Lambertini and colleagues report results of a median 7.3 years’ follow-up of 281 premenopausal women with stage I to III breast cancer who were randomly assigned to receive adjuvant chemotherapy alone or combined with the luteinizing hormone-releasing hormone analogue triptorelin. The authors found that compared with chemotherapy alone, women who received concurrent chemotherapy and triptorelin had a higher long-term probability of ovarian function recovery without a statistically significant difference in pregnancy rate or disease-free survival. In an Editorial, Partridge discusses prevention of premature menopause and fertility impairment in young cancer survivors.
Rahman and colleagues examined the effects of analgesic choice (nonsteroidal anti-inflammatory drugs [NSAIDs] vs opiates) and chest tube size (24F vs 12F) on chest tube–related pain and efficacy of pleurodesis for malignant pleural effusion in a randomized trial involving 320 patients. The authors report that pain scores did not differ between NSAIDs and opiates and that NSAIDs compared with opiate use resulted in noninferior rates of pleurodesis efficacy at 3 months. Small chest tubes were associated with lower pain scores but did not meet noninferiority criteria for pleurodesis efficacy.
The likelihood of achieving a live birth with repeated cycles of in vitro fertilization (IVF) is unclear. In an analysis of data from 156 947 women who underwent 257 398 IVF ovarian stimulation cycles, Smith and colleagues found that the live-birth rate for the first cycle of IVF was 29.5% and the cumulative prognosis-adjusted live-birth rate after 6 cycles was 65.3%. In an Editorial, Myers discusses factors that may influence live birth rates after multiple cycles of IVF.
Author Video Interview and Continuing Medical Education
Several cases of acute flaccid paralysis of unknown etiology were reported in California in 2012, prompting voluntary statewide disease surveillance. In a review of 59 reported cases (June 2012 to July 2015), Van Haren and colleagues found that most patients were children or young adults who experienced prolonged motor weakness. The etiology remains undetermined.
Easter and colleagues report results of a systematic review (14 studies identified; 23 079 patients total) to determine whether individual findings or a combination of findings can accurately distinguish patients with minor head trauma who are at high or low risk of severe intracranial injury. The authors found that certain risk factors (pedestrians struck by motor vehicles), symptoms (repetitive vomiting or posttraumatic seizures), and signs (suggesting possible skull fracture) were associated with a high risk of severe intracranial injury. In an Editorial, Rivara and colleagues discuss use of clinical prediction rules to guide computed tomography use after blunt head trauma.
Author Audio Interview and Continuing Medical Education
An article in JAMA Ophthalmology reported results of a study to develop and validate a smartphone-based technique for measuring visual acuity. In this From the JAMA Network article, Brady and colleagues discuss visual acuity measurement and practical considerations in the use of mobile phone technology in clinical assessment.
This JAMA Clinical Guidelines Synopsis by Rao and colleagues summarizes the 2014 American Gastroenterological Association Institute Guideline on the Pharmacologic Management of Irritable Bowel Syndrome (IBS). High-quality evidence supports use of linactolide in constipation-predominant IBS. Lubiprostone, polyethylene glycol, rifaximin, alosteron, loperamide, tricyclic antidepressants, and antispasmodics received conditional recommendations. Use of these medications should be individualized.
In This Issue of JAMA. JAMA. 2015;314(24):2591–2593. doi:10.1001/jama.2014.12159