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In This Issue of JAMA
June 6, 2017

Highlights

JAMA. 2017;317(21):2145-2147. doi:10.1001/jama.2016.13152
Research

Patients with chronic obstructive pulmonary disease who are hospitalized for respiratory failure, treated, and discharged to home are at risk for early rehospitalization for persistent hypercapnia. Murphy and colleagues conducted a randomized clinical trial of 116 patients with persistent hypercapnia following an acute exacerbation of chronic obstructive pulmonary disease and found that adding home noninvasive ventilation to home oxygen therapy prolonged the time to readmission or death. In an Editorial, Hill and Ugurlu compare these findings with the results of other studies and suggest that a subset of patients with severe chronic obstructive pulmonary disease may benefit from home noninvasive ventilation.

Editorial

CME

Critically ill patients and their families often rely on physicians to help them anticipate the likelihood of death, poor cognition, and other adverse health outcomes. Detsky and colleagues conducted a prospective cohort study of 303 patients who required life support in the intensive care unit (ICU), finding that physicians’ and nurses’ discriminative accuracy in predicting 6-month outcomes depended on the outcome being predicted and the confidence of the predictors. In an Editorial, Hall notes that prognostic studies may be dichotomous (life vs death) but in practice there is a continuum of possible prognoses, and this should be communicated to patients and their families in a qualitative way.

Editorial

CME

Early antiretroviral therapy (ART) improves the health of HIV-positive individuals and reduces HIV transmission. In an observational study by Petersen and colleagues of 16 rural Kenyan and Ugandan communities with a baseline HIV prevalence of 10.3%, participants were tested for HIV and the HIV-positive individuals were offered ART. Implementation of this test-and-treat strategy was associated with increased HIV diagnosis, receipt of ART, and HIV viral suppression. In an Editorial, del Rio and Armstrong suggest that the findings of this study have implications not only for rural African communities but also for resource-rich nations such as the United States.

Editorial

Body mass index and gestational weight gain are increasing globally. Goldstein and colleagues reviewed 23 observational studies of more than 1 million pregnant women and found that excessive or insufficient gestational weight gain was associated with greater risk of adverse maternal and infant outcomes. In an Editorial, Caughey notes that pregnant women are exposed to constant advertising of high-caloric foods and describes some novel approaches to changing dietary behaviors from the field of behavioral economics.

Editorial

CME

Clinical Review & Education

The American Heart Association recommends a diet that includes long-chain ω-3 polyunsaturated fatty acids (LCω3PUFAs), which are found in fish. Animal studies suggest that consumption of this nutrient may also reduce the risk of diabetic retinopathy. A study published in JAMA Ophthalmology reported a decreased risk of sight-threatening diabetic retinopathy in patients with type 2 diabetes who ate a Mediterranean diet containing at least 500 mg of dietary LCω3PUFA per day. In this From The JAMA Network article, Chew suggests that eating fish twice per week may prevent cardiovascular and retinal disease.

This JAMA Diagnostic Test Interpretation article by Foucar and Stein presents a young woman with acute hepatic vein thrombosis. Results for JAK2 V617F were positive, complete blood cell count results were normal, test results for antiphospholipid antibody syndrome were negative, flow cytometry identified CD55/59 expression, and protein C and antithrombin activities were below the lower limit of normal. How would you interpret these test results?

This Medical Letter on Drugs and Therapeutics article compares the safety and efficacy of medications for the prevention of migraine.

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