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Enforcing Federal Drug Laws in States Where Medical Marijuana Is Lawful

Mar, 10/04/2018 - 02:00
This Viewpoint describes the 2018 rescission of federal limits on enforcement of medical marijuana and discusses its possible consequences on state laws, medical research, and legal risks for physicians prescribing and patients using medical marijuana.

A Third Option: Choosing Not to Be Treated

Mar, 10/04/2018 - 02:00
In this narrative medical essay, the author recounts a patient’s brave decision to refuse a face mask and mechanical ventilation while deoxygenating from spontaenous pneumothorax and interstitial lung disease, a care choice none of the physicians considered.

Toward a United States of Health

Mar, 10/04/2018 - 02:00
Healthy People 2020, which establishes the health agenda for the United States, promotes a societal vision whereby all individuals lead long healthy lives free of preventable disease, disability, injury, and premature death. Yet new evidence in this issue of JAMA finds that vision well beyond the reach of far too many people.

Evidence Syntheses for LAMA and SMART in Guidelines for the Treatment of Asthma

Mar, 10/04/2018 - 02:00
Asthma is a chronic pulmonary disorder characterized by variable levels of dyspnea, chest tightness, wheezing, and cough that can disrupt sleep, work, and school. Asthma is a major public health problem that affects 235 million people worldwide, including 25 million people in the United States alone. Uncontrolled asthma contributes to 10.5 million days of missed school, 14.2 million days of missed work, and more than 3600 premature deaths in the United States each year.

US Burden of Diseases, Injuries, and Disease Risk Factors, 1990-2016

Mar, 10/04/2018 - 02:00
In this study, Global Burden of Disease investigators characterize trends in mortality, life expectancy, and prevalence associated with most common diseases and disease and mortality risk factors in the United States between 1990 and 2016.

Inhaled Corticosteroids and Long-Acting Muscarinic Antagonists for Uncontrolled Asthma

Mar, 10/04/2018 - 02:00
This systematic review and meta-analysis assesses the effects of long-acting muscarinic antagonist vs placebo or vs other controllers as an add-on therapy to inhaled corticosteroids and the use of triple therapy vs inhaled corticosteroids and long-acting ?-agonists in patients with uncontrolled, persistent asthma.

Use of Inhaled Corticosteroids and Long-Acting ?-Agonists for Asthma Exacerbations

Mar, 10/04/2018 - 02:00
This systematic review and meta-analysis of randomized trials compares the efficacy of combined use of inhaled corticosteroids and long-acting ?-agonists (LABAs) as the controller and the quick relief therapy (SMART) vs the same or higher doses of inhaled corticosteroids with or without a LABA used as the controller therapy and short-acting ?-agonists as the relief therapy in patients with persistent asthma.

Sequencing of Tumor DNA to Guide Cancer Therapy

Mar, 10/04/2018 - 02:00
This Genomics and Precision Health article reviews clinical applications of tumor DNA sequencing to direct treatment of melanoma and of myeloid, lung, and colorectal cancers.

A 58-Year-Old Man With a Macerated Rash of the Neck and Axilla

Mar, 10/04/2018 - 02:00
An African American man presented with a 5-year history of a pruritic and painful rash of the right lateral area of the neck and right axilla that worsened in the summer and sometimes blistered. A sister had a similar rash. What would you do next?

Benralizumab (Fasenra) for Severe Eosinophilic Asthma

Mar, 10/04/2018 - 02:00
This Medical Letter review summarizes the mechanism of action, results from clinical studies, and adverse effects of benralizumab, a humanized monoclonal antibody selective for the interleukin-5 receptor, for add-on maintenance treatment of severe asthma among patients aged 12 years or older with an eosinophilic phenotype .

Acute Malnutrition and Anemia Among Rohingya Children in Kutupalong Camp, Bangladesh

Mar, 10/04/2018 - 02:00
This survey study assesses the health and nutritional status of Rohingya children aged 6 to 59 months in the Kutupalong refugee camp in Bangladesh.

Treatment Approaches for Malignant Pleural Effusion

Mar, 10/04/2018 - 02:00
To the Editor Dr Thomas and colleagues reported that among patients with malignant pleural effusion, treatment with an indwelling pleural catheter vs talc pleurodesis resulted in significantly fewer hospitalization days from treatment to death (median, 10 d vs 12 d; P?=?.03). Interventions that aim to decrease hospitalizations in terminally ill patients may enhance their quality of life and minimize caregivers’ bereavement-related distress. The authors stated that the observed 2-day difference was of uncertain clinical importance; however, it is necessary to consider the patient’s remaining days of life to interpret the duration meaningfully. Although 2 days may be negligible for patients with a relatively long-term prognosis, it might be indispensable for patients with limited-term prognosis. Therefore, it will be essential to know additional information when making a choice between an indwelling pleural catheter or talc pleurodesis in daily clinical practice.

