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Highlights

from JAMA - 17 Dec 14



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Flavorings in Electronic Cigarettes An Unrecognized Respiratory Health Hazard?

from JAMA - 17 Dec 14

This Viewpoint examines the flavorings added to e-cigarettes and the potential respiratory risks they may pose.



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Ebola Virus Disease and the Need for New Personal Protective Equipment

from JAMA - 17 Dec 14

Preventing transmission of pathogens in the health care setting with the use of personal protective equipment (PPE) has been an area of longstanding debate in the infection prevention community. Recently, reports of nosocomial transmission of Ebola virus to 2 nurses from the same patient in Texas (despite their use of PPE) has generated great concern and presents new challenges, particularly because there is no postexposure prophylaxis or effective antiviral therapy for Ebola, and approximately



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Is the United States Prepared for Ebola?

from JAMA - 17 Dec 14

This Viewpoint discusses the health system preparedness required for the United States to handle a public health emergency like Ebola.



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Ebola in the United States EHRs as a Public Health Tool at the Point of Care

from JAMA - 17 Dec 14

This Viewpoint discusses how health information technology and electronic health records (EHRs) could be transformed into platforms for public health responses to disease.




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When Should Aspirin Be Used for Prevention of Cardiovascular Events?

from JAMA - 17 Dec 14

This Editorial discusses when aspirin should be used to prevent vascular events and the factors that should be discussed in decision making.



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Optimal Antiviral Prophylaxis Against Hepatitis B Reactivation in Patients Receiving Rituximab-Based Chemotherapy for Lymphoma

from JAMA - 17 Dec 14

This Editorial discusses the optimal antiviral prophylaxis against hepatitis B reactivation in patients receiving rituximab-based chemotherapy for lymphoma.



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Role of Glycemic Index in the Context of an Overall Heart-Healthy Diet

from JAMA - 17 Dec 14

Randomized trials designed to assess possible effects of a dietary intervention on hard outcomes such as cardiovascular disease (CVD) events, cancer incidence, or all-cause mortality are nearly nonexistent. Clinical end point studies such as these require large sample sizes, long-term follow-up measured in years, and high levels of dietary adherence to attain a valid result. These studies are difficult and expensive to conduct and are consequently rare. An important exception was the PREDIMED St



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Low-Dose Aspirin for Primary Prevention of Cardiovascular Events in Japanese Patients 60 Years or Older With Atherosclerotic Risk Factors A Randomized Clinical Trial

from JAMA - 17 Dec 14

ImportancePrevention of atherosclerotic cardiovascular diseases is an important public health priority in Japan due to an aging population.ObjectiveTo determine whether daily, low-dose aspirin reduces the incidence of cardiovascular events in older Japanese patients with multiple atherosclerotic risk factors.Design, Setting, and ParticipantsThe Japanese Primary Prevention Project (JPPP) was a multicenter, open-label, randomized, parallel-group trial. Patients (N?=?14?464) were aged 60 to 85 year



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Entecavir vs Lamivudine for Prevention of Hepatitis B Virus Reactivation Among Patients With Untreated Diffuse Large B-Cell Lymphoma Receiving R-CHOP Chemotherapy A Randomized Clinical Trial

from JAMA - 17 Dec 14

ImportanceHepatitis B virus (HBV) reactivation is a serious complication for patients with lymphoma treated with rituximab-containing chemotherapies, despite lamivudine prophylaxis treatment. An optimal prophylactic antiviral protocol has not been determined.ObjectiveTo compare the efficacy of entecavir and lamivudine in preventing HBV reactivation in patients seropositive for the hepatitis B surface antigen with untreated diffuse large B-cell lymphoma receiving chemotherapy treatment with ritux



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Effects of High vs Low Glycemic Index of Dietary Carbohydrate on Cardiovascular Disease Risk Factors and Insulin Sensitivity The OmniCarb Randomized Clinical Trial

from JAMA - 17 Dec 14

ImportanceFoods that have similar carbohydrate content can differ in the amount they raise blood glucose. The effects of this property, called the glycemic index, on risk factors for cardiovascular disease and diabetes are not well understood.ObjectiveTo determine the effect of glycemic index and amount of total dietary carbohydrate on risk factors for cardiovascular disease and diabetes.Design, Setting, and ParticipantsRandomized crossover-controlled feeding trial conducted in research units in



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Uptake and Costs of Hypofractionated vs Conventional Whole Breast Irradiation After Breast Conserving Surgery in the United States, 2008–2013

from JAMA - 17 Dec 14

ImportanceBased on randomized evidence, expert guidelines in 2011 endorsed shorter, hypofractionated whole breast irradiation (WBI) for selected patients with early-stage breast cancer and permitted hypofractionated WBI for other patients.ObjectivesTo examine the uptake and costs of hypofractionated WBI among commercially insured patients in the United States.Design, Setting, and ParticipantsRetrospective, observational cohort study, using administrative claims data from 14 commercial health car



