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Highlights

from JAMA - 27 Aug 14



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The ACA’s Contraceptive Mandate Religious Freedom, Women’s Health, and Corporate Personhood

from JAMA - 27 Aug 14

The Supreme Court on June 30, 2014, decided Burwell v Hobby Lobby Stores, Inc—a deeply divisive case. Holding that the federal government cannot lawfully mandate “closely held” for-profit corporations to provide contraceptive coverage, the Court split 5-4 along ideological lines. The Court thus entered a political quagmire at the intersection of religious freedom, women’s health, and corporate personhood.



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Engineering a Better Health Care System A Report From the President’s Council of Advisors on Science and Technology

from JAMA - 27 Aug 14

Millions of individuals have gained access to the health care system this year due to the Affordable Care Act. With greater access to health care, there is an increased need to ensure care remains high quality, affordable, and centered around the needs of patients and families. One opportunity for addressing these challenges is through systems engineering, which includes a range of tools to improve efficiency and reliability. These tools have produced substantial benefits in other industries, fr



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Recognizing Worsening Chronic Heart Failure as an Entity and an End Point in Clinical Trials

from JAMA - 27 Aug 14

Heart failure has been considered a progressive and often fatal condition. However, clinical trials conducted during the last 2 decades among outpatients with heart failure and reduced ejection fraction have shown that the negative trajectory of this syndrome can be altered with effective therapies, improving the annual mortality risk from approximately 20% to approximately 5% to 8%. The same success has not been demonstrated for patients with heart failure and preserved ejection fraction as wel



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New Opportunities in the Changing Landscape of Prevention

from JAMA - 27 Aug 14

The focus of medical research has historically been on curative medicine, yielding better drugs, medical devices, and clinical procedures. Prevention science—the systematic application of scientific methods to the causes and prevention of diseases in populations—has yet to receive the necessary investment and support required to reduce the growing burden of largely preventable noncommunicable diseases (NCDs).



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Extraordinary

from JAMA - 27 Aug 14

In my dreams, Mr Smith always looks the same. He sits at a table with a green-and-white checkered tablecloth, a pale blue hospital gown around his skeletal frame, shadows gathered behind his collarbones. His forearms are a mess of bruises—purple, blue, and a fading yellow-green—though he gestures with them wildly and easily. His amber eyes match the color of the root beer in the glass before him. Arthritic fingers close around the glass, leaving their imprints on its frosted surface. He lifts th



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Self-titration of Antihypertensive Therapy in High-Risk Patients Bringing It Home

from JAMA - 27 Aug 14

Hypertension is a common cause of premature mortality yet has been amenable to pharmacologic treatment for more than 8 decades. Resting blood pressure fluctuates for various reasons, and individual responses to different classes of antihypertensive drugs vary considerably. In another high-risk common chronic condition, diabetes, glucose levels vary widely due to factors including individual drug response, physical activity, and carbohydrate intake. Patients treated with insulin are generally ta



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A Practical and Effective Primary Care Intervention for Treating Adolescent Depression

from JAMA - 27 Aug 14

Adolescent depression is a major pediatric public health concern. Approximately 11% of US adolescents experience an episode of depression by age 18 years. The World Health Organization ranks unipolar depression as the leading cause of “illness and disability” for 10- to 19-year-old youth worldwide, above common physical health problems like anemia and asthma. The effects of depression on overall health are widespread and pervasive because of 3 principal concerns: depression is associated with se



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Effect of Self-monitoring and Medication Self-titration on Systolic Blood Pressure in Hypertensive Patients at High Risk of Cardiovascular Disease The TASMIN-SR Randomized Clinical Trial

from JAMA - 27 Aug 14

ImportanceSelf-monitoring of blood pressure with self-titration of antihypertensives (self-management) results in lower blood pressure in patients with hypertension, but there are no data about patients in high-risk groups.ObjectiveTo determine the effect of self-monitoring with self-titration of antihypertensive medication compared with usual care on systolic blood pressure among patients with cardiovascular disease, diabetes, or chronic kidney disease.Design, Setting, and PatientsA primary car



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Collaborative Care for Adolescents With Depression in Primary Care A Randomized Clinical Trial

from JAMA - 27 Aug 14

ImportanceUp to 20% of adolescents experience an episode of major depression by age 18 years yet few receive evidence-based treatments for their depression.ObjectiveTo determine whether a collaborative care intervention for adolescents with depression improves depressive outcomes compared with usual care.DesignRandomized trial with blinded outcome assessment conducted between April 2010 and April 2013.SettingNine primary care clinics in the Group Health system in Washington State.ParticipantsAdo



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Association Between Early Administration of High-Dose Erythropoietin in Preterm Infants and Brain MRI Abnormality at Term-Equivalent Age

from JAMA - 27 Aug 14

ImportancePremature infants are at risk of developing encephalopathy of prematurity, which is associated with long-term neurodevelopmental delay. Erythropoietin was shown to be neuroprotective in experimental and retrospective clinical studies.ObjectiveTo determine if there is an association between early high-dose recombinant human erythropoietin treatment in preterm infants and biomarkers of encephalopathy of prematurity on magnetic resonance imaging (MRI) at term-equivalent age.Design, Settin



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Management of Persistent Pain in the Older Patient A Clinical Review

from JAMA - 27 Aug 14

ImportancePersistent pain is highly prevalent, costly, and frequently disabling in later life.ObjectiveTo describe barriers to the management of persistent pain among older adults, summarize current management approaches, including pharmacologic and nonpharmacologic modalities; present rehabilitative approaches; and highlight aspects of the patient-physician relationship that can help to improve treatment outcomes. This review is relevant for physicians who seek an age-appropriate approach to de




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Fish Oil Supplements

from JAMA - 27 Aug 14

Long-chain omega-3 polyunsaturated fatty acids (PUFAs), which are present in cold-water fish such as herring or salmon and are commercially available in capsules (over the counter and by prescription), can decrease fasting triglyceride concentrations 20-50% by reducing hepatic triglyceride production and increasing triglyceride clearance. With long-term intake, they may increase HDL-C.



