In a population-based randomized trial in which 20 572 Norwegian individuals aged 50 to 64 years were invited to undergo (once-only) colorectal cancer screening involving flexible sigmoidoscopy either alone or combined with fecal occult blood testing and 78 220 control group individuals received no screening, Holme and colleagues found that once-only flexible sigmoidoscopy screening with or without fecal occult blood testing reduced colorectal cancer incidence and mortality on a population level. In an Editorial, Brett discusses options for colorectal cancer screening.
Clinically apparent atrial fibrillation (AF) is associated with an increased risk of ischemic stroke. Whether new-onset atrial fibrillation in the perioperative period is associated with long-term risk of ischemic stroke is unclear. In a retrospective cohort study that included more than 1.7 million patients without preexisting atrial fibrillation who were hospitalized for major surgery and discharged alive and free of documented cerebrovascular disease, Gialdini and colleagues found that perioperative atrial fibrillation was associated with an increased long-term risk of ischemic stroke, especially following noncardiac surgery.
Author Video Interview
A dilemma when performing meta-analyses is whether all available trials should be included. To address this question, Dechartres and colleagues used data from 163 meta-analyses (a total of 1240 randomized clinical trials) to compare treatment outcomes estimated by meta-analysis of all trials with outcomes estimated using several alternative analytic strategies: the single most precise trial; meta-analysis restricted to the largest trials; limit meta-analysis, which adjusts for small-study effect; and meta-analysis restricted to trials at low risk of bias. The authors found that estimation of treatment outcomes in meta-analyses differs depending on the analytic strategy used. In an Editorial, Berlin and Golub discuss limitations of meta-analysis and factors to consider in their interpretation.
Hepatitis C virus (HCV) infects an estimated 185 million individuals worldwide—a substantial number of whom progress to chronic infection, which is associated with high rates of cirrhosis and hepatocellular carcinoma. Kohli and colleagues report results of a systematic review of the evidence from 41 studies (19 063 adult patients) relating to the safety, efficacy, and tolerability of current interferon-based and oral interferon-free regimens to treat HCV infection. Overall, the authors found that new, short-duration, simpler therapies resulted in high sustained virologic response rates. A Viewpoint by Brennan and Shrank discusses the cost of new treatments for HCV infection.
Continuing Medical Education
An article in JAMA Pediatrics reported that among middle and high school students surveyed in 2011 and 2012, ever use of e-cigarettes was associated with higher odds of ever smoking conventional cigarettes. In this From the JAMA Network article, Niaura and colleagues discuss limitations of cross-sectional data to explain youth use of e-cigarettes, conventional cigarettes, or both.
This JAMA Diagnostic Test Interpretation article by Ge and Runyon presents the case of a 31-year-old Asian man with hepatitis C–related cirrhosis who is undergoing inpatient evaluation for liver transplantation. The patient has no cognitive impairment or mental status changes; however, his serum ammonia level is elevated. How would you interpret this finding?
Highlights. JAMA. 2014;312(6):575-577. doi:10.1001/jama.2013.279655