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Optimal management of patients who are assessed to be at intermediate risk of having a common bile duct stone is a matter of debate. In a randomized trial that enrolled 100 adult patients with acute gallstone-related conditions and an intermediate risk of a common bile duct stone, Iranmanesh and colleagues compared 2 management strategies—cholecystectomy first with intraoperative cholangiogram vs sequential endoscopic common bile duct assessment and subsequent cholecystectomy. The authors found the initial cholecystectomy strategy resulted in a shorter length of stay without increased morbidity. In an Editorial, Solmkin discusses blinding in surgical clinical trials.
Editorial Related Article
Whether postoperative antibiotics reduce the risk of infection after cholecystectomy for acute cholecystitis is not clear. Regimbeau and colleagues examined this question in an open-label, randomized trial involving 414 patients with mild or moderate cholecystitis who received preoperative and intraoperative amoxicillin plus clavulanic acid. The authors report that postoperative infection rates did not significantly differ among patients who did and did not receive postoperative antibiotic treatment.
Varenicline—a nicotinic receptor partial agonist—is an approved treatment for smoking cessation. Koegelenberg and colleagues assessed the efficacy of combining varenicline with the nicotine patch—a nicotine replacement therapy (NRT)—vs varenicline alone in a 12-week randomized, placebo-controlled trial of 446 adult smokers. The authors report that combination therapy was more effective than varenicline alone in achieving tobacco abstinence at the end of treatment and at 6 months’ follow-up.
Treatment of elderly patients with degenerated or failed bioprosthetic aortic valves is a clinical challenge. Transcatheter aortic valve-in-valve implantation is a less invasive approach to treatment but little is known about patient survival after the procedure. In an analysis of international registry data representing 459 patients with surgical bioprosthesis failure treated by a valve-in-valve procedure, Dvir and colleagues found that overall 1-year survival was 83.2%.
Author Video Interview
This Users’ Guide to the Medical Literature article by Murad and colleagues addresses the application of results of systematic reviews and meta-analyses in patient care decisions. The authors highlight 2 key considerations in this process: evaluating the credibility or rigor of the review and deciding on the degree of confidence in the estimates that the evidence warrants.
Continuing Medical Education
In this JAMA Clinical Evidence Synopsis, Moore and colleagues summarize the results of a Cochrane overview of 91 randomized trials (17 955 patients) evaluating antiepileptic drugs in the treatment of neuropathic and fibromyalgia pain. The authors report that compared with placebo, only gabapentin and pregabalin were associated with meaningful pain reduction in a minority (10%-25%) of patients with diabetic or postherpetic neuropathic pain. Pregabalin was associated with similar findings among patients with fibromyalgia.
In this JAMA Diagnostic Test Interpretation, Kumar and Swee present the case of a patient with persistent hypertension despite treatment with 3 antihypertensive medications. Evaluation for secondary hypertension revealed an elevated plasma aldosterone concentration and reduced plasma renin activity level. How would you interpret these findings?
Highlights. JAMA. 2014;312(2):107-109. doi:10.1001/jama.2013.279599