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Journal Cover JAMA The Journal of the American Medical Association
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     ISSN (Print) 0098-7484 - ISSN (Online) 1538-3598
     Published by American Medical Association Homepage  [11 journals]   [SJR: 4.843]   [H-I: 456]
  • Is the United States Prepared for Ebola?
    • Authors: Gostin LO; Hodge JG, Jr, Burris S.
      Abstract: This Viewpoint discusses the health system preparedness required for the United States to handle a public health emergency like Ebola.
      PubDate: Wed, 17 Dec 2014 00:00:00 GMT
  • Ebola in the United States EHRs as a Public Health Tool at the Point of
    • Authors: Mandl KD.
      Abstract: This Viewpoint discusses how health information technology and electronic health records (EHRs) could be transformed into platforms for public health responses to disease.
      PubDate: Wed, 17 Dec 2014 00:00:00 GMT
  • The Half-Wall
    • Authors: Rafelson W; Brown T.
      PubDate: Wed, 17 Dec 2014 00:00:00 GMT
  • When Should Aspirin Be Used for Prevention of Cardiovascular Events?
    • Authors: Gaziano J; Greenland P.
      Abstract: This Editorial discusses when aspirin should be used to prevent vascular events and the factors that should be discussed in decision making.
      PubDate: Wed, 17 Dec 2014 00:00:00 GMT
  • Is Aspirin a Dangerous Drug?
    • Abstract: Aspirin, or acetylsalicylic acid, has been used in enormous quantities throughout most of the world for some forty-five years. Many persons seem to have a mild idiosyncrasy to this drug or to the other salicylates and consequently avoid its use; the vast majority take it with apparent impunity. Although toxic effects have been discussed in these columns, severe reactions are certainly rare in relation to the enormous quantities consumed. Deaths from aspirin have been reported; these appear to have been more frequent in England than in this country.
      PubDate: Wed, 17 Dec 2014 00:00:00 GMT
  • Breast Cancer Screening: Benefits and Harms
    • Authors: Jin J.
      PubDate: Wed, 17 Dec 2014 00:00:00 GMT
  • Alcohol Combined With Drug Abuse Leads to More Overdoses and Deaths
    • Abstract: People treated in an emergency department (ED) for abusing opioid pain relievers (OPRs) or benzodiazepines frequently drink alcohol with the drugs, exacerbating their risk for overdose. An estimated 18.5% of ED visits related to OPR abuse and 27.2% related to benzodiazepine abuse involved alcohol, according to 2010 data from a sample of 237 EDs participating in the Drug Abuse Warning Network. Approximately one-fifth of drug-related deaths from OPRs included alcohol, as did the same proportion of deaths related to benzodiazepines, based on medical examiner and coroner data from 13 states (Jones CM. MMWR Morb Mortal Wkly Rep. 2014;63[40]:881-885).
      PubDate: Wed, 17 Dec 2014 00:00:00 GMT
  • Hispanic/Latino Individuals Lack Sufficient HIV Treatment
    • Abstract: With 3 times more Hispanic or Latino individuals receiving an HIV diagnosis each year compared with non-Hispanic white individuals, greater levels of care targeted to this demographic group are needed to meet the goals of the National HIV/AIDS Strategy.
      PubDate: Wed, 17 Dec 2014 00:00:00 GMT
  • Untitled (Composition With Grey Background) Wassily Kandinsky
    • Authors: Cole TB.
      Abstract: Untitled (Composition With Grey Background), by the Russian artist Wassily Kandinsky (1866-1944), is a floating field of geometric shapes. Four rising quadrilaterals tip their nose cones in overlapping planes. Bold outlines, harmonious contrasts, and crisp angles are classic Kandinsky motifs, supplemented in this image with the biomorphic detailing of his late work. Kandinsky’s compositions demonstrate that geometric relationships can be as pleasing to the eye as portraits or landscapes. The content of painting is painting, Kandinsky said, by which he meant that a painting does not have to imitate nature to be a work of art. By 1933, when he was compelled to move from Berlin to Paris, Kandinsky had spent his career defending the legitimacy of abstraction, and he assumed that abstract painting was familiar to art enthusiasts and gallery owners throughout Europe and North America. His paintings had been well received in Germany, where he had lived and worked for three decades, and he naturally assumed they would be admired in Paris; but to his surprise, the Parisians were unimpressed.
