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In This Issue of JAMA
March 3, 2015


JAMA. 2015;313(9):871-873. doi:10.1001/jama.2014.11609

In a randomized trial involving 1198 homeless Canadian adults with mental illness, Stergiopoulos and colleagues found that compared with usual care, subsidized access to scattered-site housing and intensive case management resulted in increased housing stability over 24 months but no improvements in health-related quality of life. In an Editorial, Katz discusses interventions to address chronic homelessness.


Author Video Interview

Sedatives are widely administered before surgery, but evidence to support this practice is lacking. In a randomized placebo-controlled trial that enrolled 1062 adults in France having elective surgery under general anesthesia, Maurice-Szamburski and colleagues found that compared with placebo or no premedication, premedication with lorazepam did not improve patients’ reported perioperative experience or satisfaction the day after surgery. Premedication was associated with longer time to extubation and a lower rate of early cognitive recovery.

The optimal approach to long-term follow-up of cytologically and sonographically benign thyroid nodules is not clear. In a prospective study involving 992 patients with presumed benign thyroid nodules, Durante and colleagues found that the majority of nodules did not increase in size and thyroid cancer diagnoses were rare during 5 years of follow-up. In an Editorial, Cappola and Mandel discuss implications of the study findings for follow-up of patients with benign thyroid nodules.


Author Audio Interview

Schaffer and colleagues assessed single- and double-lung transplant outcomes among 7308 patients with idiopathic pulmonary fibrosis (IPF) or chronic obstructive pulmonary disease (COPD) who had undergone transplant since May 2005—when allocation of donor lungs according to medical need was implemented. The authors report that double-lung transplant was associated with less mortality and better graft survival than single-lung transplant among patients with IPF. There was no survival difference between double- and single-lung recipients with COPD.

Clinical Review & Education

Based on results of a systematic literature review, Chey and colleagues summarize the evidence relating to the epidemiology, pathophysiology, and diagnosis of irritable bowel syndrome (IBS) and provide guidance for disease management. Diagnosis should rely on symptom-based criteria, exclusion of certain concerning features, and selected diagnostic tests. Treatment should be individualized and may include dietary, lifestyle, medical, and behavioral interventions.

Continuing Medical Education

An article in JAMA Internal Medicine reported a dose-dependent relationship between consumption of added sugar—sugars added in food processing or preparation—and cardiovascular disease (CVD) mortality. In this From The JAMA Network article, Dhurandhar and Thomas discuss the evidence relating to health risks of sugar consumption and implications for public health policy.

Shift workers who experience impaired sleep and reduced alertness during night shifts may request pharmacological treatment to ameliorate these adverse effects of their work schedule. This JAMA Clinical Evidence Synopsis by Liira and colleagues summarizes data from a Cochrane review of 15 randomized placebo-controlled trials examining pharmacological interventions for sleepiness and sleep disturbances caused by shift work. Among the findings was that melatonin is associated with a small increase in sleep duration but no change in sleep latency. Modafinil and armodafinil increase alertness and reduce sleepiness but are associated with headache and nausea.

A 55-year-old man was evaluated in the emergency department for blurry vision of 1 week’s duration. Direct ophthalmoscopy revealed severe bilateral optic disc edema, peripapillary hemorrhages, and absent venous pulsations. Bony sclerotic lesions were noted on a computed tomography scan of the head. What would you do next?