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In This Issue of JAMA
November 26, 2014


JAMA. 2014;312(20):2065-2067. doi:10.1001/jama.2013.279851

BK virus reactivation—a common consequence of immunosuppressive therapy—is associated with a high risk of kidney transplant failure. In a randomized placebo-controlled trial involving 154 kidney transplant recipients, Knoll and colleagues found that a 3-month course of levofloxacin—initiated within 5 days of transplantation—did not prevent BK viruria and was associated with an increased risk of adverse events.

In an analysis of data from 5 prospective population-based studies, which together included 15 975 African American participants (1248 with sickle cell trait and 14 727 noncarriers), Naik and colleagues examined the relationship between sickle cell trait and renal disease. The authors report that sickle cell trait was associated with an increased risk of chronic kidney disease, decline in estimated glomerular filtration rate, and albuminuria.

Continuing Medical Education

Participation in high-quality early childhood intervention programs has been associated with greater school readiness and success. Whether full-day vs part-day attendance improves outcomes is not known. In an analysis of end-of-preschool data from predominantly low-income children enrolled in a full-day (n=409) or part-day (n=573) high-quality, evidence-based preschool program, Reynolds and colleagues found that the full-day intervention was associated with increased school readiness skills—including socioemotional development, language, and math—and higher rates of attendance compared with the part-day program. In an Editorial, Schweinhart discusses the value of high-quality full-day preschool programs.


Author Video Interview

In a prospective evaluation of cost data from 2344 critically ill patients enrolled in a multicenter randomized trial comparing unfractionated heparin with the low-molecular-weight heparin dalteparin for prophylaxis against venous thromboembolism, Fowler and colleagues found that dalteparin was more effective and was associated with similar or lower costs than unfractionated heparin.

Clinical Review & Education

Mello and colleagues report recent trends in medical liability claims and costs and discuss nontraditional approaches to liability reform that are intended to improve the safety of care and patients’ access to compensation while reducing liability-related burdens for physicians. In an Editorial, Sage discusses the prospect of achieving both monetary and nonmonetary goals of malpractice claim resolution in an improved medical malpractice system.


Author Audio Interview

An article in JAMAPediatrics reported that among adolescent boys and young men, personal concerns about physique and use of potentially unhealthful behaviors to achieve a desired muscularity are relatively common. In this From The JAMA Network article, Neumark-Sztainer and Eisenberg discuss body image concerns and their potential consequences in young men.

A young woman with a recent diagnosis of Crohn disease presented with intermittent high fevers and a rapidly enlarging leg ulcer that did not respond to systemic antibiotics. Results of blood and wound cultures were negative and serum autoantibodies were not detected. What would you do next?

This JAMA Diagnostic Test Interpretation article by Rajkumar and Kyle presents the case of an older woman with progressive numbness in her hands. The patient’s history was negative for alcohol use and diabetes. Upper and lower extremity deep tendon reflexes were reduced bilaterally and signs of carpal tunnel syndrome were present. Serum protein electrophoresis and immunofixation revealed a monoclonal protein. How would you interpret these findings?