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Featured Clinical Reviews

In This Issue of JAMA
September 20, 2016


JAMA. 2016;316(11):1127-1129. doi:10.1001/jama.2015.14484


Whether wearable technologies that monitor physical activity and diet improve long-term weight loss is not clear. In a clinical trial involving 471 overweight and obese young adults, Jakicic and colleagues compared weight loss among participants randomly assigned to use a wearable technology and to participate in a standard lifestyle intervention of low-calorie diet, prescribed increases in physical activity, and group counseling with weight loss among participants assigned to the lifestyle intervention alone. The authors report that addition of a wearable technology to a standard behavioral weight loss intervention resulted in less weight loss over 24 months.

Author Video Interview

Response to tumor–necrosis factor-α (TNF) inhibitors is insufficient in many patients with rheumatoid arthritis. In this situation, it remains unclear whether the best next-choice drug should be a non–TNF-targeted biologic drug or a second (different) anti-TNF drug. In a 52-week pragmatic open-label randomized trial that enrolled 300 patients with rheumatoid arthritis and an insufficient response to anti-TNF therapy, Gottenberg and colleagues found that a non-TNF–biologic agent was more effective than a second anti-TNF medication in achieving a good or moderate disease activity response at 24 weeks.

Related Article

Ierodiakonou and colleagues report results of a systematic review and meta-analysis of data from 146 studies that evaluated the timing of allergenic food introduction during infancy and the risk of allergic or autoimmune disease. Among the findings was that early egg or peanut introduction was associated with a lower risk of developing egg or peanut allergy. In an Editorial, Greenhawt discusses the evidence relating to protective effects of early dietary allergen introduction.



Clinical Review & Education

Antibiotic development is considered among the most important advances in medicine. However, antimicrobial resistance to antibiotics threatens to impede or even reverse this progress. Based on a review of 103 articles, databases, and reports addressing antimicrobial resistance, Marston and colleagues review the diverse factors that contribute to antimicrobial resistance, including human behavior, bacterial genetics, and the lack of economic incentives to spur pharmaceutical innovation. Strategies to address the challenges posed by antimicrobial resistance are discussed.


This JAMA Guide to Statistics and Methods article by Sox and Lewis discusses pragmatic clinical trials—a study design that focuses on questions of greatest interest to those on the frontline of medical decision making—physicians, patients, and policy makers. The authors discuss features of pragmatic trials and highlight factors that differentiate pragmatic and explanatory trial design. Issues clinicians should consider when deciding whether results of a pragmatic trial apply to patients in their practice are discussed.

Related Article

Identifying and addressing suboptimal episodes of health care is key to improving health care quality. A new JAMA series, JAMA Performance Improvement, aims to facilitate physicians’ incorporation of performance improvement in their individual practices through a case-based discussion of suboptimal clinical care and consideration of options to address quality of care problems highlighted by the case. In this inaugural article, Minnier and colleagues present the case of a 90-year-old woman who was admitted to the hospital with shortness of breath and suspected pneumonia. Nursing staff were unable to obtain intravenous access to administer antibiotics. The admitting physician entered an order for central line placement; however, a dialysis catheter was placed instead. What should be done next? Livingston introduces the article series in an accompanying Editorial.


Author Audio Interview and CME