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Many children develop recurrent, severe episodes of lower respiratory tract illness (LRTI), often related to viral infection, although bacterial infection may also contribute. In a randomized placebo-controlled trial involving 607 young children who had a history of recurrent, severe LRTI, Bacharier and colleagues found that early use of azithromycin during an apparent respiratory tract illness reduced the likelihood of progression to severe LRTI. In an Editorial, Cohen and Pelton contrast individual benefit with potential adverse societal consequences of antibiotic use for pediatric LRTI.
Author Video Interview
To improve patient selection for percutaneous coronary intervention (PCI), the Appropriate Use Criteria for Coronary Revascularization were developed and published in 2009. In an analysis of registry data from 2.7 million PCI procedures performed between July 1, 2009, and December 31, 2014, Desai and colleagues found that since publication of the criteria, there have been significant reductions in the volume of nonacute PCI procedures and in the proportion of nonacute PCIs classified as inappropriate. Hospital-level variation in inappropriate PCI persists. In an Editorial, Harrington discusses efforts to ensure appropriate use of coronary revascularization.
Continuing Medical Education
Jemal and colleagues assessed concurrent trends in prostate cancer incidence and self-reported prostate-specific antigen (PSA) testing in analyses of 2005-2012 prostate cancer registry data (446 009 men) and National Health Interview Survey data from 2005, 2008, 2010, and 2013. The authors report that the incidence of early-stage prostate cancer declined from 2008 to 2012. Prostate-specific antigen screening rates increased from 2005 to 2008 and decreased from 2010 to 2013—coinciding with the 2012 US Preventive Services Task Force recommendation against PSA-based screening. In an Editorial, Penson discusses risks and benefits associated with the decline in prostate cancer screening.
Author Audio Interview and Continuing Medical Education
Editorial, Related Articles 1 and 2, and Patient Page
All intravenous (IV) iron products are associated with a risk of anaphylaxis, but the comparative safety of each product is not established. In an analysis of Medicare (nondialysis) claims data from 688 183 patients receiving IV iron dextran, iron gluconate, iron sucrose, or ferumoxytol, Wang and colleagues found that the risk of anaphylaxis with first exposure to IV iron was highest for iron dextran and lowest for iron sucrose.
In the evaluation of children with suspected appendicitis, ultrasonography (US)—despite inferior diagnostic performance—is preferred to computed tomography (CT) to reduce exposure to ionizing radiation. An article in JAMA Pediatrics reported that despite increased use of US and concomitant declines in CT use, rates of appendiceal perforation and emergency department revisits remained steady and negative appendectomies declined slightly from 2010 through 2013. In this From the JAMA Network article, Carroll discusses when doing less medicine is sometimes enough.
Two weeks after having a tattoo placed on her arm, a woman presented with gradually increasing swelling and itching in a red ink area of the tattoo. Topical steroid cream provided no benefit. Examination of the tattoo revealed marked swelling and keloid formation without drainage, local warmth, or tenderness. What would you do next?
This JAMA Diagnostic Test Interpretation article by Barry and Hayes presents the case of a 59-year-old white man in good health and without a family history of prostate cancer who had an enlarged prostate without nodules on digital rectal examination. Annual assessment of the prostate-specific antigen (PSA) level documented an increase from 3.0 ng/mL to 4.9 ng/mL over a decade. How would you interpret these results?
Editorial and Related Articles 1 and 2
Highlights. JAMA. 2015;314(19):1999–2001. doi:10.1001/jama.2014.12089