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Clinical Trial Participation After Myocardial Infarction in a National Cardiovascular Data Registry

from JAMA - 27 Aug 14

Randomized clinical trials of patients with acute myocardial infarction (MI) enroll selected populations, with low enrollment in the United States, raising questions whether findings are generalizable. We evaluated whether participants in cardiovascular trials are representative of contemporary patients with MI.



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Bioprosthetic Valves for Transcatheter Aortic Valve Replacement

from JAMA - 27 Aug 14

To the Editor Dr Abdel-Wahab and colleagues reported a head-to-head comparison between currently available bioprostheses for transcatheter aortic valve replacement (TAVR). In the Comparison of Transcatheter Heart Valves in High Risk Patients With Severe Aortic Stenosis: Medtronic CoreValve vs Edwards SAPIEN XT (CHOICE) trial, a higher rate of device success was obtained with a balloon-expandable prosthesis than with a self-expanding prosthesis. This finding was partly driven by “a lower frequenc



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Bioprosthetic Valves for Transcatheter Aortic Valve Replacement

from JAMA - 27 Aug 14

To the Editor The CHOICE trial is the first randomized trial comparing balloon-expandable and self-expandable valves for TAVR. This trial used the VARC definition of device success as a composite primary end point. It found a higher device success with the balloon-expandable valve, driven largely by a lower frequency of aortic regurgitation. There are several serious flaws in the trial design that call these conclusions into question.



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Bioprosthetic Valves for Transcatheter Aortic Valve Replacement—Reply

from JAMA - 27 Aug 14

In Reply We do not share the concerns of Dr Barbanti and colleagues or of Dr Reardon about the use of angiography as the primary tool for assessment of aortic regurgitation after TAVR in the CHOICE trial. Aortic regurgitation after TAVR is commonly paravalvular. These paravalvular jets are usually eccentric with crescentic, irregular orifices and may become entrained along the left ventricular wall, altering their appearance and the perception of severity, particularly with echocardiography.



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Patients Affected by Changes to Hypertension Guideline

from JAMA - 27 Aug 14

To the Editor A recent study by Dr Navar-Boggan and colleagues used data from the National Health and Nutrition Examination Survey to estimate changes in the proportion of US adults who would be recommended for hypertension treatment based on the 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults by Panel Members Appointed to the Eighth Joint National Committee (JNC 8).



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Patients Affected by Changes to Hypertension Guideline—Reply

from JAMA - 27 Aug 14

In Reply Dr Margolis raised a few concerns regarding our interpretations of the 2014 blood pressure guideline and our calculations of patients who would be affected by the changes. Specifically, she questioned our use of a cutoff of 150 mm Hg for systolic blood pressure and 90 mm Hg for diastolic blood pressure for initiation of treatment in adults aged 70 years or older with chronic kidney disease and in those aged 60 years or older with diabetes. For both of these issues, the guideline is some



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Cost-Related Motivations for Research

from JAMA - 27 Aug 14

To the Editor We agree with the authors of the Viewpoint on cost-related motivations for conducting research that patients should be fully informed of the purposes of a clinical trial. We were surprised, however, that the Comparison of Age-Related Macular Degeneration Treatment Trials (CATT) was selected as an example of a clinical trial for which cost was a primary reason for performing the trial and about which patients did not receive an adequate explanation of the purpose of the study.



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Cost-Related Motivations for Research—Reply

from JAMA - 27 Aug 14

In Reply We argued in our Viewpoint that when the cost of treatment is a factor motivating the design and conduct of a randomized trial, then this should be disclosed in the section of consent documents devoted to describing the purpose of the research.



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Additional Information Omitted

from JAMA - 27 Aug 14

In the Viewpoint entitled “Cost-Related Motivations for Conducting Research: Participation Should Be Informed” published in the April 16, 2014, issue of JAMA (2014;311[15]:1491-1492. doi:10.1001/jama.2014.1821), additional information about the author was omitted. The end matter should have included the following: “Additional Information: Dr Miller was a member of the data and safety monitoring committee for the CATT study.” This article was corrected online.



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Data Error in Table

from JAMA - 27 Aug 14

In the Original Investigation entitled “Proportion of US Adults Potentially Affected by the 2014 Hypertension Guideline” published in the April 9, 2014, issue of JAMA (2014;311[14]:1424-1429. doi:10.1001/jama.2014.2531), a typographical error appeared in Table 1. In the bottom half of the table (Age =60 y), in the CKD data, the row headed =70 y should have reported “SBP =150 or DBP =90” in the Above 2014 BP Guideline Goal column (instead of DBP twice). This article was corrected online.



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Chikungunya Virus Transmission Found in the United States US Health Authorities Brace for Wider Spread

from JAMA - 27 Aug 14

It’s official: the chikungunya virus has arrived in the United States. Public health authorities confirmed the first 2 cases of local transmission in Florida about 6 weeks ago.


 

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