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Esophageal adenocarcinoma originates from Barrett esophagus, a metaplastic change in the esophageal epithelium that likely progresses in a step-wise fashion from nondysplastic to low- and high-grade dysplasia before eventually becoming adenocarcinoma. In a multicenter randomized trial involving 136 patients with Barrett esophagus containing low-grade dysplasia, Phoa and colleagues found that compared with endoscopic surveillance, endoscopic radiofrequency ablation reduced the risk of progression to high-grade dysplasia and adenocarcinoma. In an Editorial, Mönkemüller discusses the treatment of Barrett esophagus with low-grade dysplasia.
Continuing Medical Education
To assess the effect of web-based alcohol screening and brief intervention on unhealthful alcohol use, Kypri and colleagues invited 14 991 New Zealand university students to complete web-based screening. Among 5620 students who completed screening, 3422 screened positive for problem alcohol use and were randomly assigned to additional self-assessment and feedback (intervention) or screening alone (controls). The authors report the intervention produced no significant reductions in the frequency or in the overall volume of drinking, or in academic problems. A small effect on the amount of alcohol consumed per drinking session was possible. In an Editorial, Naimi and Cole discuss web-based alcohol screening intervention programs to reduce excessive alcohol use among college students.
Author Video Interview
Elevated glycated hemoglobin (HbA1c) levels have been associated with higher cardiovascular disease (CVD) incidence, and some guidelines recommend inclusion of glycemia measures in algorithms used to predict the risk of CVD. In an analysis of individual-level data from 73 prospective cohort studies involving 294 998 participants without a known history of diabetes or CVD at baseline, the Emerging Risk Factors Collaboration found that assessment of HbA1c in the context of CVD risk assessment provided little incremental benefit in predicting incident CVD.
Centralization of specialized health care services such as organ transplantation has been advocated to improve quality and efficiency; however, whether increased travel compromises access to care or patient outcomes is not clear. In a retrospective study of 50 637 veterans classified as potentially eligible for a liver transplant, Goldberg and colleagues found that 2895 (6%) were placed on a transplant list. In analyses that considered the distance a patient lived from a transplant center, the authors found that greater distance was associated with a lower likelihood of being waitlisted or transplantation and a greater likelihood of death.
An article in JAMA Surgery reported results of a meta-analysis of data from 44 observational studies that examined outcomes of carotid endarterectomy and carotid artery stenting procedures in young and elderly patients. In this From The JAMA Network article, Perler discusses the efficacy and safety of the 2 procedures among patients 65 years or older. He finds that carotid stenting is an evolving technology that may be appropriate for selected patients; however, the available evidence favors carotid endarterectomy for most elderly patients with significant carotid artery disease who are at risk of stroke.
Recent direct-to-consumer advertisements advise patients with atrial fibrillation to “rethink warfarin” in favor of apixaban, a new oral anticoagulant. This Medical Letter article summarizes the advantages and disadvantages of 3 new oral anticoagulant medications and includes recommendations to help guide medication choice for patients currently taking warfarin and those who are initiating treatment.
Highlights. JAMA. 2014;311(12):1177-1179. doi:10.1001/jama.2013.279402