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Featured Clinical Reviews

In This Issue of JAMA
April 26, 2016


JAMA. 2016;315(16):1679-1681. doi:10.1001/jama.2015.14227


House dust mite (HDM) sensitization is present in many patients with asthma. In a randomized placebo-controlled study that enrolled 834 adults with HDM allergy and asthma not well-controlled by inhaled corticosteroids (ICS), Virchow and colleagues found that the addition of an HDM sublingual allergy immunotherapy tablet to asthma maintenance medications improved time to first asthma exacerbation during a period of inhaled corticosteroid reduction. In an Editorial, Wood discusses advances in allergen immunotherapy.


Continuing Medical Education

Studies linking shift work to coronary heart disease (CHD) have yielded inconsistent results. Vetter and colleagues assessed the relationship between rotating night shift work—defined as 3 or more night shifts per month plus day and evening shifts—and incident CHD in 2 prospective cohorts of female registered nurses (189 158 women from both studies) who were followed up for 24 years. The authors found that increasing years of rotating night shift work was associated with a statistically significant but small absolute increase in CHD risk.

Author Video Interview

Yeh and colleagues report results of a study to develop a clinical prediction score to identify patients expected to derive benefit or harm from continuation of dual antiplatelet therapy for more than 1 year after percutaneous coronary intervention (PCI). The prediction rule was developed and externally validated in analyses of data from clinical trials of PCI with stent placement (development cohort, 11 648 patients; validation cohort, 8136 patients). The authors found the prediction rule had modest accuracy in identifying patients with greater expected benefit vs expected harm from extended dual antiplatelet therapy. In an Editorial, Pencina and Peterson discuss use of predictive models in clinical medicine.


Clinical Review & Education

In an analysis of 1.4 billion de-identified tax records and Social Security Administration death records, Chetty and colleagues found that between 2001 and 2014, higher income was associated with greater longevity throughout the income distribution, with substantial variation across geographic areas. Differences in life expectancy across income groups increased during this period. Three Editorials discuss income inequality, social and community determinants of health, and interventions to improve quality of life and life expectancy.

Editorials 1, 2, and 3

Author Audio Interview

Based on a review of 361 articles published in 2005 through 2015, Sanchez and colleagues summarize the evidence relating to the diagnosis, treatment, and prevention of 3 tick-borne infections: Lyme disease, human granulocytic anaplasmosis, and babesiosis. The authors found that recent evidence supports a 10-day course of oral doxycycline for treatment of erythema migrans and a 14-day course to treat early neurologic Lyme disease in ambulatory patients.

Related Article

Author Audio Interview and Continuing Medical Education

An article in JAMA Ophthalmology reported that among Asian patients with type 2 diabetes, a higher body mass index appeared to have a protective effect on diabetic retinopathy, while a higher waist-to-hip ratio was associated with the presence and severity of retinopathy in women. In this From The JAMA Network article, Klein and Klein discuss the relationship between body fat distribution and diabetic retinopathy.

A pediatrician was consulted for evaluation of a painless, annular skin lesion—attributed to a “bug bite”—that had enlarged and then cleared centrally over several weeks’ time. Some fading occurred after parental application of over-the-counter antifungal cream. Concerned about a possible arthropod bite, the pediatrician ordered serologic testing for Lyme disease and prescribed doxycycline. How would you interpret the test results?

Related Article