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In This Issue of JAMA
August 11, 2015


JAMA. 2015;314(6):535-537. doi:10.1001/jama.2014.11907

Testosterone use in older men is increasing. To determine the effect of testosterone administration on subclinical atherosclerosis progression in older men with low or low-normal testosterone levels, Basaria and colleagues randomly assigned 308 men aged 60 years or older to receive testosterone gel or placebo for 3 years. The authors report that compared with placebo, testosterone administration for 3 years did not result in a significant difference in rates of change in measures of common carotid intima-media thickness or coronary artery calcification.

Author Video Interview and Continuing Medical Education

Patients with end-stage renal disease who might be candidates for renal transplantation typically require a referral for transplant evaluation from a dialysis facility. In an analysis of data from a cohort of 15 279 adult patients receiving dialysis at 308 dialysis facilities in Georgia in 2005-2011, Patzer and colleagues found that the median within-facility percentage of patients referred for kidney transplantation evaluation within 1 year of starting dialysis was 24% and varied from 0% to 75%. In an Editorial, Kucirka and colleagues discuss factors contributing to disparities in kidney transplantation and strategies to improve access.


Author Audio Interview and Continuing Medical Education

Intermittent hypoxemia or bradycardia is common among extremely preterm infants. In a post hoc analysis of data from a cohort of 1019 extremely preterm infants who survived to 36 weeks’ postmenstrual age, Poets and colleagues found that hypoxemic episodes that lasted at least 1 minute during the first 2 to 3 months after birth were associated with a composite outcome of death or disability at 18 months corrected age. In an Editorial, Doyle discusses hypoxemia and neurodevelopmental outcomes in extremely preterm infants.


The US Food and Drug Administration often approves high-risk medical devices via the Premarket Approval (PMA) pathway. Rathi and colleagues assessed the totality of clinical evidence generated for 28 high-risk therapeutic devices that received initial market approval via the PMA pathway in 2010 and 2011. Among the authors’ findings were wide variation in the number and quality of premarket and postmarket studies, with just 13% of initiated postmarket studies completed within 3 to 5 years of premarket approval.

Clinical Review & Education

An article in JAMA Surgery reported that young adults with colon cancer who were treated from 2003 through 2005 received more systemic chemotherapy—at all stages of disease—but experienced only minimal gains in survival compared with patients aged 65 to 75 years who received less treatment. In this From The JAMA Network article, Berian and colleagues discuss the increasing incidence of young-onset colorectal cancer and appropriate use of adjuvant therapy.

This JAMA Clinical Guidelines Synopsis article by Saunders and colleagues summarizes the 2013 American College of Physicians Screening for Chronic Kidney Disease Guideline. The guideline, based on a systematic review of the literature (1985-2011), addresses the benefits and harms of screening and any treatment that may be initiated. Routine screening for chronic kidney disease in asymptomatic adults without risk factors is not recommended.

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A 67-year-old woman presented with fatigue of 4 weeks’ duration. On examination, the spleen was palpable 5 cm below the costal margin. She had no fever or lymphadenopathy. Laboratory evaluation revealed a white blood cell count of 91 × 103/μL with increased immature granulocytes. What would you do next?