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In This Issue of JAMA
June 9, 2015

Highlights

JAMA. 2015;313(22):2199-2201. doi:10.1001/jama.2014.11791
Americans with Disabilities Act

Edited by Lawrence O. Gostin, JD, Howard Bauchner, MD, and Phil B. Fontanarosa, MD, MBA

Research

In an analysis of 1993-2012 data from the Nationwide Inpatient Sample, Jain and colleagues assessed trends in acute traumatic spinal cord injury (SCI) incidence, etiology, mortality, and associated surgical procedures. Among their findings was that the incidence of acute traumatic SCI remained relatively stable, with the largest increase observed in the elderly—an increase largely attributed to falls.

Some patients with lower leg amputations may be candidates for motorized prosthetic limbs. Optimal control of such devices requires accurate classification of the patient’s ambulation mode—for example walking on level ground vs descending stairs. In a randomized crossover clinical trial involving 7 patients with lower limb amputations, Hargrove and colleagues found that including residual limb muscle electromyography data and gait information in the control system of a motorized prosthetic limb improved measures of limb performance.

Related Article

Author Video Interview and Continuing Medical Education

Individuals with documented disabilities may receive testing accommodations—for example, extra testing time—when sitting for the Medical School Admission Test (MCAT). In a retrospective study involving 2 cohorts of students: 2011-2013 US medical school applicants (n=134 397) and 2000-2004 medical school matriculants (n=76 711), Searcy and colleagues found that compared with students reporting MCAT scores obtained with standard test-taking time, students who reported extra administration time had similar rates of medical school admission but lower rates of passing the United States Medical Licensing Examination Step examinations and of medical school graduation within 4 to 8 years of matriculation.

Clinical Review & Education

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of liver disease worldwide and its prevalence is increasing in parallel with that of obesity and diabetes. Based on a systematic review—including 16 randomized trials, 44 cohort or case-control studies, 6 population-based studies, and 7 meta-analyses, Rinella discusses identification of patients with NAFLD—particularly those at greatest risk of nonalcoholic steatohepatitis and cirrhosis; benefits of lifestyle modification; and appropriate use of existing drug therapy and liver transplantation.

Continuing Medical Education

The standard recommended insulin dose (0.1 U/kg per hour) in diabetic ketoacidosis (DKA) guidelines is not backed by strong clinical evidence. A randomized trial reported in JAMA Pediatrics found that low-dose insulin (0.05 U/kg per hour) was noninferior to standard-dose insulin with respect to the rate of blood glucose decrease and resolution of acidosis in children with DKA. In this From The JAMA Network article, Carmody and colleagues discuss insulin dosing in pediatric DKA.

This JAMA Clinical Evidence Synopsis article by van Durme and colleagues summarizes a recent Cochrane review of 23 randomized trials that compared nonsteroidal anti-inflammatory drugs (NSAIDs) with other therapies for reducing pain and joint swelling and improving joint function in acute gout. Among the findings was that compared with cyclooxygenase inhibitors, NSAIDs were associated with no difference in pain reduction but were associated higher rates of withdrawal due to adverse effects.

In a JAMA Diagnostic Test Interpretation article, Heckman and O’Connor present a 67-year-old man who has a 45–pack-year smoking history and worsening dyspnea. Findings from physical examination, chest x-ray, and pulmonary function tests are summarized. How would you interpret these test results?

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