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In This Issue of JAMA Internal Medicine
October 28, 2013


JAMA Intern Med. 2013;173(19):1761-1763. doi:10.1001/jamainternmed.2013.6328

Few evidence-based treatments have produced clinically meaningful weight loss among black women, a group with high rates of obesity. In a randomized clinical trial, Bennett and coauthors investigated an alternative approach—weight gain prevention—among 194 premenopausal black women with a body mass index of 25 to 34.9. Patients were randomized to usual care or a behavioral intervention that included weekly telephonic monitoring of personalized behavior change goals and individual coaching sessions with a registered dietitian; the intervention prevented weight gain—and even produced slight weight reductions—over 18 months. In an Invited Commentary, Benjamin and coauthors discuss the challenges of weight loss interventions in the primary care setting.

Invited Commentary

Author Video Interview

Although a serious fall injury is often a devastating event, little is known about the course of disability (ie, functional trajectories) prior to a serious fall injury or the relationship between these trajectories and those that follow the fall. In a prospective cohort study of 130 older persons (62 hip fracture and 68 other injury) with monthly assessments of functional status, Gill and coauthors evaluated the course of disability in the year immediately before and after a serious fall injury. For both hip fractures and other serious fall injuries, the probabilities of the postfall trajectories were greatly influenced by the prefall trajectories, such that a meaningful recovery was highly unlikely among those who had progressive or severe disability before the fall. In an Invited Commentary, Studenski discusses the clinical and policy implications of varying definitions of recovery.

Invited Commentary

There is wide variation in the management of thyroid nodules identified on ultrasound imaging. In a retrospective case-control study of 8806 patients who underwent thyroid ultrasound imaging between January 1, 2000, and March 30, 2005, Smith-Bindman and colleagues quantify the risk of thyroid cancer associated with thyroid nodules based on their ultrasound imaging characteristics. They found that microcalcifications, size greater than 2 cm, and an entirely solid composition were the only findings associated with the risk of thyroid cancer. In an Invited Commentary, Alexander and Cooper address the clinical implications of the study’s findings.

Invited Commentary, Related Article

With the rapid growth of health information technology, the potential value of the data generated is also growing for uses such as research and public health as well as commercial marketing. Grande and colleagues conducted a national survey to examine consumer preferences for how health data from electronic health records should be used for purposes other than personal medical care. In a conjoint analysis, use of data was the most important factor to respondents, compared with the user and data sensitivity. Kohane considers the stakes and parameters of the electronic health record use conversation in an Invited Commentary.

Invited Commentary

Despite the growing number of myocardial infarction (MI) survivors in the United States, information on diet after MI and mortality is limited. In a prospective study of diet quality among 2258 women from the Nurses’ Health Study and 1840 men from the Health Professional Follow-up Study, Li and coauthors found that better diet quality after MI was associated with a 24% lower all-cause and 26% lower cardiovascular mortality. Greater improvement of diet quality from before to after MI was associated with a 30% lower all-cause and 40% lower cardiovascular mortality. Estruch and Ros situate this study in the context of other major dietary studies in an Invited Commentary.

Invited Commentary

Rhabdomyolysis ranges in severity from asymptomatic elevations in creatine phosphokinase levels to a life-threatening disorder characterized by severe acute kidney injury requiring renal replacement therapy. In a retrospective cohort study of 2371 patients presenting with rhabdomyolysis, McMahon and colleagues report the derivation and validation of a risk score for the prediction of adverse outcomes (death or acute kidney injury requiring renal replacement therapy). The risk score, which incorporates readily available clinical and laboratory variables, can aid in the stratification of patients with rhabdomyolysis into low- and high-risk categories. In an Invited Commentary, Wilhelm-Leen and Winkelmayer discuss the clinical value of the risk score.

Invited Commentary

Continuing Medical Education