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The Diagnosis and Management of Mild Cognitive Impairment A Clinical Review

from JAMA - 17 Dec 14

ImportanceCognitive decline is a common and feared aspect of aging. Mild cognitive impairment (MCI) is defined as the symptomatic predementia stage on the continuum of cognitive decline, characterized by objective impairment in cognition that is not severe enough to require help with usual activities of daily living.ObjectiveTo present evidence on the diagnosis, treatment, and prognosis of MCI and to provide physicians with an evidence-based framework for caring for older patients with MCI and t



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Oral Anticoagulants and the Risk of Intracranial Hemorrhage

from JAMA - 17 Dec 14

JAMA NeurologyNew Oral Anticoagulants and the Risk of Intracranial Hemorrhage: Traditional and Bayesian Meta-analysis and Mixed Treatment Comparison of Randomized Trials of New Oral Anticoagulants in Atrial FibrillationSaurav Chatterjee, MD; Partha Sardar, MD; Giuseppe Biondi-Zoccai, MD; Dharam J. Kumbhani, MD, SM, MRCPImportance Randomized studies have shown a decreased risk of intracranial hemorrhage (ICH) with use of novel oral anticoagulants (NOACs). However, it is unclear whether the magni




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A Stool DNA Test (Cologuard) for Colorectal Cancer Screening

from JAMA - 17 Dec 14

The FDA has approved a stool DNA test to screen average-risk adults =50 years old for colorectal cancer.



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Durability of Benefits of an Outpatient Antimicrobial Stewardship Intervention After Discontinuation of Audit and Feedback

from JAMA - 17 Dec 14

This follow-up to a randomized trial found that an intervention to reduce inappropriate antibiotic prescribing was effective only as long as audit and feedback to clinicians was in place.



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Assessment of Outcomes of Hepatitis C Treatment

from JAMA - 17 Dec 14

To the Editor The review by Dr Kohli and colleagues illustrated how hepatitis C virus (HCV) treatment has moved from the low efficacy and high complication rates observed with ribavirin plus interferon to the high sustained viral response (SVR) and rare complication rates observed with directly acting antivirals. Directly acting antivirals have been embraced by clinical guidelines and, given their comparable safety and efficacy, the discussion over which specific drug will be used in the near fu



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Assessment of Outcomes of Hepatitis C Treatment—Reply

from JAMA - 17 Dec 14

In Reply Dr Chavez-Tapia and colleagues raise an important clinical question. Is SVR the appropriate clinical end point with new treatments for HCV or should clinical outcomes be assessed? Clinical outcomes of HCV include progression of liver fibrosis, decompensated liver disease, occurrence of hepatocellular carcinoma, and mortality, all of which take years to develop. In the interferon era of HCV therapeutics, occurrence of SVR was correlated with improved liver-related and overall outcomes, i



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Causes of Ferritin Elevation

from JAMA - 17 Dec 14

In Reply Dr Lippi raises the important point that an elevated serum ferritin level may also be associated with underlying malignancy; it is true that ferritin may be elevated in a broad variety of other disease processes, as we noted in our JAMA Diagnostic Test Interpretation article. Elevated serum ferritin levels are commonly encountered in general practice and many elevations may be due to non–iron overload conditions.



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Causes of Ferritin Elevation

from JAMA - 17 Dec 14

To the Editor Drs VanWagner and Green analyzed the case of a 46-year-old man with inflammatory arthritis presenting with an elevated ferritin level of 2556 µg/L. Of the potential causes of ferritin elevation, the authors primarily considered hereditary hemochromatosis, which was the final diagnosis, as well as excess iron supplementation, frequent blood transfusions, obesity, alcohol consumption, hematologic disorders, and inflammatory arthritis.



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Prevention of Noncommunicable Diseases

from JAMA - 17 Dec 14

To the Editor We agree with Dr Yach and Mr Calitz in their Viewpoint on the changing landscape of prevention of noncommunicable diseases that increased and more targeted research on prevention, adequate infrastructure at the National Institutes of Health (NIH), public-private partnerships, and use of up-to-date health technology tools are needed. In addition, we would like to add another perspective.



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Prevention of Noncommunicable Diseases

from JAMA - 17 Dec 14

In Reply We agree with Drs Pachter and Cheng about the value of research into the early origins of chronic diseases. Further progress requires greater investment in large-scale birth cohort studies to better understand the complex interactions of genetic, environmental, and social factors and their trajectories over time.



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Nobel Prize Winners’ Research Relates to Brain Function and Neurodegenerative Diseases

from JAMA - 17 Dec 14

Work by this year’s Nobel Prize in Physiology or Medicine awardees, a British-American scientist and 2 Norwegian researchers, has had a significant effect on our understanding of human cognition and will likely lead to insights related to processes involved in the development of neurological diseases.


 

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