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In This Issue of JAMA
May 21, 2014


JAMA. 2014;311(19):1939-1941. doi:10.1001/jama.2013.279500

McEvoy and colleagues compared the effectiveness of paliperidone palmitate—a long-acting injectable second-generation atypical antipsychotic—with the older long-acting injectable agent haloperidol decanoate as maintenance therapy for schizophrenia or schizoaffective disorder in a randomized trial that enrolled 311 patients who were at high risk of relapse. The authors found the 2 medications did not differ in the rate of efficacy failure—defined as inadequate control of psychopathology assessed by a blinded adjudication committee. In an Editorial, Goff discusses maintenance treatment of schizophrenia with injectable long-acting antipsychotic medications.


Evidence is limited on the efficacy of physical therapy to reduce pain and improve physical function among patients with hip osteoarthritis. In a randomized, participant- and assessor-blinded 12-week trial involving 102 patients with painful hip osteoarthritis, Bennell and colleagues compared physical therapy (education/advice, manual therapy, home exercise, and gait aid if appropriate) with sham treatment (inactive ultrasound and inert gel application) and found that physical therapy did not result in greater improvement in pain or function compared with sham treatment.

Author Audio Interview

Kris and colleagues report results of a study that used multiplex genotyping to assess the frequency of oncogenic drivers—genomic alterations critical to cancer development, maintenance, or both—in 1007 patients with lung adenocarcinomas; the utility of assay results to select genotype-directed therapy; and the effect on patient survival. The authors report actionable oncogenic drivers were detected in 466 of 733 tumors tested (64%) with the complete (10 driver) multiplex assay. Assay results were used to select a targeted therapy or clinical trials for 28% of the patients, and individuals who received driver-targeted drugs lived longer. In an Editorial, Pasche and Grant discuss genomic testing to guide cancer treatment and enhance clinical trial design.


Author Video Interview and Continuing Medical Education

Clinical Review & Education

Ms W, a 62-year-old woman with initial symptoms of stress urinary incontinence, now reports urge incontinence symptoms as well, a condition termed mixed urinary incontinence. In a discussion of this case, Myers reviews the prevalence, diagnosis, treatment, and outcomes of mixed urinary incontinence. In a literature review of 73 articles, the author found high-quality evidence to support treatment of urinary incontinence with weight loss; surgical treatment of stress urinary incontinence; and managing urge incontinence with anticholinergic medications. High-quality evidence for the treatment of mixed urinary incontinence was lacking, as are clear diagnostic criteria. Thus, treatment of mixed urinary incontinence typically begins with conservative management of the most bothersome component.

An 8-year-old boy was found outside, unconscious on a rainy day. He was observed to be fine 1 hour before and was previously healthy. The boy was amnesic for events leading to his injuries. On examination he had trismus, left leg pain, and mild erythema of the left foot with dry, black punctate lesions. Similar lesions were noted on the forearms. Venous blood gas analysis revealed severe lactic acidosis. What would you do next?

In this JAMA Diagnostic Test Interpretation article, Wagner and Hiatt present the case of a 92-year-old man who, 3 days after undergoing laparoscopic right hemicolectomy for adenocarcinoma of the cecum, developed atrial fibrillation. Breath sounds were diminished and a chest x-ray showed pulmonary edema. Serum troponin and B-type natriuretic peptide (BNP) levels were elevated. How would you interpret the test results? In an Editorial, Livingston and McDermott discuss the format and goals of this new JAMA series.