In a multicenter randomized trial involving 830 patients who had undergone cardiothoracic surgery and either developed or were at risk of acute respiratory failure after extubation, Stéphan and colleagues found that compared with noninvasive ventilation—delivered as intermittent bilevel positive airway pressure—use of high-flow nasal oxygen therapy did not result in a worse rate of treatment failure—defined as reintubation, switch to the other study treatment, or premature treatment discontinuation. In an Editorial, Del Sorbo and Ferguson discuss the management of postoperative respiratory failure and particular features of this study to consider when interpreting the results.
In a multicenter randomized trial that enrolled 530 adult patients whose acute appendicitis was confirmed as uncomplicated by computed tomographic scan, Salminen and colleagues compared treatment with antibiotics vs appendectomy. The primary end points were appendectomy for patients randomly assigned to appendectomy or hospital discharge without appendectomy and no recurrent appendicitis during 1-year follow-up for patients assigned to antibiotics. The authors report that based on their prespecified noninferiority margin (24%) for the difference between treatments, noninferiority of antibiotic treatment relative to surgery could not be established. In an Editorial, Livingston and Vons discuss nonsurgical treatment of uncomplicated appendicitis.
Editorial and Related Articles 1, 2, and 3
Author Audio Interview and Continuing Medical Education
Colonoscopy quality, as measured by adenoma detection rate, varies widely between physicians with unknown consequences for the benefits and cost of colorectal cancer (CRC) screening programs. Meester and colleagues used data from a community-based health care system (57 588 screening colonoscopies performed by 136 physicians) and microsimulation models to examine the relationship of adenoma detection rates to CRC incidence, mortality, complications, and costs. Among the authors’ findings was that higher adenoma detection rates in screening colonoscopy were associated with lower lifetime risks of CRC incidence and mortality without higher overall costs.
Author Video Interview and Continuing Medical Education
High-income countries and private organizations provide billions of dollars to developing countries for health programs. Dieleman and colleagues analyzed 1990-2014 budget, revenue, and expenditure data from agencies and organizations that provided development assistance for health, and report that funding has increased substantially since 1990. Major areas of focus have been HIV/AIDS and maternal, newborn, and child health, with limited funding for noncommunicable diseases. In an Editorial, Haines discusses development assistance for health and achievement of international health goals.
An article in JAMA Surgery reported that adherence to the revised Surgical Care Improvement Project (SCIP) perioperative β-blocker continuation measure—extending β-blocker therapy from the postanesthetic care unit to at least 1 of the first 2 postoperative days—was associated with a reduction in major adverse cardiovascular or cerebrovascular events. In this From The JAMA Network article, Urbach and Bell discuss hazards of estimating treatment effects from observational data.
This JAMA Guide to Statistics and Methods article by Kaji and Lewis considers key aspects of a noninferiority trial, a type of clinical trial that seeks to determine whether a new intervention offering advantages such as less toxicity or lower cost is not less effective than an established treatment. The authors discuss factors to consider in defining the noninferiority margin and interpreting the results of noninferiority trials.
A 44-year-old man with a history of gastroesophageal reflux disease presents for evaluation of mouth ulcers that typically resolve within a few weeks and then recur on different mucosal surfaces. Intraoral examination demonstrates an ulcer with a pseudomembrane and erythematous halo on the lateral surface of the tongue. What would you do next?
Highlights. JAMA. 2015;313(23):2299-2301. doi:10.1001/jama.2014.11805