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Highlights

from JAMA - 17 Sep 14



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Population-Based Screening for BRCA1 and BRCA2 2014 Lasker Award

from JAMA - 17 Sep 14

This Viewpoint describes the application of the discovery of BRCA1 and discusses screening for BRCA1/2 in clinical practice.



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Discovery of High-Frequency Deep Brain Stimulation for Treatment of Parkinson Disease 2014 Lasker Award

from JAMA - 17 Sep 14

This Viewpoint provides a summary of their discoveries in understanding the role of the basal ganglia in movement, in determining the neurophysiology of Parkinson disease, and in the development of deep brain stimulation.



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The Ebola Epidemic A Global Health Emergency

from JAMA - 17 Sep 14

On August 8, the World Health Organization (WHO) Director-General Margaret Chan declared the West Africa Ebola crisis a “public health emergency of international concern,” triggering powers under the 2005 International Health Regulations (IHR). The IHR requires countries to develop national preparedness capacities, including the duty to report internationally significant events, conduct surveillance, and exercise public health powers, while balancing human rights and international trade. Until l



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Quantifying a Nonnotifiable Disease in the United States The National Amyotrophic Lateral Sclerosis Registry Model

from JAMA - 17 Sep 14

Public health surveillance is an essential tool for assessing, controlling, and preventing disease. In the United States, public health surveillance has evolved from a focus on monitoring infectious diseases to also tracking injuries, chronic diseases, birth defects, environmental and occupational exposures, and risk factors. Despite this evolution of surveillance topics, many conditions still are not notifiable to federal public health officials nor are there surveillance systems in place to ca



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Whose Autonomy?

from JAMA - 17 Sep 14

During my medical residency, I took care of a 64-year-old man, Ian (a pseudonym, as are all names in this essay). He had come to the emergency department for an exacerbation of his chronic obstructive pulmonary disease. He also had rheumatoid arthritis, and before I could take a history, his wife Sarah pulled me aside to say that he was in increasing pain from his arthritis. He never missed a dose of methotrexate, but refused to take nonsteroidal anti-inflammatory drugs. I asked if there was som



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Treating COPD in the Real World

from JAMA - 17 Sep 14

Evidence-based medicine is central to modern medical practice and relies on the availability of data from appropriately conducted randomized clinical trials (RCTs). These studies establish whether treatment is effective and, when an active comparator group is included in the trial, whether the new therapy is better than currently used treatment. In some conditions such as chronic obstructive pulmonary disease (COPD) for which no single surrogate end point predicts response to treatment, multiple



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Child Health Theme Issue 2015 Call for Papers

from JAMA - 17 Sep 14

In hospital corridors, it is easy to spot a pediatrician a mile away. It’s the adornments—the miniature bear on the stethoscope, the Mickey Mouse earrings, the comical tie. But caring for children differs from caring for adults in more ways than the clinician’s appearance. Caring for children involves a different set of diseases, such as congenital anomalies, different concerns, such as developmental issues, and different treatments. Yet, despite the differences, the health of children should be



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School-age Outcomes of Very Preterm Infants After Antenatal Treatment With Magnesium Sulfate vs Placebo

from JAMA - 17 Sep 14

ImportanceAntenatal magnesium sulfate given to pregnant women at imminent risk of very preterm delivery reduces the risk of cerebral palsy in early childhood, although its effects into school age have not been reported from randomized trials.ObjectiveTo determine the association between exposure to antenatal magnesium sulfate and neurological, cognitive, academic, and behavioral outcomes at school age.Design, Setting, and ParticipantsThe ACTOMgSO4 was a randomized clinical trial conducted in 16



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Combination Long-Acting ß-Agonists and Inhaled Corticosteroids Compared With Long-Acting ß-Agonists Alone in Older Adults With Chronic Obstructive Pulmonary Disease

from JAMA - 17 Sep 14

ImportanceChronic obstructive pulmonary disease (COPD), a manageable respiratory condition, is the third leading cause of death worldwide. Knowing which prescription medications are the most effective in improving health outcomes for people with COPD is essential to maximizing health outcomes.ObjectiveTo estimate the long-term benefits of combination long-acting ß-agonists (LABAs) and inhaled corticosteroids compared with LABAs alone in a real-world setting.Design, Setting, and PatientsPopulatio



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Clinical and Safety Outcomes Associated With Treatment of Acute Venous Thromboembolism A Systematic Review and Meta-analysis

from JAMA - 17 Sep 14

ImportanceMany anticoagulant strategies are available for the treatment of acute venous thromboembolism, yet little guidance exists regarding which drug is most effective and safe.ObjectiveTo summarize and compare the efficacy and safety outcomes associated with 8 anticoagulation options (unfractionated heparin [UFH], low-molecular-weight heparin [LMWH], or fondaparinux in combination with vitamin K antagonists); LMWH with dabigatran or edoxaban; rivaroxaban; apixaban; and LMWH alone) for treatm