      PubDate: Wed, 17 Dec 2014 00:00:00 GMT
  • Hawking
    • Authors: Collins M.
      Abstract: His mind, distended like an egg-eating snake, yawns upover epochs, from big bang to youngest synapse.Yet he sits frozen in his chair, his machine voice touching airround vocal cords long since destroyed. He seems almostall spirit. But the children of his body are strong, his contactwith the world sharp as a grappling hook. The outcry
      PubDate: Wed, 17 Dec 2014 00:00:00 GMT
  • The Challenges of Reforming Graduate Medical Education Payments
    • Authors: Wilensky G.
      Abstract: A recent report by an Institute of Medicine (IOM) committee on the financing and governance of graduate medical education (GME) considered an important question for health care in the United States: to what extent does the current GME system, which provides the training of interns and residents after medical school, help produce a physician workforce that can deliver efficient, high-quality, patient-centered health care?
      PubDate: Wed, 17 Dec 2014 00:00:00 GMT
  • Diagnosing and Treating Infections in Young Infants in Developing
    • Authors: Friedrich MJ.
      Abstract: Health workers on the frontlines in low- and middle-income countries (LMIC) are able to identify bacterial infections in most cases among young infants (those younger than 2 months), but the availability of injectable antibiotics is low, according to a report from US and UK investigators (Lee ACC et al. PLoS Med. 2014;11[10]:e1001741).
      PubDate: Wed, 17 Dec 2014 00:00:00 GMT
  • Higher Global Burden of TB
    • Authors: Friedrich MJ.
      Abstract: There is a higher global burden of tuberculosis (TB) than previously estimated, according to improved national data from 202 countries and territories that were used in the latest annual report on TB from the World Health Organization, “Global tuberculosis report 2014,” ( More than half of the 9 million people who developed TB in 2013 were in the Southeast Asia and Western Pacific regions.
      PubDate: Wed, 17 Dec 2014 00:00:00 GMT
  • Latrines Alone Do Not Improve Health of Children in Rural India
    • Authors: Friedrich MJ.
      Abstract: Latrine construction in rural Indian villages did not improve the health of young children as expected, according to a study carried out by investigators from the United States, the United Kingdom, and India (Clasen T et al. Lancet Glob Health. 2014;2[11]:e645-e653).
      PubDate: Wed, 17 Dec 2014 00:00:00 GMT
  • Sierra Leone Patient Data Provide Insight for Curbing Ebola Outbreak
    • Authors: Friedrich MJ.
      Abstract: Clinical and laboratory data from patients with Ebola virus disease (EVD) in Sierra Leone that were analyzed by an international group of researchers are providing a better understanding of this latest manifestation of the disease that can be used to improve care for current and future outbreaks (Schieffelin JS et al. N Engl J Med. doi:10.1056/NEJMoa1411680 [published online October 29, 2014]).
      PubDate: Wed, 17 Dec 2014 00:00:00 GMT
  • Causes of Ferritin Elevation
    • Authors: VanWagner LB; Green RM.
      Abstract: In Reply Dr Lippi raises the important point that an elevated serum ferritin level may also be associated with underlying malignancy; it is true that ferritin may be elevated in a broad variety of other disease processes, as we noted in our JAMA Diagnostic Test Interpretation article. Elevated serum ferritin levels are commonly encountered in general practice and many elevations may be due to non–iron overload conditions.
      PubDate: Wed, 17 Dec 2014 00:00:00 GMT
  • Causes of Ferritin Elevation
    • Authors: Lippi G.
