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In This Issue of JAMA
October 20, 2015


JAMA. 2015;314(15):1539-1541. doi:10.1001/jama.2014.12033

Treatment of low back pain with multiple concurrent medications—often nonsteroidal anti-inflammatory drugs (NSAIDs), a skeletal muscle relaxant, and an opioid—is common; however, whether this results in better pain relief or improved functional outcomes is unclear. In a randomized 3-group study that enrolled 323 patients with acute, nontraumatic, and nonradicular low back pain presenting for care at an urban emergency department, Friedman and colleagues found that adding cyclobenzaprine or oxycodone plus acetaminophen to naproxen alone did not improve functional outcomes or pain at 7 days’ follow-up.

Continuing Medical Education

It is recommended that pregnant women receive tetanus, diphtheria, and acellular pertussis (Tdap) vaccine during each pregnancy—regardless of prior immunization status. Sukumaran and colleagues assessed the association of Tdap vaccination with acute events and adverse birth outcomes in a retrospective cohort study involving 29 155 pregnant women who had received the Tdap vaccine within 2 years, within 2 to 5 years, or more than 5 years of a prior tetanus-containing vaccine. The authors found no increased risk of acute maternal events (fever, allergy, or local reactions) or adverse birth outcomes (small for gestational age, preterm delivery, or low birth weight) associated with the interval between tetanus-containing vaccinations.

The risk of congenital heart defects among infants of women with preeclampsia is unclear. In an analysis of Quebec, Canada, hospital discharge data (1989-2012) representing more than 1.9 million mother and infant pairs, Auger and colleagues examined the relationship between preeclampsia and eclampsia before or after 34 weeks of gestation and congenital heart defects. The authors report that preeclampsia, particularly when it begins before 34 weeks’ gestation, was associated with an increased risk of critical and noncritical heart defects in the infants; however, the absolute risk of these heart defects was low.

Clinical Review & Education

Oeffinger and colleagues report recommendations for breast cancer screening for women at average risk in a guideline update from the American Cancer Society. With a particular focus on patient age, 3 key questions were addressed: the relative benefits, limitations, and harms of mammography screening compared with no screening; the benefits, limitations, and harms associated with screening intervals; and the benefits, limitations, and harms of clinical breast examination as a screening method. In an Editorial, Keating and Pace discuss shared decision making about breast cancer screening.

Editorial, Related Articles 1 and 2, and JAMA Patient Page

Author Video Interview, Author Audio Interview, and CME

To inform the American Cancer Society’s breast cancer screening guideline development process, Myers and colleagues completed a systematic review of the evidence related to benefits and harms of screening mammography and clinical breast examination from 10 randomized trials, 72 observational studies, 7 systematic reviews, and 1 modeling study. The authors summarize findings from their analysis and highlight areas of uncertainty in ascertaining benefits and harms of breast cancer screening.

Editorial and Related Article

Author Audio Interview

An article in JAMA Oncology reported that premenopausal women diagnosed with breast cancer following biennial screening mammography were more likely to have tumors with less favorable prognostic characteristics than women screened annually. Among postmenopausal women, the proportion of less favorable tumors did not differ for biennial vs annual screening. In this From the JAMA Network article, Yi and Hunt discuss risk stratification to inform decisions about breast cancer screening intervals.

Related Article

In observational clinical studies, which by design do not involve random assignment of treatments, multivariable statistical methods can estimate the probability that each study participant would receive the treatment of interest. These probabilities—termed propensity scores—are used to adjust for differences between study groups and reduce bias in estimating treatment effects. This JAMA Guide to Statistics and Methods article by Haukoos and Lewis discusses the use, limitations, and interpretation of propensity scores.