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In patients with heart failure, iron deficiency is associated with reduced functional capacity, poor quality of life, and increased mortality. The results of intravenous iron repletion trials have been favorable, but treating patients with intravenous iron products is expensive and poses logistical challenges for outpatients. To learn whether oral iron would be beneficial for these patients, Lewis and colleagues randomized 225 patients with iron deficiency and heart failure with reduced left ventricular ejection fraction and found that high-dose oral iron did not improve exercise capacity over 16 weeks.
Intra-articular corticosteroids are administered to patients with osteoarthritis of the knee to suppress inflammation and prevent the destruction of cartilage; however, corticosteroid treatment has antianabolic effects on healthy cartilage and has been shown in some studies to be associated with adverse joint outcomes. In a randomized clinical trial of 140 patients treated with intra-articular triamcinolone acetonide vs saline, McAlindon and colleagues found that triamcinolone treatment resulted in greater cartilage volume loss and no significant difference in knee pain.
Author Video Interview and CME
County-level differences in cardiovascular disease mortality rates can differ substantially from the national average and may have important implications for local and national health policy. Using validated small area estimation models to estimate county-level mortality rates from cardiovascular diseases in 3110 US counties, Roth and colleagues identified regional clusters of atrial fibrillation, aortic aneurysm, and endocarditis. In an Editorial, Mensah and colleagues note that adherence to effective clinical strategies is poor in many high-risk counties; they call for implementation research to facilitate the adoption of proven approaches to evaluation, prevention, and treatment.
A randomized clinical trial of uveitis therapies found that a surgically placed intravitreous fluocinolone acetonide implant was superior to systemic immunosuppressive therapy for controlling inflammation, with no difference in visual acuity. To investigate whether local adverse effects associated with implant therapy might subsequently alter visual outcomes, the Multicenter Uveitis Steroid Treatment (MUST) Trial and Follow-up Study Research Group conducted an extended follow-up of this trial. By year 7, patients in the systemic therapy group had better visual acuity.
Conscious sedation is safe for most patients undergoing endoscopy and is less expensive than deep sedation with monitored anesthesia. An article in JAMA Internal Medicine assessed recent trends in the use of monitored anesthesia for outpatient gastrointestinal endoscopy. In this From The JAMA Network article, Leung suggests that pain associated with gas insufflation of the colon may account for the increased use of monitored anesthesia and recommends less painful methods for distending the colon to visualize the mucosa.
Treatment of venous thromboembolism has changed markedly over the last 4 years with the advent of non–vitamin K oral anticoagulants (NOACs). In this JAMA Clinical Guidelines Synopsis article discussing the update of the American College of Chest Physicians ninth-edition guidelines for antithrombotic therapy and prevention of thrombosis, Jain and Cifu address the role of NOACs and provide new recommendations for management of subsegmental pulmonary embolism and cancer-associated venous thrombosis.
This Medical Letter on Drugs and Therapeutics article compares the safety and efficacy of several treatments for head lice infestation.
Highlights. JAMA. 2017;317(19):1927–1929. doi:10.1001/jama.2016.13130
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