      Abstract: To the Editor Drs VanWagner and Green analyzed the case of a 46-year-old man with inflammatory arthritis presenting with an elevated ferritin level of 2556 μg/L. Of the potential causes of ferritin elevation, the authors primarily considered hereditary hemochromatosis, which was the final diagnosis, as well as excess iron supplementation, frequent blood transfusions, obesity, alcohol consumption, hematologic disorders, and inflammatory arthritis.
      PubDate: Wed, 17 Dec 2014 00:00:00 GMT
  • Prevention of Noncommunicable Diseases
    • Authors: Pachter LM; Cheng TL.
      Abstract: To the Editor We agree with Dr Yach and Mr Calitz in their Viewpoint on the changing landscape of prevention of noncommunicable diseases that increased and more targeted research on prevention, adequate infrastructure at the National Institutes of Health (NIH), public-private partnerships, and use of up-to-date health technology tools are needed. In addition, we would like to add another perspective.
      PubDate: Wed, 17 Dec 2014 00:00:00 GMT
  • Prevention of Noncommunicable Diseases
    • Authors: Yach D; Calitz C.
      Abstract: In Reply We agree with Drs Pachter and Cheng about the value of research into the early origins of chronic diseases. Further progress requires greater investment in large-scale birth cohort studies to better understand the complex interactions of genetic, environmental, and social factors and their trajectories over time.
      PubDate: Wed, 17 Dec 2014 00:00:00 GMT
  • Nobel Prize Winners’ Research Relates to Brain Function and
           Neurodegenerative Diseases
    • Authors: Hampton T.
      Abstract: Work by this year’s Nobel Prize in Physiology or Medicine awardees, a British-American scientist and 2 Norwegian researchers, has had a significant effect on our understanding of human cognition and will likely lead to insights related to processes involved in the development of neurological diseases.
      PubDate: Wed, 17 Dec 2014 00:00:00 GMT
  • Highlights
    • PubDate: Wed, 17 Dec 2014 00:00:00 GMT
  • Flavorings in Electronic Cigarettes An Unrecognized Respiratory Health
    • Authors: Barrington-Trimis JL; Samet JM, McConnell R.
      Abstract: This Viewpoint examines the flavorings added to e-cigarettes and the potential respiratory risks they may pose.
      PubDate: Wed, 17 Dec 2014 00:00:00 GMT
  • Ebola Virus Disease and the Need for New Personal Protective Equipment
    • Authors: Edmond MB; Diekema DJ, Perencevich EN.
      Abstract: Preventing transmission of pathogens in the health care setting with the use of personal protective equipment (PPE) has been an area of longstanding debate in the infection prevention community. Recently, reports of nosocomial transmission of Ebola virus to 2 nurses from the same patient in Texas (despite their use of PPE) has generated great concern and presents new challenges, particularly because there is no postexposure prophylaxis or effective antiviral therapy for Ebola, and approximately half of the cases are fatal.
      PubDate: Wed, 17 Dec 2014 00:00:00 GMT
  • Pustulonodular Lesion on the Nose
    • Authors: Gundelly P; Young M.
      PubDate: Wed, 17 Dec 2014 00:00:00 GMT
  • A Stool DNA Test (Cologuard) for Colorectal Cancer Screening
    • Abstract: The FDA has approved a stool DNA test to screen average-risk adults ≥50 years old for colorectal cancer.
      PubDate: Wed, 17 Dec 2014 00:00:00 GMT
  • Durability of Benefits of an Outpatient Antimicrobial Stewardship
           Intervention After Discontinuation of Audit and Feedback
    • Authors: Gerber JS; Prasad PA, Fiks AG, et al.
      Abstract: This follow-up to a randomized trial found that an intervention to reduce inappropriate antibiotic prescribing was effective only as long as audit and feedback to clinicians was in place.
      PubDate: Wed, 17 Dec 2014 00:00:00 GMT
  • Assessment of Outcomes of Hepatitis C Treatment
    • Authors: Chavez-Tapia NC; Barrientos-Gutierrez T, Uribe M.
