Guidelines recommend corticosteroids for the treatment of patients with immunoglobulin A (IgA) nephropathy and persistent proteinuria, but it is uncertain whether the benefits outweigh the risks. In a randomized clinical trial of 262 patients with IgA nephropathy and proteinuria, Lv and colleagues found that oral methylprednisolone was associated with an increased risk of serious infections. In an Editorial, O’Shaughnessy and Lafayette suggest that patients with IgA nephropathy who receive treatment with corticosteroids should be closely monitored for the development of adverse events.
Rapid revascularization may improve clinical outcomes in patients with ischemic stroke. In a randomized clinical trial of 381 patients with acute ischemic stroke and large vessel occlusion in the anterior circulation, Lapergue and colleagues found that thrombectomy with contact aspiration and thrombectomy using a stent retriever technique resulted in similar rates of revascularization.
Under Medicare’s Physician Value-Based Payment Modifier Program, physician practices receive penalties or bonuses based on quality and costs of care. In a cross-sectional study of 899 US practices caring for 5 189 880 fee-for-service Medicare beneficiaries, Chen and colleagues found that practices serving more socially high-risk patients had lower quality and lower costs, and practices that served more medically high-risk patients had lower quality and higher costs.
The difficulty of diagnosing bacterial pneumonia in children with respiratory illness has contributed to antibiotic overuse. This article by Shah and colleagues in the JAMA Rational Clinical Examination series reviews the accuracy of symptoms and physical examination findings for identifying children with radiographic pneumonia.
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The clinical utility of testing children with respiratory illnesses for viral infections is uncertain, as discussed in an article in JAMA Pediatrics. In this From the JAMA Network article, Schroeder and Ralston discuss the limited benefits and potential harms of excessive diagnostic testing.
This JAMA Diagnostic Test Interpretation article by Song and Maalouf presents a 29-year-old man with recurrent nephrolithiasis. A 24-hour urine study demonstrated hypercalciuria. How do you interpret these results?
Highlights. JAMA. 2017;318(5):403–405. doi:10.1001/jama.2016.13245