Meaning of a Smile From a Tortured Woman

Mar, 09/01/2018 - 01:00
In this humanities essay, a former combat medic recalls an encounter with a patient whose smile and calm demeanor belied acute physical signs of torture.

Lack of Benefit With Idalopirdine for Alzheimer Disease Another Therapeutic Failure in a Complex Disease Process

Mar, 09/01/2018 - 01:00
Alzheimer disease is a large and growing public health problem that has prompted governments around the world, including in the United States, to develop national plans to address the disease. However, medications approved for the treatment of Alzheimer disease provide little symptomatic benefit, and the most recent approval by the US Food and Drug Administration occurred in 2003 (not including reformulations).

Handovers During Anesthesia Care

Mar, 09/01/2018 - 01:00
Optimal patient care and clinical outcomes depend not only on technical knowledge and skill but, even more importantly, on ready access to critical information on which to base patient care decisions. Access to needed information at the appropriate time is a crucial form of communication. Numerous studies have shown that inadequate communication is the leading cause of harm to patients. It is estimated that the majority of serious adverse events in health care involve miscommunication during the handoff between physicians and perhaps between other health care practitioners. Contributing factors to inadequate communication during handoffs include insufficient or misleading information, absence of safety culture, ineffective communication methods, lack of time, poor timing, inadequate feedback between sender and receiver, interruptions or distractions, lack of standardized procedures, and insufficient staffing.

Evolving Recommendations for Scoliosis Screening

Mar, 09/01/2018 - 01:00
Medical professionals have advocated for screening for idiopathic scoliosis among asymptomatic adolescents for the last century, and school-based screening has been advocated in the United States since the early 1960s. Scoliosis, defined as a lateral curvature of the spine of 10° or more that is not attributable to an underlying condition, is estimated to affect as many as 3% of youth aged 10 to 17 years in the United States (an estimated approximately 1.4 million individuals). However, in 2004 the US Preventive Services Task Force (USPSTF) reviewed published evidence and issued a “D” grade recommending against routine screening of asymptomatic adolescents for idiopathic scoliosis. At that time, the USPSTF based its recommendation on a general lack of direct evidence about the benefits and harms of screening.

Effect of Idalopirdine as Adjunct to Cholinesterase Inhibitors for Alzheimer Disease

Mar, 09/01/2018 - 01:00
This report describes findings from 3 randomized trials comparing the cognitive effects of 10, 30, or 60 mg/d of idalopirdine added to stable cholinesterase inhibitor treatment or placebo for symptomatic treatment of mild to moderate Alzheimer disease.

Intraoperative Anesthesia Handovers and Complications After Major Surgery

Mar, 09/01/2018 - 01:00
This cohort study uses Canadian administrative health care data to investigate associations between handover of intraoperative anesthesia care between one physician and another and risk of adverse postoperative outcomes among patients undergoing major surgery.

Breast Cancer Mortality by Molecular Subtype, 2000-2012

Mar, 09/01/2018 - 01:00
This simulation study estimates reductions in breast cancer mortality associated with screening and treatment by estrogen-receptor and human epidermal growth factor receptor 2 (ERBB2) status.

USPSTF Recommendation: Screening for Adolescent Idiopathic Scoliosis

Mar, 09/01/2018 - 01:00
This Recommendation Statement from the US Preventive Services Task Force concludes that current evidence is insufficient to assess the balance of benefits and harms of screening for adolescent idiopathic scoliosis in children and adolescents aged 10 to 18 years (I statement).

USPSTF Evidence Review: Screening for Adolescent Idiopathic Scoliosis

Mar, 09/01/2018 - 01:00
This systematic review to support the 2018 update of the US Preventive Services Task Force Recommendation Statement on screening for adolescent idiopathic scoliosis (AIS) summarizes published evidence on the benefits and harms of AIS screening and treatment for children and adolescents aged 10 to 18 years.

Lesinurad/Allopurinol (Duzallo) for Gout-Associated Hyperuricemia

Mar, 09/01/2018 - 01:00
This Medical Letter review summarizes the mechanism of action and adverse effects of combination lesinurad, an uric acid transporter 1, and allopurinol, a xanthine oxidase inhibitor, for treatment of gout-associated hyperuricemia in patients who have not achieved target serum uric acid levels with allopurinol alone.

Hospital Participation in CMS’ Bundled Payments for Care Improvement Initiative, 2013-2016

Mar, 09/01/2018 - 01:00
This study describes hospital participation and dropout in the Centers for Medicare & Medicaid Innovation’s Bundled Payments for Care Improvement Initiative, which allows hospitals and practices to retain savings if they meet quality targets.

