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In This Issue of JAMA
June 13, 2017


JAMA. 2017;317(22):2251-2253. doi:10.1001/jama.2016.13163

The Focused Assessment With Sonography for Trauma (FAST) examination can decrease the use of hospital resources, but it is not routinely used in the evaluation of injured children. Holmes and colleagues conducted a randomized clinical trial of 925 children and adolescents with blunt torso trauma and found that the FAST examination compared with usual care did not improve resource use, emergency department length of stay, safety, or hospital charges. In an Editorial, Kessler considers the challenges of adopting point-of care ultrasound in emergency departments and recommends further study of the FAST examination to reduce exposure to ionizing radiation.



The most common cause of treatment failure in children with iron-deficiency anemia is nonadherence to iron replacement therapy. Powers and colleagues conducted a randomized clinical trial of iron replacement therapies in 81 children with nutritional iron-deficiency anemia. Compared with iron polysaccharide complex, ferrous sulfate resulted in a greater increase in hemoglobin at 12 weeks.

Elevated brain amyloid may be an indicator of progression to Alzheimer disease. Donohue and colleagues conducted exploratory analyses on a cohort of 445 cognitively normal individuals and found that after a median of 3.1 years, an elevation in baseline brain amyloid level, compared with normal brain amyloid level, was associated with a greater likelihood of cognitive decline. In an Editorial, Visser and Tijms cite ongoing trials of amyloid-modulating drugs that may slow the preclinical progression of Alzheimer disease and delay the onset of dementia.



It has been suggested that the American Board of Internal Medicine’s Internal Medicine Maintenance of Certification (IM-MOC) examination may not be an optimal assessment of the knowledge, diagnostic reasoning, and clinical judgment expected of a general internist who delivers care in office and hospital settings. Gray and colleagues compared IM-MOC examination questions with diagnoses for 13 832 patients with office visits and 108 472 patients with hospital discharges and found that 69% of questions on IM-MOC examinations were concordant with conditions seen in general internal medicine practices. In an Editorial, Schwartz and Schwartz discuss the recertification approach of the American Board of Internal Medicine and how it might be made more relevant for practicing physicians.


Clinical Review & Education

About one-fourth of US adults have used an online physician rating site to evaluate the performance of their clinicians. An article published in JAMA Dermatology described the findings of a qualitative analysis of patient-generated reviews of dermatology practices on 2 consumer review platforms. In this From The JAMA Network article, Davis and Hanauer recommend ways to improve the consistency and comprehensiveness of online quality ratings to make them more useful to patients.

This JAMA Clinical Evidence Synopsis by Enthoven and colleagues summarizes findings from a Cochrane review of clinical trials comparing nonsteroidal anti-inflammatory drugs (NSAIDs) with other drug treatments, nondrug treatments, or placebo in patients with chronic low back pain. Use of NSAIDs is associated with improvement in pain and disability compared with placebo, but the strength of the association is small and clinically not meaningful.

This JAMA Clinical Challenge by Chalhoub and colleagues presents a 71-year-old man with a diffuse rash and pain in the elbow and knee. A punch biopsy of the skin was performed. What would you do next?