Observational data suggest a possible inverse association between serum 25-hydroxyvitamin D levels and the incidence of upper respiratory tract infections (URIs). Murdoch and colleagues randomly assigned 322 healthy adults with mean vitamin D levels of 29 ng/mL to receive either oral vitamin D3 (200 000 IU for 2 months, then 100 000 IU/month for a total of 18 months) or placebo tablets. The authors report that vitamin D supplementation did not reduce the incidence or severity of URIs in healthy adults with near-normal vitamin D levels. In an editorial, Linder discusses vitamin D and the search for a cure for the common cold.
Bangalore and colleagues assessed the efficacy of β-blocker therapy in stable patients with and without coronary artery disease (CAD) in an analysis of data from 44 708 patients enrolled in a prospective, observational registry. The authors examined the relationship in 3 patient cohorts: those with known prior myocardial infarction (MI), those with known CAD without MI, and patients with CAD risk factors alone. During a median 44 months of follow-up, the authors found that β-blocker use was not associated with a lower risk of cardiovascular death, MI, or stroke.
Recent reports have suggested that rheumatoid arthritis may be a risk factor for venous thromboembolism (VTE), particularly in conjunction with hospitalization. In an analysis of Swedish patient registry data from 37 856 patients with prevalent rheumatoid arthritis, 7904 patients with incident rheumatoid arthritis, and 207 271 matched general population comparators, Holmqvist and colleagues found that patients with rheumatoid arthritis had an elevated risk of VTE that was stable over the first 10 years after diagnosis. Hospitalization was a VTE risk factor the first year after discharge; however, the risk was no greater in patients with rheumatoid arthritis than in the general population.
Patients with nondystrophic myotonias (NDM)—rare diseases caused by mutations in skeletal muscle ion channels—experience stiffness and pain. In a randomized, placebo-controlled, crossover study that involved 59 patients with NDM, Statland and colleagues found that 4 weeks' treatment with mexiletine—an antiarrhythmic medication that acts through sodium channel blockade—resulted in significant improvement in patient-reported stiffness. In an editorial, Hoffman and Kaminski discuss implications of this investigation for clinical research on rare diseases.
Pulmonary hypertension, defined as mean pulmonary artery pressure of 25 mm Hg or greater, is common in the general population and associated with increased mortality. Shah discusses the differential diagnosis, disease categorization, etiologies, and pathogenesis; diagnostic approach—particularly the appropriate use and interpretation of invasive hemodynamic testing; and treatment challenges.
A number of barriers hinder clinicians from translating new research findings, especially negative findings, into medical practice.
Controlling urban epidemics of West Nile virus infection
Patient-centered, team-based care
Article AND AUTHOR AUDIO INTERVIEW
A new model for medical education
“I did the math. The chances of my getting this disease were literally less than one in a million. I had become what you never want to be: an ‘interesting patient.’” From “Lack of Data.”
Mary McGrae McDermott, MD, summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.
Join Robert W. Haley, MD, Wednesday October 10, from 2 to 3 PM eastern time to discuss controlling urban epidemics of West Nile virus infection. To register, go to http://www.ihi.org/AuthorintheRoom.
For your patients: Information about pulmonary hypertension.
This Week in JAMA. JAMA. 2012;308(13):1291. doi:10.1001/jama.2012.3243