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Evaluation and Treatment of Older Patients With Hypercholesterolemia A Clinical Review

from JAMA - 17 Sep 14

ImportanceHypercholesterolemia is common among people older than 80 years. Substantial functional heterogeneity exists among older patients, and decision making for statin use differs in older patients relative to younger ones.ObjectiveTo discuss the presentation, modifying factors, and treatment of hypercholesterolemia (usually with statins) among persons older than 80 years.Evidence ReviewMEDLINE and other sources were searched from January 1990 to June 2014. Personal libraries and a hand sear



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Treating Prescription Opioid Dependence

from JAMA - 17 Sep 14

JAMA PsychiatryA Randomized, Double-blind Evaluation of Buprenorphine Taper Duration in Primary Prescription Opioid AbusersStacey C. Sigmon, PhD; Kelly E. Dunn, PhD; Kathryn Saulsgiver, PhD; Mollie E. Patrick, MA; Gary J. Badger, MS; Sarah H. Heil, PhD; John R. Brooklyn, MD; Stephen T. Higgins, PhDImportance Although abuse of prescription opioids (POs) is a significant public health problem, few experimental studies have investigated the treatment needs of this growing population.Objective To




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Trends in Mean Waist Circumference and Abdominal Obesity Among US Adults, 1999-2012

from JAMA - 17 Sep 14

Waist circumference is a simple and valuable anthropometric measure of total and intra-abdominal body fat. The clinical guidelines from the National Heart, Lung, and Blood Institute on the identification, evaluation, and treatment of overweight and obesity in adults recommend that clinicians assess waist circumference of their patients. Although the prevalence of abdominal obesity has increased in the United States through 2008, its trend in recent years is unknown. Therefore, our objective was



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Diabetes Prevalence Among Youth

from JAMA - 17 Sep 14

To the Editor The SEARCH investigators assessed the burden of diagnosed diabetes among youth. We wish to discuss 2 important limitations of the SEARCH study design.



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Diabetes Prevalence Among Youth—Reply

from JAMA - 17 Sep 14

In Reply Accurate estimation of the prevalence of childhood diabetes is challenging. Dr Demmer and colleagues raised 2 issues: undiagnosed diabetes and geographic representativeness.



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Recurrence Rates in Autism Spectrum Disorders

from JAMA - 17 Sep 14

To the Editor The recent report by Dr Sandin and colleagues contributes to a converging body of recent research specifying recurrence rates in autism spectrum disorders (ASD) by analyzing data from a large epidemiological birth cohort in Sweden.



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Recurrence Rates in Autism Spectrum Disorders—Reply

from JAMA - 17 Sep 14

In Reply We share Dr Constantino’s interest in determining if there are differences in the etiology of ASD between males and females. We did not compare the heritability of ASD between males and females in the study for 2 reasons.



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Certification of Mobile Apps for Health Care

from JAMA - 17 Sep 14

To the Editor A Viewpoint by Dr Powell and colleagues highlighted just how difficult it is for patients and clinicians to identify safe, effective mobile apps for health care, with the thousands of apps in the marketplace having received little review or clinical evaluation. The authors called for more “rigorous certification criteria and unbiased accrediting bodies,” claiming the need for certification of apps.



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Certification of Mobile Apps for Health Care—Reply

from JAMA - 17 Sep 14

In Reply We agree with Drs Chan and Misra that it is difficult to review and certify large numbers of mHealth apps and that conducting traditional randomized clinical trials of specific apps may not be reasonable given the current rate of innovation. However, we also believe it is problematic to ask clinicians and patients to fend for themselves when evaluating apps. The new challenges that the rapid innovation in apps present may require new types of solutions.



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Incorrect Data in a Table

from JAMA - 17 Sep 14

In the Grand Rounds report entitled “Resistant Hypertension: A Review of Diagnosis and Management” published in the June 4, 2014, issue of JAMA (2014;311[21]:2216-2224. doi:10:1001/jama.2014.5180), an incorrect dose range was presented in Table 2. In the Lisinopril row, the dosing range should be “5-80 mg/d.” This article was corrected online.



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Guideline: New HCV Drugs Should Go to Sickest Patients

from JAMA - 17 Sep 14

Patients who have advanced liver disease or other severe symptoms of hepatitis C virus (HCV) infection should be first in line for an expensive new medication for treating HCV, according to a new guideline. The guideline, from the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America, was created with support from the International Antiviral Society–USA (IAS-USA). It is the latest in a series of guidelines from the groups on treating HCV.



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USPSTF: Lifestyle Counseling Advised for Overweight, Obese Adults With Other Cardiovascular Risk Factors

from JAMA - 17 Sep 14

Adults who are overweight or obese and have additional risk factors for cardiovascular disease such as hypertension, dyslipidemia, or impaired fasting glucose should be offered intensive counseling to promote a healthful diet and physical activity, the US Preventive Service Task Force (USPSTF) has advised (http://bit.ly/1lu0CMp).



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Reports: HIV Drugs Targeted for Black Market

from JAMA - 17 Sep 14

Expensive HIV medications are likely being targeted for resale on the black market, according to a new report from a federal watchdog. The report explained that the patterns the agency detected could mean patients were diverting the drugs for sale on the black market or that pharmacies were fraudulently billing Medicare for drugs that were never dispensed.


 

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