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In This Issue of JAMA
June 11, 2019


JAMA. 2019;321(22):2143-2145. doi:10.1001/jama.2018.15366

Patients receiving mechanical ventilation are typically assessed for their readiness to be weaned from ventilatory support after a trial of spontaneous breathing. Subirà and colleagues randomized 1153 patients who were receiving mechanical ventilation and found that a trial of spontaneous breathing consisting of 30 minutes of pressure support ventilation, compared with 2 hours of T-piece ventilation, led to higher rates of successful extubation. In an Editorial, Girard and Burns discuss the importance of recognizing the earliest time when patients are ready for extubation.


Visual Abstract

It has been hypothesized that transfusions from female donors to male recipients may be associated with adverse outcomes attributable to immunological mechanisms. Edgren and colleagues for the NHLBI Recipient Epidemiology and Donor Evaluation Study–111 analyzed data for 1 047 382 patients and found that red blood cell transfusions from female, previously pregnant, or sex-discordant donors were not significantly associated with increased mortality.

Transcatheter aortic valve replacement (TAVR) can be technically challenging for patients with bicuspid aortic valves. Makkar and colleagues conducted a prospective cohort study of 81 822 patients undergoing TAVR and found no significant differences in 30-day or 1-year mortality for patients with bicuspid vs tricuspid valve replacement, but bicuspid valve replacement was associated with an increased 30-day risk for stroke. In an Editorial, Barker and Reardon suggest that randomized trials of TAVR for patients with bicuspid stenosis should consider valve anatomy subtypes, optimal valve sizing, and best practice implantation techniques.

Editorial and Related Article


Clinical Review & Education

HIV infection is acquired from previously infected individuals during sexual activity or by sharing needles used for injecting drugs. The US Preventive Services Task Force recommends that clinicians offer preexposure prophylaxis with effective antiretroviral therapy to individuals who are at high risk of HIV acquisition. In an Editorial, Scott and Volberding note that less than 10% of individuals with an indication for preexposure prophylaxis are receiving it.

Editorial, Related Article, and JAMA Patient Page

Author Audio Interview and CME

In a review of 29 studies with 55 000 participants, Chou and colleagues found that preexposure prophylaxis of adults at increased risk of HIV infection using oral tenofovir disoproxil fumarate monotherapy or tenofovir disoproxil fumarate/emtricitabine was associated with a decreased risk of acquiring HIV infection.

Editorial, Related Article, and JAMA Patient Page

Author Audio Interview

The incidence of osteoporotic fracture increases with age. This JAMA Insights article by Berry and colleagues discusses the prevention of osteoporotic fractures based on estimates of risk and life expectancy, using pharmacologic and nonpharmacologic interventions.

Related Article

The choice of therapy for osteoporosis is based on cost-effectiveness, pill burden, and comorbidities. This Medical Letter on Drugs and Therapeutics lists formulations and dosages of 7 classes of drugs for the prevention and treatment of postmenopausal osteoporosis.

Related Article