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This Week in JAMA
January 2, 2013

This Week in JAMA

JAMA. 2013;309(1):5. doi:10.1001/jama.2012.145018

In a randomized, placebo-controlled trial that enrolled 406 women with threatened preterm labor between 26 and 32 weeks' gestation who had not delivered after 48 hours of tocolysis, Roos and colleagues found that compared with placebo, maintenance tocolysis with nifedipine (80 mg/d for 12 days) was not associated with a reduction in adverse perinatal outcomes.

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Stephansson and colleagues examined the risk of stillbirth and infant mortality associated with maternal use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy in a population-based cohort study. Among the more than 1.6 million singleton births analyzed, 29 228 mothers had filled an SSRI prescription during pregnancy. In analyses that considered maternal characteristics and psychiatric disease severity, the authors found no association between SSRI use during pregnancy and the risk of stillbirth, neonatal mortality, or postneonatal mortality.

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In an analysis of data from 5383 patients who received a primary prevention implantable cardioverter defibrillator (ICD) in clinical practice and were propensity score matched with 1571 patients who had been randomly assigned to receive an ICD in 2 primary prevention clinical trials, Al-Khatib and colleagues found no difference in survival between trial-eligible patients and matched patients enrolled in the clinical trials.

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Fructose consumption has increased in parallel with the obesity epidemic. To explore neurophysiological factors that might underlie this association, Page and colleagues analyzed magnetic resonance imaging changes in regional cerebral blood flow after glucose and fructose ingestion in 20 healthy, normal-weight volunteers. The authors found that compared with glucose consumption, fructose consumption resulted in a distinct pattern of cerebral blood flow—particularly in brain regions related to appetite and reward. In an editorial, Purnell and Fair discuss neurophysiologic effects of fructose.

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In a meta-analysis of data from 97 prospective population-based studies—yielding a combined sample of more than 2.88 million adults—Flegal and colleagues assessed the association between standard body mass index (BMI) categories and all-cause mortality. Among the authors' findings was that relative to normal weight, obesity (all grades) and grades 2 and 3 obesity were associated with higher all-cause mortality, and overweight was associated with lower all-cause mortality. In an editorial, Heymsfield and Cefalu discuss the relationship between BMI and mortality risk.

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Is a lower vs higher hemoglobin threshold for red blood cell (RBC) transfusion best for minimizing RBC use and adverse clinical outcomes in patients with anemia? Carson and colleagues summarize the evidence derived from 19 clinical trials (>6000 patients) to address this question in a JAMA Clinical Evidence Synopsis. In an editorial, McDermott and Livingston introduce this new JAMA series.

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Coronary artery bypass graft surgery produces better outcomes than percutaneous coronary intervention in patients with diabetes who require multivessel revascularization.

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Health care in the US vs other OECD countries

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Physician organizations and health care delivery reform

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Cancer tissue handling in the genomic era

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“[P]atients' wherewithal to ask . . . questions in the time-pressured, nerve-wracking, or upsetting setting of the clinical encounter may be severely restricted, especially for those with limited health literacy, English proficiency, or confidence.” From “Mind the Outcomes.”

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Dr Bauchner summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl

Join Robert H. Shmerling, MD, January 16, from 2 to 3 PM eastern time to discuss the management of gout. To register, go to http://www.ihi.org/AuthorintheRoom.

For your patients: Information about severe combined immunodeficiency.

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