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In This Issue of JAMA Internal Medicine
April 2018


JAMA Intern Med. 2018;178(4):445-447. doi:10.1001/jamainternmed.2017.5204


Buist and colleagues performed a population-based cohort study using data from 6 Breast Cancer Surveillance Consortium registries to evaluate biopsy rates and yield in the 90 days following screening among women with and without a personal history of breast cancer. Results showed that women with and without a personal history who undergo screening magnetic resonance imaging experience higher biopsy rates coupled with significantly lower cancer yield findings following biopsy compared with those who undergo screening mammography alone. Further work is needed to identify women who will benefit from screening magnetic resonance imaging to ensure an acceptable benefit-to-harm ratio.

In this longitudinal, population-based cohort study, Christensen and colleagues investigated the mortality risks associated with current and former use of cigars, pipes, and cigarettes. The study included 357 420 participants who reported exclusively using cigar, pipes, or cigarettes or reported never using any type of tobacco product. Results provide further evidence that exclusive use of cigar, pipes, and cigarettes each confers significant mortality risks.

Continuing Medical Education

Waxman and colleagues performed a retrospective cohort study including all Medicare claims for 2006 to 2014 to estimate the proportions of emergency department visits attributable to symptoms of imminent ruptured abdominal aortic aneurysm, acute myocardial infarction, stroke, aortic dissection, and subarachnoid hemorrhage that end in discharge without diagnosis; to evaluate longitudinal trends; and to identify patient characteristics independently associated with missed diagnostic opportunities. Results showed that among Medicare patients, opportunities to diagnose certain unrecognized cardiovascular emergencies were missed in less than 1 in 20 emergency department presentations, and further improvement may prove difficult.

Continuing Medical Education

For this cohort study of 403 268 women identified from 7 Breast Cancer Surveillance Consortium registries, Braithwaite and colleagues examined whether first-degree family history is associated with increased risk of breast cancer among older women, as well as whether the association varies by breast density. Results showed that first-degree family history was associated with increased risk of invasive breast cancer in all subgroups of older women irrespective of a relative’s age at diagnosis.

In this systematic review and meta-analysis, Mohananey and colleagues studied the association of vegetation size greater than 10 mm with embolic events in patients with infective endocarditis by analyzing all pertinent publications in the PubMed and EMBASE databases from inception to May 1, 2017. Observational studies or randomized clinical trials that evaluated the association in adult patients with infective endocarditis were included and yielded 21 unique studies. The authors concluded that patients with vegetation size greater than 10 mm had significantly increased odds of embolism and mortality. Understanding the risk of embolization will allow clinicians to adequately risk stratify patients, as well as help facilitate discussions regarding surgery in patients with a vegetation size greater than 10 mm.

For this single-blind, 2-arm, multisite randomized clinical trial, Bekelman and colleagues examined whether a symptom and psychosocial collaborative care intervention improves heart failure–specific health status, depression, and symptom burden in patients with heart failure. Included patients were randomized to receive the Collaborative Care to Alleviate Symptoms and Adjust to Illness intervention or usual care. Results did not demonstrate improved heart failure–specific health status, but secondary outcomes of depression and fatigue, both difficult symptoms to treat in heart failure, improved.

For this multicenter randomized stepped-wedge clinical trial of 248 patients being considered for destination therapy left ventricular (LV) assist device, Allen and colleagues assessed the effectiveness of a shared decision support intervention for patients considering device placement. The main measure was decision quality as measured by knowledge and values-choice concordance. Results showed that a shared decision-making intervention for destination therapy LV assist device modestly improved patient decision quality as measured by patient knowledge and concordance between stated values and patient-reported treatment choice, but did not improve concordance between stated values and actual treatment received. Liu and Curfman provide an Editorial.


Bhasin and colleagues conducted a randomized clinical trial of 92 men to investigate whether increasing protein intake to 1.3 g/kg/d in older adults with physical function limitations and usual protein intake within the recommended dietary allowance improves lean body mass, muscle performance, physical function, fatigue, and well-being and augments lean body mass response to a muscle anabolic drug. Participants were randomized for 6 months to controlled diets with 0.8 g/kg/d of protein plus placebo, 1.3 g/kg/d of protein plus placebo, 0.8 g/kg/d of protein plus testosterone enanthate, or 1.3 g/kg/d of protein plus testosterone. Results showed that protein intake exceeding the recommended dietary allowance did not increase lean body mass, muscle performance, physical function, or well-being measures or augment anabolic response to testosterone in this population.