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Impaired renal activation of vitamin D may increase the risk of cardiovascular disease. The J-DAVID Investigators randomized 976 patients from 108 dialysis centers and found that oral alfacalcidol, a vitamin D receptor activator, did not reduce the incidence of cardiovascular events. In an Editorial, Hall and Scialla discuss the complexity of mineral metabolism in patients with end-stage kidney disease.
CME and Visual Abstract
Hospitalization offers an opportunity to engage patients and family caregivers in self-management of chronic conditions. Aboumatar and colleagues randomized 240 hospitalized patients with chronic obstructive pulmonary disease (COPD) and found that assistance with transitional care and long-term self-management resulted in fewer COPD-related hospitalizations and emergency department visits and better health-related quality of life. In an Editorial, Rinne and colleagues suggest that engaging patients during transitional care may encourage them to make lifestyle changes for better disease management.
The sodium channel blocker mexiletine is an antimyotonic treatment for patients with nondystrophic myotonia. In a series of randomized N-of-1-trials in 30 patients with nondystrophic myotonia, Stunnenberg and colleagues found that patients treated with mexiletine experienced less muscle stiffness than patients who received a placebo.
Author Audio Interview
Young individuals with atrial fibrillation appear to have a genetic predisposition for the disease, but the mechanisms are incompletely understood. In this case-control study of 2781 patients with early-onset atrial fibrillation and 4959 controls, Choi and colleagues for the DiscovEHR Study and NHLBI Trans-Omics for Precision Medicine Consortium found that loss-of-function variants in TTN, the gene encoding the sarcomeric protein titin, were associated with early-onset atrial fibrillation.
Variation in treatment effects may be random or systematic and may occur at different levels of the data, such as random differences between individual patients or systematic differences between studies. In this JAMA Guide to Statistics and Methods, McGlothlin and Viele explain how Bayesian hierarchical models account for these sources of variation and estimate treatment effects for subgroups simultaneously.
The goals of treatment for patients with lower extremity superficial thrombophlebitis are to prevent thrombosis extension, decrease the risk of thromboembolic events, and reduce local pain. In this JAMA Clinical Evidence Synopsis summarizing a Cochrane review of 33 randomized trials, Di Nisio and colleagues discuss the limited evidence for effective treatment of this condition.
This JAMA Diagnostic Test Interpretation article by Legrand and Kellum presents a 73-year-old man whose surgery was complicated by pneumonia and sepsis. Measurements of serum creatinine increased marginally on successive postoperative days. How do you interpret these test results?
Highlights. JAMA. 2018;320(22):2283–2285. doi:10.1001/jama.2017.12669
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