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In This Issue of JAMA
October 13, 2015


JAMA. 2015;314(14):1421-1423. doi:10.1001/jama.2014.12019


Patients with recent-onset low back pain (LBP) are often seen in primary care settings. Whether physical therapy is beneficial in early-onset LBP is unclear. Current treatment guidelines advise delaying physical therapy for a few weeks to permit spontaneous recovery. In a randomized trial involving 220 adults with LBP of less than 16 days’ duration and without symptoms distal to the knee in the prior 3 days, Fritz and colleagues found that compared with usual care that was limited to educational materials and no additional intervention for 4 weeks, early physical therapy, consisting of manipulation and exercise, resulted in a modest improvement in disability that did not achieve a minimum clinically important difference.

Continuing Medical Education

Morbidity and mortality associated with nonmedical use of prescription opioids have increased in the United States. To examine recent trends in nonprescription opioid use and opioid use disorders, Han and colleagues analyzed data from 472 200 adult participants in the 2003-2013 National Surveys on Drug and Use and Health. The authors report that from 2003 to 2013, the prevalence of nonmedical use of prescription opioids decreased; however, the prevalence of prescription opioid use disorders, frequency of use, and related mortality increased. In an Editorial, Nelson and coauthors discuss nonmedical opioid use and strategies to reduce the number of new opioid users.

Editorial and Related Article

Continuing Medical Education

Globally, carbapenem-resistant enterobacteriaceae (CRE) are increasingly reported as a cause of high-mortality infections. In an analysis of 2012-2013 CRE infection surveillance data from 7 US metropolitan areas, Guh and colleagues found the incidence of CRE infection was 2.93 per 100 000 population. Carbapenem-resistant Enterobacteriaceae were most often isolated from urine and often associated with prior hospitalizations or with indwelling devices. In an Editorial, Hayden discusses surveillance as a first step to control CRE in the United States.


Grijalva and colleagues assessed the association between influenza vaccination status and hospitalization for community-acquired laboratory-confirmed influenza pneumonia in an analysis of multisite observational data from 2767 patients aged 6 months and older who were hospitalized for community-acquired pneumonia from January 2010 through June 2012. The authors report that compared with 2605 patients with influenza-negative pneumonia, 162 patients with laboratory-confirmed influenza-associated pneumonia were less likely to have received an influenza vaccination for the current influenza season.

Author Video Interview

Clinical Review & Education

Pericarditis is the most common form of pericardial disease and a relatively common cause of chest pain. Imazio and colleagues view the current evidence relating to the diagnosis and treatment of pericarditis based on a literature review and identification of 31 relevant studies (5 meta-analyses, 10 randomized trials, and 16 cohort studies; 7569 total patients). The authors discuss common causes of pericarditis, clinical presentation, diagnostic findings, and prognostic factors. The evidence review supports nonsteroidal anti-inflammatory drugs and colchicine as first-line therapy for idiopathic (often viral) pericarditis.

An article in JAMA Pediatrics reported that among adolescents and young adults who did not smoke cigarettes at baseline, water pipe tobacco smoking or the use of snus—a moist smokeless tobacco product—independently predicted interim cigarette smoking and current cigarette smoking at a 2-year follow-up. In this From the JAMA Network article, Amrock and Weitzman discuss regulatory implications of adolescent use of alternative tobacco products.

In this JAMA Clinical Guidelines Synopsis, Huang and Davis summarize the Guidelines for Improving the Care of Older Adults With Diabetes Mellitus: 2013 Update, developed by the American Geriatrics Society. The updated guideline was based on a review of data from adults aged 65 years and older who were included in clinical trials, systematic reviews, and meta-analyses published from 2002-2012. The guidelines emphasize an individualized approach to glycemic control in older adults, which considers comorbid conditions, functional status, and life expectancy.