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Mammogram Reading Order and Breast Cancer Detection
Interpreting screening mammograms is a repetitive task that may demonstrate “vigilance decrement” and a reduced cancer detection rate with time on task. In a multicenter cluster randomized trial conducted at 46 breast screening centers in England and involving 360 qualified mammography readers, Taylor-Phillips and colleagues found no difference in breast cancer detection rate when a second reader reviewed batched digital mammograms (median batch size, 35 mammograms) in the same order or opposite order as the first reader. In an Editorial, Burnside and colleagues discuss the potential of pragmatic studies to improve screening mammography practice.
Continuing Medical Education
Rehydration Solutions in Pediatric Gastroenteritis
In a randomized single-blinded trial that enrolled 647 children (aged 6 to 60 months) presenting to a pediatric emergency department with mild gastroenteritis and minimal dehydration, Freedman and colleagues assessed whether oral hydration with diluted (1/2 strength) apple juice followed by the child’s preferred fluids was noninferior to electrolyte maintenance solutions on a composite measure of treatment failure within 7 days of enrollment. The authors report that initial oral hydration with diluted apple juice followed by the child’s preferred fluids resulted in fewer treatment failures.
Macitentan, New Ischemic Digital Ulcers in Systemic Sclerosis
Endothelin-1—a mediator of vascular proliferation, inflammation, and fibrosis—is overexpressed in the plasma of patients with systemic sclerosis, particularly among patients with digital ulcers. Khanna and colleagues evaluated the efficacy of macitentan—a novel dual endothelin receptor antagonist—in reducing the number of new digital ulcers in 2 multicenter, randomized, placebo-controlled trials involving 289 patients and 265 patients with systemic sclerosis and active digital ulcers, respectively. The authors found that compared with placebo, treatment with macitentan did not reduce new digital ulcers over 16 weeks.
BMI Associated With Lowest Mortality, 1976-2013
Prior research has shown a U-shaped pattern of body mass index (BMI) and mortality. To test the hypothesis that the BMI value associated with the lowest all-cause mortality has increased over a period of 3 decades, Afzal and colleagues analyzed data from 3 cohorts of the Danish general population who were recruited in 1976-1978 (n=13 704), 1991-1994 (n=9482), and 2003-2012 (n=97 362). The authors report that the BMI associated with the lowest all-cause mortality increased by 3.3 from 1976-1978 through 2003-2013.
Clinical Review & Education
Treatment of ADHD in Adolescents
In a systematic review of pharmacological (6 randomized trials and 1 meta-analysis; 1752 patients) and psychosocial (10 randomized trials; 916 participants) treatment of attention-deficit/hyperactivity disorder (ADHD) in adolescents, Chan and colleagues found evidence that several approved stimulant medications and a nonstimulant medication improve symptoms of ADHD. Psychosocial treatments were associated with inconsistent effects on ADHD symptoms but improved academic and organizational skills.
Author Audio Interview
Methylphenidate for ADHD in Children and Adolescents
Storebø and colleagues summarize a Cochrane review of 185 trials that assessed methylphenidate treatment for children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Methylphenidate is associated with improvement in ADHD symptoms, general behavior, and quality of life; however, the magnitude of the improvement is uncertain. In an Editorial, Shaw discusses complexities in quantifying benefits and risks of methylphenidate use in ADHD.
Editorial and Related Article
Smoking Cessation in Adults and Pregnant Women
Haddad and Davis summarize the US Preventive Services Task Force guideline, Tobacco Smoking Cessation in Adults and Pregnant Women: Behavior and Pharmacotherapy Interventions. Behavioral interventions should be provided to all adults who use tobacco. Smoking cessation pharmacotherapy should be prescribed to all nonpregnant adults who use tobacco. There is insufficient evidence to recommend pharmacotherapy for pregnant women who use tobacco or to recommend use of electronic nicotine delivery systems in any adults.
Highlights . JAMA. 2016;315(18):1925–1927. doi:10.1001/jama.2015.14253
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