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In This Issue of JAMA
March 14, 2017

Highlights

Author Affiliations
 

Copyright 2017 American Medical Association. All Rights Reserved.

JAMA. 2017;317(10):987-989. doi:10.1001/jama.2016.13031
Research

Integrated pest management (IPM) interventions can reduce home mouse allergen concentrations, but whether they reduce asthma morbidity is unknown. In this randomized clinical trial by Matsui and colleagues, there was no significant difference in maximal asthma symptom days for 361 mouse-sensitized children and adolescents who received either an intensive year-long IPM intervention plus education or pest management education alone. In an Editorial, Bacharier suggests that reducing exposures in the home without also reducing exposures in schools and other environments may not be sufficient to yield clinical improvements.

Editorial

CME

It is unclear whether inpatient rehabilitation is superior to outpatient or home-based programs for patients recovering from total arthroplasty of the knee. In a randomized clinical trial of 165 patients undergoing total knee arthroplasty, Buhagiar and colleagues found that inpatient rehabilitation did not improve mobility at 26 weeks after surgery in comparison with a monitored home-based program.

Spontaneous preterm birth is a leading cause of infant mortality. To identify women at risk, Esplin and colleagues enrolled 9410 nulliparous women with singleton pregnancies in a prospective cohort study and found that quantitative vaginal fetal fibronectin and serial transvaginal ultrasound cervical length had low predictive accuracy for spontaneous preterm birth. In an Editorial, Bloom and Leveno note that consensus clinical guidelines have promoted cervical length screening in the absence of evidence for clinical utility, resulting in unnecessary health care expenditures; they suggest that guideline committees should advocate for investing resources in clinical research instead of unproven interventions.

Editorial

CME

Antithrombotic therapies reduce the risk of stroke in patients with atrial fibrillation but are often underused in community practice. Xian and colleagues conducted a retrospective observational study of 94 474 patients with acute ischemic stroke and a history of atrial fibrillation and found that therapeutic anticoagulation was associated with lower odds of moderate or severe stroke and lower odds of in-hospital mortality.

CME

Clinical Review & Education

Logistic regression models can predict the outcomes of future patients based on risk factors derived from a study group, but some models are more accurate than others. In this JAMA Guide to Statistics and Methods, Meurer and Tolles review the use of logistic regression model diagnostics to determine how well a particular model is able to predict health outcomes.

An article in JAMA Psychiatry reported that cannabis use is associated with an increased risk for several substance use disorders. In this From The JAMA Network article, Hill discusses the evidence and notes that the risk appears to increase with frequency of cannabis use.

This JAMA Clinical Challenge article by Medarov and colleagues presents a man with a 3-year history of chronic obstructive pulmonary disease (COPD) who had increasing dyspnea on exertion, signs of pulmonary hypertension, and a nonocclusive thrombus in the left femoral and popliteal veins. What would you do next?

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