      Abstract: To the Editor The review by Dr Kohli and colleagues illustrated how hepatitis C virus (HCV) treatment has moved from the low efficacy and high complication rates observed with ribavirin plus interferon to the high sustained viral response (SVR) and rare complication rates observed with directly acting antivirals. Directly acting antivirals have been embraced by clinical guidelines and, given their comparable safety and efficacy, the discussion over which specific drug will be used in the near future has turned to availability and affordability. Yet in the midst of this discussion is a more clinically relevant question: now that SVR and safety seem assured, should the outcomes of HCV treatment be redefined?
      PubDate: Wed, 17 Dec 2014 00:00:00 GMT
  • Assessment of Outcomes of Hepatitis C Treatment—Reply
    • Authors: Kohli A; Kottilil S.
      Abstract: In Reply Dr Chavez-Tapia and colleagues raise an important clinical question. Is SVR the appropriate clinical end point with new treatments for HCV or should clinical outcomes be assessed? Clinical outcomes of HCV include progression of liver fibrosis, decompensated liver disease, occurrence of hepatocellular carcinoma, and mortality, all of which take years to develop. In the interferon era of HCV therapeutics, occurrence of SVR was correlated with improved liver-related and overall outcomes, including hepatocellular carcinoma. Long-term follow-up studies of patients who achieve SVR need to be performed to evaluate whether interferon-free directly acting antiviral therapy reduces these outcomes. Our systematic review of the literature on advances in treatment regimens used to treat HCV cannot address this issue. However, we agree that measuring and defining the effect of treatment with directly acting antivirals for HCV on mortality is the next step and would help determine the value of treatment for various populations of patients (eg, those with various stages of liver disease, patients coinfected with human immunodeficiency virus, children). In addition, further delineation of the effect of therapy on the transmission of HCV is necessary from a public health perspective to understand and define the benefit of SVR on curtailing disease spread.
      PubDate: Wed, 17 Dec 2014 00:00:00 GMT
  • Oral Anticoagulants and the Risk of Intracranial Hemorrhage
    • Authors: Vespa PM.
      Abstract: JAMA NeurologyNew Oral Anticoagulants and the Risk of Intracranial Hemorrhage: Traditional and Bayesian Meta-analysis and Mixed Treatment Comparison of Randomized Trials of New Oral Anticoagulants in Atrial FibrillationSaurav Chatterjee, MD; Partha Sardar, MD; Giuseppe Biondi-Zoccai, MD; Dharam J. Kumbhani, MD, SM, MRCPImportance Randomized studies have shown a decreased risk of intracranial hemorrhage (ICH) with use of novel oral anticoagulants (NOACs). However, it is unclear whether the magnitude of benefit is similar for all NOACs currently available.Objective To perform a systematic review and meta-analysis to quantitatively assess the rates of ICH within the framework of both conventional and Bayesian statistics.Data Sources The MEDLINE, CENTRAL, CINAHL, and EBSCO databases, supplemented with conference abstracts, were searched up to December 1, 2012, with no language restriction.Study Selection Randomized trials comparing NOACs vs a comparator and reporting on ICH events.Data Extraction and Synthesis The NOACs were pooled to perform a comparison with all comparators and among themselves in both traditional frequentist and Bayesian random-effects models using vague priors and Markov chain Monte Carlo simulation with Gibbs sampling, calculating pooled odds ratios and associated 95% confidence intervals as well as numbers needed to treat and 95% credible intervals for the Bayesian analysis.Main Outcomes and Measures Intracranial hemorrhage events associated with NOACs in comparison with comparators, expressed as odds ratios.Results Six studies (1 administering dabigatran etexilate mesylate, 2 administering rivaroxaban, and 3 administering apixaban) enrolling a total of 57 491 patients were included for analysis. The NOACs significantly reduced the risk of ICH against all comparators (odds ratio = 0.49; 95% CI, 0.36-0.65). Each of the 3 drugs reduced the risk of ICH, with Bayesian indirect comparison analysis not revealing a significant credible difference between the specific medications.Conclusions and Relevance Novel oral anticoagulants are uniformly associated with an overall reduced risk of ICH when used for stroke prevention in atrial fibrillation. Any of the currently available NOACs can be considered first line for patients at high risk for ICH.JAMA Neurol. 2013;70(12):1486-1490. doi:10.1001/jamaneurol.2013.4021.
