Mineralocorticoid receptor activation by aldosterone contributes to the progression of heart failure. Edelmann and colleagues assessed the efficacy and safety of long-term (12 months) aldosterone receptor blockade with spironolactone in a randomized, placebo-controlled trial that included 422 patients with heart failure and preserved ejection fraction. The authors report that compared with placebo, aldosterone receptor blockade improved left ventricular diastolic function but not exercise capacity. In an editorial, Cleland and Pellicori discuss how diagnostic uncertainty complicates identification of effective therapies for diastolic heart failure.
Since 2006, coverage of bariatric surgery for Medicare beneficiaries has been limited to hospitals designated as centers of excellence. In an analysis of 2004-2009 hospital discharge data from 273 252 Medicare and non-Medicare patients undergoing bariatric surgery, Dimick and colleagues found no difference in the rates of complications and reoperations before vs after the Medicare coverage decision for bariatric surgery. In an editorial, Greenberg discusses a new paradigm for promoting quality surgical care.
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Johnson and colleagues analyzed national Surveillance, Epidemiology, and End Results data (1973-2009) to assess breast cancer incidence, trends, and survival as a function of age and disease extent at diagnosis. Among their findings was that from 1973 to 2009, the incidence of distant disease increased among women aged 25 to 39 years without a corresponding increase among older women.
Patients with small abdominal aortic aneurysms (AAAs) typically undergo periodic surveillance ultrasound scans to monitor aneurysm growth and limit the risk of aneurysm rupture. In an analysis of data from 15 471 patients undergoing surveillance for small AAA, Bown and colleagues quantified AAA growth rates and rupture risk as a function of baseline aortic diameter. The authors report that surveillance intervals of several years may be clinically acceptable for a majority of patients.
The CONSORT (Consolidated Standards of Reporting Trials) Statement provides evidence-based recommendations to improve reporting of randomized controlled trials (RCTs). However, the CONSORT statement lacks guidance on the reporting of trial outcomes that are patient-reported. Calvert and colleagues describe the development and use of an extension of the CONSORT statement (CONSORT PRO [patient-reported outcome]), which includes 5 items that should be reported in all RCTs in which patient-reported outcomes are primary or important secondary end points.
A previously healthy teenager reports acute onset of severe retrosternal and epigastric pain after swallowing a mouthful of cold soda. His vital signs are stable; radiography reveals a small pneumomediastinum and retropharyngeal and paratracheal air. What would you do next?
Recent mass shootings have spurred efforts to find ways to reduce gun violence in the United States, such as banning sales of assault weapons.
US health relative to other high-income countries
Ethics of parsimonious medicine
Value of low-value lists
Health policy and the American Taxpayer Relief Act
“When did old age become a crime punishable by death?” From “If Only Grown-ups Would Pay Attention.”
Call for Papers
Authors are invited to submit manuscripts for an upcoming JAMA theme issue.
Dr Livingston summarizes and comments on this week's issue. Go to www.jama.com.
Join Daniel J. Buysse, MD, March 20, 2013, from 2 to 3 PM eastern time to discuss insomnia. To register, go to http://www.ihi.org/AuthorintheRoom.
For your patients: Information about adult sinusitis.
This Week in JAMA. JAMA. 2013;309(8):741. doi:10.1001/jama.2012.145246