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Clinical guidelines discourage opioid prescribing for chronic pain. Krebs and colleagues randomized 240 patients with moderate to severe chronic pain despite analgesic use and found that treatment with opioids was not superior to treatment with nonopioid medications for improving pain-related function.
Prostate-specific antigen screening may decrease mortality at the risk of harm from overdetection and overtreatment. Martin and colleagues for the CAP Trial Group randomized 573 general practices to offer male patients aged 50 to 69 years a single prostate-specific antigen test or maintain the standard practice of no screening and found no difference in prostate cancer mortality. In an Editorial, Barry suggests that active surveillance programs may inadvertently harm patients by increasing the frequency of biopsies and imaging tests to avoid missing curable cancers.
Editorial and Related Article
Prostate cancers with Gleason score 9-10 are likely to spread more quickly than cancers with lower scores. In a retrospective cohort study of 1809 patients with Gleason score 9-10 prostate cancer, Kishan and colleagues found that external beam radiotherapy (EBRT) plus brachytherapy with androgen deprivation therapy was associated with better prostate cancer–specific mortality and longer time to distant metastasis than EBRT with androgen deprivation therapy or prostatectomy.
In theory, exposure to antigens from multiple vaccines could induce immune dysfunction and increase the risk for infections not targeted by vaccines. Glanz and colleagues conducted a nested case-control study of 944 children and found no association of non–vaccine-targeted infections with cumulative exposure to vaccines. In an Editorial, O’Leary and Maldonado emphasize the importance of maintaining public confidence in the safety of childhood immunization.
Most thyroid nodules are benign, but some are associated with compressive symptoms, thyroid dysfunction, or malignancy. Durante and colleagues review a diagnostic approach for thyroid nodules that minimizes cost and unnecessary testing.
Procalcitonin is a biological marker of bacterial infection that can facilitate decisions about antibiotic therapy. In this Clinical Evidence Synopsis summarizing a Cochrane review of 26 randomized trials, Schuetz and colleagues discuss the utility of procalcitonin-guided antibiotic management vs routine clinical care.
In this JAMA Clinical Guidelines Synopsis of a 2016 guideline developed by the National Institute of Allergy and Infectious Disease, Volerman and Cifu discuss the introduction of peanut-containing foods to infants at risk of developing peanut allergy.
JAMA Patient Page
CME and Author Audio Interview
Highlights. JAMA. 2018;319(9):843–845. doi:10.1001/jama.2017.12262
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