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In This Issue of JAMA
August 8, 2017


JAMA. 2017;318(6):493-495. doi:10.1001/jama.2016.13256

Music therapy may facilitate social communication in patients with autism spectrum disorder. In a trial of 364 children with autism spectrum disorder, Bieleninik and colleagues found no difference in social affect score for those who received improvisational music therapy compared with those who received enhanced standard care. In an Editorial, Broder-Fingert and colleagues comment on the diversity of musical traditions, cognitive abilities, and cultural expectations of the participants in this study and speculate whether a trial of music therapy for likely responders might have had a different result.



Embolic protection devices are designed to reduce the incidence of central nervous system infarction in patients undergoing surgical aortic valve replacement. In a randomized trial of 383 patients by Mack and colleagues, the incidence of infarction was not altered by either of 2 embolic protection devices vs a standard aortic cannula.


Studies have suggested that levosimendan may prevent low cardiac output syndrome, a major complication of cardiac surgery. In a randomized trial of 336 patients with low ejection fraction undergoing coronary artery bypass graft surgery with cardiopulmonary bypass, levosimendan compared with placebo did not result in a significant difference in a composite outcome for low cardiac output syndrome.


Airflow decline is an early manifestation of posttransplant bronchiolitis obliterans syndrome, which may respond to the immunomodulatory and anti-inflammatory effects of macrolide antibiotics such as azithromycin. A randomized trial of azithromycin vs placebo in 480 patients who had undergone an allogeneic hematopoietic stem cell transplant for a hematological malignancy was terminated early because of an unanticipated increase in the hematological relapse rate in the azithromycin group. Analysis of the available data indicated that the early administration of azithromycin compared with placebo resulted in worse airflow decline–free survival.

Clinical Review & Education

Preoperative testing has limited clinical usefulness for relatively healthy patients and may be harmful if false-positive or incidental findings are detected. In their discussion of a 2016 guideline on routine preoperative testing for elective surgery developed by the National Clinical Guideline Centre, Martin and Cifu note that this and other guidelines on preoperative testing are based primarily on expert opinion in the absence of high-quality evidence.

This JAMA Clinical Challenge by Cohen and colleagues presents the case of a 30-year-old woman with an eruption on the skin of her abdomen and extremities. Results of a skin punch biopsy were consistent with leukocytoclastic vasculitis. What would you do next?