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In This Issue of JAMA
November 20, 2018


JAMA. 2018;320(19):1955-1957. doi:10.1001/jama.2017.12636

Intensive care unit nurses are exposed to occupational stress in the form of time pressure, high workloads, interpersonal conflicts, and moral and spiritual distress. El Khamali and colleagues for the SISTRESSREA Study Group enrolled 198 intensive care unit nurses in a randomized clinical trial and found that a multimodal intervention with education, role-play, and debriefing resulted in a lower prevalence of job strain. In an Editorial, Seaman and colleagues suggest that reducing job-related stress can increase the productivity of nurses and improve their quality of care.


Audio Interview, CME, and Visual Abstract

Preliminary studies have suggested that treatment with alkaline phosphatase can improve kidney function in patients with sepsis. Pickkers and colleagues for the STOP-AKI Investigators randomized 301 patients with sepsis-associated acute kidney injury (AKI) and found that human recombinant alkaline phosphatase, compared with placebo, did not significantly improve short-term kidney function.

Somatostatin analogues, such as lanreotide, may be renoprotective in patients with polycystic kidney disease. In a trial by Meijer and colleagues for the DIPAK-1 Investigators that randomized 309 patients with autosomal dominant polycystic kidney disease, treatment with lanreotide did not slow the decline in kidney function over 2.5 years of follow-up.

Clinical Review & Education

Physical activity fosters normal growth and development; makes people feel better, function better, and sleep better; and reduces the risk of many chronic diseases. On the basis of a systematic review addressing 38 questions about physical activity and health, Piercy and a panel of experts revised a set of recommendations on types and amounts of physical activity to achieve substantial health benefits. In an Editorial, Thompson and Eijsvogels emphasize that even small amounts of physical activity can reduce the risk of disease and disability.

Related Article and Editorial

Summary Video and CME

This JAMA Clinical Challenge by Awali and Chandrasekar presents a 25-year-old woman with a hypoesthetic macule and peripheral nerve enlargement. What would you do next?

This JAMA Diagnostic Test Interpretation article by Wilder and colleagues presents a 64-year-old man who had been successfully treated for chronic hepatitis C. A measurement of liver stiffness was elevated. How do you interpret these results?