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In This Issue of JAMA
April 16, 2019


JAMA. 2019;321(15):1429-1431. doi:10.1001/jama.2018.15289

Semaglutide, a glucagon-like peptide 1 receptor agonist (GLP-1RA), improves glycemic control and may also have cardiovascular benefits. Rosenstock and colleagues for the PIONEER 3 Investigators randomized 1864 patients who had type 2 diabetes that was uncontrolled by metformin with or without sulfonylurea and found that oral semaglutide, compared with sitagliptin, resulted in significantly greater reductions in hemoglobin A1c. In an Editorial, Hirsch notes that adding a GLP-1RA to metformin is now recommended for patients with diabetes and atherosclerotic cardiovascular disease who need further glycemic lowering.


Visual Abstract

Oral mucositis is an adverse effect of radiotherapy for head and neck cancer. Sio and colleagues randomized 275 patients with oral mucositis pain after head and neck radiotherapy and found that doxepin mouthwash and diphenhydramine-lidocaine-antacid mouthwash each reduced oral mucositis pain, but the measured reductions may not be clinically important. In an Editorial, Elad and Yarom suggest that mouthwashes may reduce the need for pain control with systemic opioids.


Workplace wellness programs are designed to lower health care costs and improve employee health and productivity. Song and Baicker randomized 140 worksites with 32 974 employees and found that a workplace wellness program increased self-reported health behaviors but did not improve clinical measures of health, health care spending and utilization, or employment outcomes. In an Editorial, Abraham suggests that integrating wellness programs with tobacco-free policies, healthy cafeteria options, and onsite workout facilities can support healthy choices in the workplace.



Clinical Review & Education

Exposure to environmental lead is associated with multiple adverse health outcomes. The US Preventive Services Task Force concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for elevated blood lead levels in asymptomatic children or pregnant women. In an Editorial, Spanier and colleagues suggest that blood lead testing may be indicated for high-risk groups, such as young children living in older homes with flaking, lead-based paint.

Editorial, Related Article, and JAMA Patient Page

CME and Author Audio Interview

In a review of 24 studies with 11 433 participants, Cantor and colleagues found that screening questionnaires were not accurate for identifying children with elevated blood lead levels, chelating agents were associated with harms and limited benefits for treated children, and the benefits of screening and treatment for lead exposure in pregnant women could not be determined with available evidence.

Editorial, Related Article, and JAMA Patient Page

In this JAMA Clinical Guidelines Synopsis of a 2017 update of a 2014 guideline developed by the American College of Cardiology and American Heart Association, Dia and colleagues discuss the indications for transcatheter valve replacement in patients with severe aortic stenosis.