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In This Issue of JAMA
May 24/31, 2016


JAMA. 2016;315(20):2143-2145. doi:10.1001/jama.2015.14279

Endobronchial coils compress emphysematous lung tissue and may improve lung function and exercise tolerance in patients with emphysema. In a multicenter randomized trial involving 315 patients with emphysema and severe hyperinflation, Sciurba and colleagues found that compared with guideline-based usual care alone, endobronchial coil treatment added to usual care resulted in a modest improvement in exercise tolerance that was of uncertain clinical significance. Major complications were more common among patients receiving coil treatment.

To assess the optimal timing of initiation of renal replacement therapy (RRT) among critically ill patients with acute kidney injury, Zarbock and colleagues randomly assigned 231 such patients to either early (≤8 hours of diagnosis of Kidney Disease: Improving Global Outcomes [KDIGO] stage 2) or delayed (≤12 hours of KDIGO stage 3 or not at all) initiation of RRT. The authors found early initiation of RRT compared with delayed initiation reduced mortality over the first 90 days after randomization. In an Editorial, Chertow and Winkelmayer discuss the need for additional investigation of the optimal timing of dialytic support in critically ill patients.


Continuing Medical Education

The relationship between dietary sodium intake and incident cardiovascular disease (CVD) among patients with chronic kidney disease is not known. In a prospective cohort of 3757 patients with chronic kidney disease, Mills and colleagues found that higher urinary sodium excretion was associated with increased risk of CVD. In an Editorial, Powe and Bibbins-Domingo discuss dietary sodium intake and cardiovascular health among patients with chronic kidney disease.

Editorial and JAMA Patient Page

Continuing Medical Education

To assess whether walkable neighborhoods can mitigate increasing rates of obesity-related diseases, Creatore and colleagues analyzed 2001 to 2012 administrative health care and Canadian Community Health Survey data from adult residents of 15 municipalities in Ontario, Canada. The authors found that urban neighborhoods characterized by a more walkable design were associated with decreased prevalence of overweight and obesity and decreased incidence of diabetes. In an Editorial, Rundle and Heymsfield discuss the role of urban design in reducing the incidence of obesity-related conditions.


Author Video Interview and Continuing Medical Education

Clinical Review & Education

Tinnitus is a common condition that affects an estimated 50 million US adults. This JAMA Clinical Guidelines Synopsis article summarizes the American Academy of Otolaryngology–Head and Neck Surgery clinical practice guideline on tinnitus. Most patients who seek treatment for tinnitus have no underlying medical cause. Routine imaging is not recommended. Good evidence supports cognitive behavioral therapy as a treatment modality.

A patient who had undergone resection of an appendiceal adenocarcinoma presented with a 4-month history of a rash and alopecia that began on his face and spread to the scalp, axilla, and groin. There was no response to oral fluconazole, topical antibiotic ointment, or intravenous antibiotics. The patient had a colostomy and had required total parenteral nutrition for the past year. What would you do next?

A 71-year-old woman presented for evaluation of higher than normal hemoglobin and hematocrit levels. A serum erythropoietin level was low-normal (5.1 IU/L; reference range, 4.0-21.0 IU/L). The patient reported recent fatigue and night sweats but no family history of blood disorders. How would you interpret the test results?