Intravenous tissue plasminogen activator (IV tPA) improves outcomes in ischemic stroke; however, whether patients receiving long-term warfarin therapy face an increased risk of intracranial hemorrhage when treated with IV tPA is not clear. In a multicenter cohort study that included 23 437 patients with ischemic stroke who were treated with IV tPA, Xian and colleagues found that patients who were taking warfarin within 7 days of the ischemic stroke were at no greater risk of symptomatic intracranial hemorrhage than patients not taking warfarin. In an editorial, Alberts discusses the use of IV-tPA in patients with ischemic stroke who are receiving long-term anticoagulation therapy.
In a clinical trial that involved 88 children with stage I or II Hodgkin lymphoma, Metzger and colleagues assessed the need for radiotherapy based on patients' early response to chemotherapy. All patients received 4 cycles of chemotherapy with vinblastine, doxorubicin, methotrexate, and prednisone. Patients who achieved a complete response after 2 chemotherapy cycles did not receive radiotherapy, whereas those with less than complete response did. The authors report that patients with a complete early response to chemotherapy and no subsequent radiotherapy had comparable 2-year event-free survival as patients who received radiotherapy. In an editorial, Whelan and Goldman discuss the evolution of Hodgkin lymphoma treatment in children.
Two articles in this issue examine weight loss interventions and the effect of diet macronutrient composition on energy expenditure during weight-loss maintenance. Jakicic and colleagues randomly assigned 363 overweight or obese adults to either a standard behavioral weight loss intervention or a stepped-care weight loss intervention that allowed modifications in the intensity and frequency of the behavioral intervention components when weight loss goals were not met. The authors found that the standard behavioral weight loss intervention resulted in a greater mean weight loss over 18 months. Ebbeling and colleagues report results of a controlled feeding study that involved 21 overweight and obese adults who had achieved 10% to 15% weight loss and who consumed each of 3 isocaloric diets with differing macronutrient composition during a weight maintenance phase. The authors found that declines in resting and total energy expenditure were greatest with a low-fat diet, intermediate with a low–glycemic index diet, and least with a very low-carbohydrate diet. In an editorial, Bray discusses implications of these findings for the treatment of obesity.
A 56-year-old man with acute myelogenous leukemia and a treatment course complicated by prolonged neutropenia and fever of unknown origin developed a nonblanching, necrotic-appearing, and violaceous plaque on his neck. What would you do next?
US health authorities warn that some patients with multiple sclerosis are turning to an unproven surgical treatment that is associated with serious risks.
Bone density screening: one size does not fit all
Health information technology and health care reform
Physician performance: measurement and motivation
“Health care is a human right; it must be made so in our nation; and it is your duty to make it so.” From “To Isaiah.”
How would you manage a 76-year-old woman who experienced delirium after surgery? Go to www.jama.com to read the case. Submit your response by July 1 for possible online posting.
Dr Bauchner summarizes and comments on this week's issue. Go to http://jama.jamanetwork.com/multimedia.aspx#Weekly.
Join Peter B. Bach, MD, MAPP, and George T. O’Connor, MD, Wednesday, July 18, from 2 to 3 pm eastern time to discuss the benefits and harms of computed tomographic screening for lung cancer. To register, go to http://www.ihi.org/AuthorintheRoom.
For your patients: Information about insomnia.
This Week in JAMA. JAMA. 2012;307(24):2565. doi:10.1001/jama.2012.3063