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In This Issue of JAMA
January 5, 2016

Highlights

JAMA. 2016;315(1):5-7. doi:10.1001/jama.2015.14032
Innovations in Health Care Delivery

Edited by Howard Bauchner, MD, Donald Berwick, MD, MPP, and Phil B. Fontanarosa, MD

Research

Many patients with heart failure with preserved ejection fraction (HFPEF) are overweight or obese and experience exercise intolerance. In a randomized, attention-controlled, 2 × 2 factorial trial involving 100 obese adults with chronic HFPEF, Kitzman and colleagues found that caloric restriction or aerobic exercise training increased participants’ exercise capacity and the effects may be additive. Neither intervention had a significant effect on quality of life (QOL). In an Editorial, Wenger discusses the potential for lifestyle interventions to improve exercise tolerance among overweight patients with HFPEF. In an Editorial, Sciurba and colleagues discuss optimal patient selection for lung volume reduction strategies.

Editorial

Author Video Interview and Continuing Medical Education

To explore clinical phenotypes in unselected individuals with incidentally identified and possibly pathogenic arrhythmia-related gene variants, Van Driest and colleagues analyzed data from 2022 unselected individuals undergoing DNA sequencing for drug response phenotypes. The authors found low concordance among laboratories in designating variants in 2 arrhythmia genes (SCN5A and KCNH2) as pathogenic. Review of participants’ electronic medical records suggested the putatively pathogenic genetic variants were not associated with abnormal cardiac conduction phenotypes. In an Editorial, Feero discusses the challenge of establishing clinical validity of genetic variations proposed as biomarkers of disease.

Editorial

Vaginal candidiasis is common during pregnancy. Oral fluconazole can be used for recurrent infection, when topical treatment has failed or by patient choice. Limited data are available regarding the association of oral fluconazole with spontaneous abortion and stillbirth. In a cohort study of approximately 1.4 million pregnancies in Denmark, Mølgaard-Nielsen and colleagues foujhhnd that oral fluconazole use was associated with an increased risk of spontaneous abortion compared with both unexposed women and women with topical azole exposure.

To inform understanding of genetic and environmental factors contributing to cancer pathogenesis, Mucci and colleagues analyzed long-term (median, 32 years) follow-up data from 80 309 monozygotic and 123 382 dizygotic and same-sex twin individuals participating in the population-based Nordic Twin Study of Cancer. The authors report a significant excess familial risk for cancer overall and for specific cancers, including prostate, melanoma, breast, ovary, and uterus.

Continuing Medical Education

Clinical Review & Education

An article in JAMA Oncology reported results of a cost-effectiveness analysis of lung cancer screening within the publicly funded Canadian health care system using low-dose computed tomographic (LDCT) scans. The investigators found LDCT for lung cancer screening to be cost-effective. In this From the JAMA Network article, Roth and Ramsey discuss factors that could alter the short-term and long-term value of LDCT screening for lung cancer.

A 75-year-old woman with rheumatoid arthritis—treated with long-term prednisone—and a history of genital herpes simplex virus 2 presented with a painful, pruritic rash on her buttock. She had recently tapered her prednisone dosage, resulting in an arthritis flare, and had initiated pregabalin for pain 3 days prior to the skin eruption. Valacyclovir for 1 week was not beneficial. Physical examination revealed warm, indurated, and well-circumscribed erythematous plaques with subtle vesicles. What would you do next?

This JAMA Diagnostic Test Interpretation article by Lebwohl and Green presents a 23-year-old woman whose sibling has celiac disease. The patient seeks advice regarding her risk of celiac disease. She denies symptoms. Her physical examination results were normal with the exception of dental enamel defects. An antitissue transglutaminase IgA level was 124 U (reference range, 0-19 U). How would you interpret this result?

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