Menopausal Estrogen Therapy and Breast Cancer Mortality

Mar, 09/01/2018 - 01:00
To the Editor Dr Manson and colleagues presented long-term all-cause and cause-specific mortality from the Women’s Health Initiative (WHI) randomized trials. Consistent with previous WHI publications, they reported a discrepancy in breast cancer outcomes between women taking different formulations of hormone therapy: conjugated equine estrogens (CEE) alone or combined hormone therapy (CEE plus medroxyprogesterone acetate). Specifically, deaths from breast cancer were increased in users of combined hormone therapy (hazard ratio [HR], 1.44 [95% CI, 0.97-2.15]; P?=?.07) but reduced in women taking estrogen alone (HR 0.55, 95% CI, 0.33-0.92; P?=?.02).

Menopausal Estrogen Therapy and Breast Cancer Mortality—Reply

Mar, 09/01/2018 - 01:00
In Reply Dr Hickey and colleagues inquire about the role of previous bilateral oophorectomy as a determinant of the reduced risk of breast cancer among women assigned to CEE alone compared with those assigned to placebo in the WHI randomized trial of hormone therapy. As noted in their letter and in our WHI publication on long-term all-cause and cause-specific mortality, there was only a small difference in the baseline prevalence of prior bilateral oophorectomy in the 2 randomized groups (39.5% in the CEE-alone group and 42.0% in the placebo group), and all women had undergone prior hysterectomy. Thus, baseline oophorectomy status could not have been a confounder of the trial’s results and, in fact, the slightly higher prevalence of prior oophorectomy in the placebo group at baseline led to modest attenuation of the HR. When we added oophorectomy status as a covariate in the analyses of CEE alone and breast cancer mortality over the cumulative 18 years of follow-up, the HR changed minimally from 0.55 to 0.54. Other risk factors for breast cancer also were well balanced between the 2 randomized groups at baseline, as in our long-term mortality study and previous publications.

Dermoscopic Patterns of Spitz Nevi

Mar, 09/01/2018 - 01:00
To the Editor In a JAMA Clinical Challenge, Dr Liu and colleagues mentioned that dermoscopic examination of Spitz nevi “reveals a starburst appearance and globular pattern.” Spitz nevi can mimic melanoma at the clinical, histologic, and dermoscopic levels. It is therefore important to be aware of all of the dermoscopic patterns of Spitz nevi.

Dermoscopic Patterns of Spitz Nevi—Reply

Mar, 09/01/2018 - 01:00
In Reply We agree with Dr Pollock that Spitz nevi can mimic melanoma at the clinical, histologic, and dermoscopic levels, and it is important to know all of the dermoscopic patterns of Spitz nevi. The patient in our case did not have a dermoscopic examination, and the diagnosis was made according to the clinical, histopathologic, and immunochemical manifestations. Therefore, we mentioned only the 2 main dermoscopic patterns of Spitz nevi in the discussion.

Improving Diagnostic Decisions

Mar, 09/01/2018 - 01:00
To the Editor Dr Cifu stated in his Viewpoint that diagnostic calibration is “…the relationship between diagnostic accuracy and physician confidence in that accuracy” and suggested static and dynamic influences determine diagnostic calibration. We agree with Cifu and Meyer et al that the most worthwhile effort in improving diagnostic calibration is receiving regular feedback on diagnostic accuracy.

Improving Diagnostic Decisions—Reply

Mar, 09/01/2018 - 01:00
In Reply Drs Patel and Bergl add to the dynamic factors that I cited in my Viewpoint as affecting diagnostic calibration, discussing topics such as fatigue, ambient conditions, and team dynamics. These factors absolutely play a role in diagnostic accuracy and are often referred to as part of “situativity” in the diagnostic reasoning literature.

Error in Affiliation

Mar, 09/01/2018 - 01:00
In the Letter entitled “Prediabetes Prevalence in China,” published in the October 24, 2017, issue of JAMA, there was an error in the author affiliations. Dr Fu's affiliation is First Affiliated Hospital Guangdong Pharmaceutical University, Guangzhou, China, not Guangdong Pharmaceutical University, Zhongshan, China. This article was corrected online.

Factual Error

Mar, 09/01/2018 - 01:00
In the Editorial entitled “The Success of State Newborn Screening Policies for Critical Congenital Heart Disease” published in the December 5, 2017, issue of JAMA, a factual error occurred. On page 2088, in the first full paragraph, the first sentence should have stated that “… only 2 states, Idaho and Kansas, do not have a mandate for critical congenital heart disease newborn screening.” This article was corrected online.

Why Are American Indians Dying Young?

Mar, 09/01/2018 - 01:00
This Medical News article discusses data on American Indian and Alaska Native premature mortality and its causes.

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