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Featured Clinical Reviews

In This Issue of JAMA
March 22/29, 2016


JAMA. 2016;315(12):1203-1205. doi:10.1001/jama.2015.14175


In a randomized trial involving 342 adults with chronic low back pain, Cherkin and colleagues evaluated the effectiveness of mindfulness-based stress reduction—an intervention that focuses on awareness and acceptance of moment-to-moment physical discomfort—compared with cognitive behavioral therapy and usual medical care. The authors found that compared with usual care, 8 weekly treatments involving either mindfulness-based stress reduction or cognitive behavioral therapy resulted in greater improvement in back pain and functional limitations at 26 weeks. In an Editorial, Goyal and Haythornthwaite discuss mind-body approaches for chronic back pain.


Author Video Interview and Continuing Medical Education

Parallel endoscopic placement of multiple plastic stents—necessitating multiple endoscopic retrograde cholangiopancreatography procedures (ERCPs)—is the first-line treatment for most benign biliary strictures. Preliminary studies suggest that placement of a single, covered, self-expandable metallic stent (cSEMS) may resolve benign biliary strictures and would require fewer ERCPs to treat a stricture. In a multicenter open-label randomized trial involving 112 patients with treatment-naive benign biliary strictures and a bile duct diameter of 6 mm or more, Coté and colleagues found that cSEMS were not inferior to multiple plastic stents in achieving stricture resolution after 12 months.

Antibiotic exposure in early life is associated with increased adiposity in animal models. In a retrospective longitudinal study of 38 522 singleton children and 92 twin pairs (discordant in antibiotic exposure), Gerber and colleagues assessed the association between early life antibiotic exposure and childhood weight gain. The authors report that compared with no exposure, exposure to antibiotics in the first 6 months of life was not associated with a significant difference in weight gain through age 7 years.

Continuing Medical Education

Among patients with familial adenomatous polyposis who have undergone colectomy, duodenal adenocarcinoma is the leading cause of cancer death. Based on findings in a mouse model of familial adenomatous polyposis, Samadder and colleagues hypothesized that a combination of cyclooxygenase and epidermal growth factor receptor inhibition would reduce duodenal adenoma formation in this patient population. In a randomized trial that enrolled 92 patients with familial adenomatous polyposis, the investigators found that compared with placebo, use of sulindac and erlotinib resulted in a lower duodenal polyp burden after 6 months.

Continuing Medical Education

Clinical Review & Education

An article in JAMA Surgery reported that among obese persons with type 2 diabetes, bariatric surgery and 2 years of a lifestyle intervention resulted in more diabetes remission than the lifestyle intervention alone. In this From The JAMA Network article, Arterburn and McCulloch discuss longer-term effectiveness of bariatric surgery for type 2 diabetes.

This JAMA Clinical Guidelines Synopsis article by Tanksley and Cifu summarizes 2 US Preventive Services Task Force Recommendation Statements—one addressing screening for hepatitis B virus infection in nonpregnant adolescents and adults and the other screening for chlamydia and gonorrhea. Screening for hepatitis B infection focuses on high-risk populations. Screening for gonorrhea and chlamydia is recommended for all sexually active women 24 years or younger and older women at high risk of infection.

This JAMA Diagnostic Test Interpretation article by Hilal and Romond presents a 35-year-old woman with a palpable left breast mass. Two separate left breast masses were seen on mammography. Biopsy results indicated both masses were poorly differentiated invasive ductal adenocarcinoma. Tumor human epidermal growth factor receptor 2, ERRBB2/HER2, status by immunohistochemistry was scored as negative (1+). How would you interpret this test result?