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This Week in JAMA
June 19, 2013

This Week in JAMA

JAMA. 2013;309(23):2411. doi:10.1001/jama.2013.5824

In a randomized trial involving 137 patients with juvenile idiopathic arthritis (JIA) who had undergone primary measles-mumps-rubella (MMR) immunization, Heijstek and colleagues assessed the effect of MMR booster vaccination compared with no vaccine booster on JIA disease activity. The authors report that receipt of the MMR booster vaccination did not result in worse JIA disease activity scores in the subsequent year.

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To evaluate the optimal diagnostic modality in patients with suspected stage I or II pulmonary sarcoidosis, von Bartheld and colleagues randomly assigned 304 patients to undergo either bronchoscopy with lung biopsy or esophageal or endobronchial endosonography with intrathoracic lymph node aspiration. The authors found that endosonographic nodal aspiration resulted in greater diagnostic yield than bronchoscopic lung biopsy—the current diagnostic standard.

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Among patients who received Exserohilum rostratum–contaminated methylprednisolone injections, insidious onset of infection at the injection site has been reported months later. Malani and colleagues performed screening magnetic resonance imaging (MRI) studies in 172 patients who received a spinal or paraspinal methylprednisolone injection from a contaminated lot and found that 36 patients (21%) had an abnormal MRI—all but 1 of whom met the case definition for probable or confirmed fungal infection. In an editorial, Thompson and colleagues discuss management of patients who may have been exposed to injections with contaminated methylprednisolone.

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Antibodies to pancreatic islet cells are common in the preclinical phase of type 1 diabetes. To assess the rate of progression to diabetes after seroconversion, Ziegler and colleagues analyzed data from 3 multicenter cohort studies of children who were at increased risk of type 1 diabetes. The authors found that among the 585 children with 2 or more autoantibodies, 84% progressed to diabetes over 15 years' follow-up. In an editorial, Skyler and Sosenko discuss the evolution of type 1 diabetes.

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Benefit from intravenous tissue-type plasminogen activator (tPA) in patients with acute ischemic stroke is time dependent. In an analysis of data from 58 353 patients with acute ischemic stroke treated with tPA within 4.5 hours of symptom onset, Saver and colleagues found that earlier treatment was associated with reduced in-hospital mortality and intracerebral hemorrhage and with higher rates of independent ambulation at discharge and discharge to home.

See Article and Author Audio Interview

Health Checks to Reduce Morbidity and Mortality

Krogsbøll and colleagues summarize a 2012 Cochrane review of 14 randomized clinical trials of general health checks vs usual care—involving 182 880 participants enrolled between 1963 and 1999 and followed up from 1970 to 2009—that found general health checks were not associated with lower rates of mortality or morbidity compared with usual care. In an editorial, Sox discusses health screening in contemporary medical practice.

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Fueled by provisions of health care reform and informed by research, the collaborative care model for treating mental illness in primary care is gaining momentum.

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Spinal injection therapy for low back pain

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Boston Marathon response: why did it work so well?

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Building trust that “big data” research will serve the public good

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Defining term pregnancy

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“My medical experience does not offer much help in our seeking ways to adjust to each day's events that we wish will remain the same, but know will not.” From “The Things That Matter.”

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Dr Bauchner summarizes and comments on this week's issue, including Viewpoints, Editorials, Original Contributions, and clinical content. Go to http://jama.jamanetwork.com/multimedia.aspx#Weekly

For your patients: Information about summer safety for kids.

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