Treatment Approaches for Malignant Pleural Effusion

Mar, 10/04/2018 - 02:00
In Reply Dr Yagi and colleagues reiterate the importance of reducing hospitalization time in terminally ill patients with cancer and considering patients’ remaining lifespan to meaningfully interpret their total hospitalization time. In our trial, patients randomized to indwelling pleural catheter treatment spent significantly less of their total time in the trial (from procedure to death or end of 12-month follow-up) in hospital (median, 6.2% [interquartile range {IQR}, 1.1%-15.0%] vs 11.1% [IQR, 3.2%-37.0%] in the talc pleurodesis group; P?=?.01; Figure 2 in the article). The benefit of an indwelling pleural catheter in reducing hospitalization days is especially relevant for patients with a limited prognosis. We agree with Yagi and colleagues that, conversely, for the subset of patients with malignant pleural effusion and a longer expected survival, more aggressive attempts with pleurodesis can have theoretical advantages over long-term indwelling pleural catheter use. This will be the subject of the Australasian Malignant Pleural Effusion–3 randomized trial (in planning stage).

Fracking and Climate Change

Mar, 10/04/2018 - 02:00
To the Editor Drs Wilke and Freeman provided a helpful discussion of air and water contamination related to fracking. However, they omitted key parts of the fracking story.

Fracking and Climate Change—Reply

Mar, 10/04/2018 - 02:00
In Reply Drs Frumkin and Patz extend the dialogue begun in our Viewpoint on the potential health implications of fracking to include a discussion about climate change. We agree that regulatory agencies monitoring compliance need to be supported. We also agree with the need to further the dialogue about fossil fuel combustion as a major contributor to climate change and an influence on human health. There is growing concern about the potential effect of climate change on the behavioral and socioeconomic well-being of communities, particularly in the agricultural sector. The ongoing development and expansion of clean renewable energy resources, including solar and wind power, represent key factors optimizing the health of the US population.

Diagnosing Acute Mountain Sickness

Mar, 10/04/2018 - 02:00
To the Editor The systematic review by Dr Meier and colleagues demonstrated that most research on acute mountain sickness (AMS) conducted during the last 2 decades used either the self-reported Lake Louise Questionnaire Score (LLQS) or the Acute Mountain Sickness-Cerebral (AMS-C) score for diagnosing AMS. Because no criterion standard exists, the authors used the LLQS as a reference for comparison with the AMS-C score. Compared with an LLQS of 5 or greater, using an AMS-C score of 0.7 or greater to indicate AMS had a sensitivity of 67% and a specificity of 92%, with a positive likelihood ratio (LR) of 8.2 and a negative LR of 0.36. Two recent field studies found better agreement of the AMS-C score with the LLQS. In the first study, 235 participants completed both questionnaires at an altitude of 3450 m; the sensitivity of the AMS-C score was 91%, specificity was 94%, positive LR was 15.2, and negative LR was 0.1. In the second study, 191 participants answered questionnaires at an altitude of 4559 m; the sensitivity of the AMS-C score was 80%, specificity was 98%, positive LR was 40, and negative LR was 0.2. In contrast to the pooled data analysis from Meier et al, which showed significant data heterogeneity (I2?=?98%), data from the 2 studies were obtained by the same investigators with the same methods and in comparable study populations.

Diagnosing Acute Mountain Sickness–Reply

Mar, 10/04/2018 - 02:00
In Reply Dr Macholz and colleagues report better agreement of the AMS-C score with the LLQS in 2 recent field studies compared with the results of our pooled analysis. These data were not included in our publication because they were published after the period covered by the systematic review (from inception until May 2017).

Author Names Omitted

Mar, 10/04/2018 - 02:00
In the article entitled “Effect of Haloperidol on Survival Among Critically Ill Adults With a High Risk of Delirium: The REDUCE Randomized Clinical Trial” published in the February 20, 2018, issue of JAMA, several authors’ names, affiliations, and contributions were omitted. This article was corrected online.

Incorrect Age Range

Mar, 10/04/2018 - 02:00
In the Editorial entitled “Screening for Prostate Cancer: Is the Third Trial the Charm?” published in the March 6, 2018, issue of JAMA, an incorrect age range was reported twice. In the first paragraph, the third sentence should be “In this cluster randomized trial, 573 primary care practices in the United Kingdom offered men aged 50 to 69 years a single PSA screening test or usual care.” In the fifth paragraph, the second sentence should be “Based on the CAP results, an offer of a single PSA screen in a population of men aged 50 to 69 years is ineffective, and given the higher risk of a prostate cancer diagnosis this approach engenders, likely does more harm than good.” This article was corrected online.

Incorrect Data Reported

Mar, 10/04/2018 - 02:00
In the Viewpoint entitled “Hip and Knee Replacements: A Neglected Potential Savings Opportunity,” published in the March 13, 2018, issue, incorrect data were reported. The sentence in the second paragraph should have read as follows: “In 2017, the Organisation for Economic Co-operation and Development reported that hip replacements in the United States increased 22% (from 167 to 204 per 100?000) and knee replacements increased 22% (from 185 to 226 per 100?000).” This article was corrected online.

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