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This Week in JAMA
January 14, 2009

This Week in JAMA

JAMA. 2009;301(2):133. doi:10.1001/jama.2008.992

Supervised treadmill exercise improves walking performance in patients with peripheral arterial disease (PAD) and symptoms of intermittent claudication. However it is not clear whether patients with PAD and no symptoms of intermittent claudication benefit from supervised treadmill exercise or whether strength training is beneficial for patients with PAD. To address these questions, McDermott and colleagues randomly assigned patients with PAD to supervised treadmill exercise, to supervised lower extremity resistance training, or to a control group. At a 6-month follow-up, the authors found that participants with PAD—with and without intermittent claudication symptoms—who were assigned to treadmill exercise had greater increases in their 6-minute walk distance than did participants assigned to strength training. Neither exercise group experienced improvements in their physical performance battery scores.

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Accretion of the n-3 long-chain polyunsaturated fatty acid docosahexaenoic acid (DHA), a major lipid in the brain, is greatest during the last trimester of pregnancy and DHA deficiency is hypothesized to result in poor neurodevelopmental outcomes in preterm infants. In a randomized trial that enrolled infants born at less than 33 weeks' gestation, Makrides and colleagues assessed the effect of high-dose DHA vs standard-dose DHA enteral feeds—from day 2 to 4 of life until term-corrected age—on neurodevelopmental outcomes. The authors report that compared with standard-dose DHA, high-dose DHA enteral feedings were not associated with higher scores on the Bayley Mental Development Index at the 18-month follow-up. In a subgroup analysis, girls, but not boys, fed the high-DHA diet had improved mental development index scores.

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It is estimated that 50% of incarcerated individuals meet the diagnostic criteria for drug abuse or dependence. Chandler and colleagues discuss the neurological basis of addictive behavior; evidence-based principles of addiction treatment that could be used in the criminal justice system; and the implications of addressing addiction within the criminal justice system for persons with addiction and society.

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In the second in a series of 3 Users' Guides to the Medical Literature on genetic association studies, Attia and colleagues use the APOE polymorphism and its association with dementia to discuss how to assess the validity of these studies. The third article, which will discuss how to interpret study results and apply this information in clinical care, will be published in next week's issue of JAMA.

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Symptoms of fibromyalgia syndrome (FMS) include chronic pain, fatigue, nonrestorative sleep, and other somatic and psychological symptoms, and effective treatment options are needed. In a meta-analysis of randomized placebo-controlled trials of antidepressants in the treatment of FMS, Häuser and colleagues found that antidepressant therapy is associated with reductions in pain, fatigue, depressed mood, and sleep disturbances and improvements in quality of life.

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“Doc's diagnoses were rendered with such authority and confidence that his patients were certain that theirs was the best, most competent physician to be had at any price.” From “Provenance.”

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Experts are working to improve the diagnosis and treatment of Chiari malformation.

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Transparency in standards for diabetes performance measures

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Sliding scale insulin therapy

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Improving health care quality: who is responsible for what?

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Call for Papers

Authors are encouraged to submit manuscripts for an upcoming JAMA theme issue.

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Join David J. A. Jenkins, MD, PhD, January 21 from 2 to 3 PM eastern time to discuss low–glycemic index or high–cereal fiber diets and type 2 diabetes. To register, go to http://www.ihi.org/AuthorintheRoom.

For your patients: Information about peripheral arterial disease.

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