      PubDate: Wed, 17 Dec 2014 00:00:00 GMT
  • The Diagnosis and Management of Mild Cognitive Impairment A Clinical
    • Authors: Langa KM; Levine DA.
      Abstract: ImportanceCognitive decline is a common and feared aspect of aging. Mild cognitive impairment (MCI) is defined as the symptomatic predementia stage on the continuum of cognitive decline, characterized by objective impairment in cognition that is not severe enough to require help with usual activities of daily living.ObjectiveTo present evidence on the diagnosis, treatment, and prognosis of MCI and to provide physicians with an evidence-based framework for caring for older patients with MCI and their caregivers.Evidence AcquisitionWe searched PubMed for English-language articles in peer-reviewed journals and the Cochrane Library database from inception through July 2014. Relevant references from retrieved articles were also evaluated.FindingsThe prevalence of MCI in adults aged 65 years and older is 10% to 20%; risk increases with age and men appear to be at higher risk than women. In older patients with MCI, clinicians should consider depression, polypharmacy, and uncontrolled cardiovascular risk factors, all of which may increase risk for cognitive impairment and other negative outcomes. Currently, no medications have proven effective for MCI; treatments and interventions should be aimed at reducing cardiovascular risk factors and prevention of stroke. Aerobic exercise, mental activity, and social engagement may help decrease risk of further cognitive decline. Although patients with MCI are at greater risk for developing dementia compared with the general population, there is currently substantial variation in risk estimates (from
      PubDate: Wed, 17 Dec 2014 00:00:00 GMT
  • Uptake and Costs of Hypofractionated vs Conventional Whole Breast
           Irradiation After Breast Conserving Surgery in the United States,
    • Authors: Bekelman JE; Sylwestrzak G, Barron J, et al.
      Abstract: ImportanceBased on randomized evidence, expert guidelines in 2011 endorsed shorter, hypofractionated whole breast irradiation (WBI) for selected patients with early-stage breast cancer and permitted hypofractionated WBI for other patients.ObjectivesTo examine the uptake and costs of hypofractionated WBI among commercially insured patients in the United States.Design, Setting, and ParticipantsRetrospective, observational cohort study, using administrative claims data from 14 commercial health care plans covering 7.4% of US adult women in 2013, we classified patients with incident early-stage breast cancer treated with lumpectomy and WBI from 2008 and 2013 into 2 cohorts: (1) the hypofractionation-endorsed cohort (n = 8924) included patients aged 50 years or older without prior chemotherapy or axillary lymph node involvement and (2) the hypofractionation-permitted cohort (n = 6719) included patients younger than 50 years or those with prior chemotherapy or axillary lymph node involvement.ExposuresHypofractionated WBI (3-5 weeks of treatment) vs conventional WBI (5-7 weeks of treatment).Main Outcomes and MeasuresUse of hypofractionated and conventional WBI, total and radiotherapy-related health care expenditures, and patient out-of-pocket expenses. Patient and clinical characteristics included year of treatment, age, comorbid disease, prior chemotherapy, axillary lymph node involvement, intensity-modulated radiotherapy, practice setting, and other contextual variables.ResultsHypofractionated WBI increased from 10.6% (95% CI, 8.8%-12.5%) in 2008 to 34.5% (95% CI, 32.2%-36.8%) in 2013 in the hypofractionation-endorsed cohort and from 8.1% (95% CI, 6.0%-10.2%) in 2008 to 21.2% (95% CI, 18.9%-23.6%) in 2013 in the hypofractionation-permitted cohort. Adjusted mean total health care expenditures in the 1 year after diagnosis were $28 747 for hypofractionated and $31 641 for conventional WBI in the hypofractionation-endorsed cohort (difference, $2894; 95% CI, $1610-$4234; P 
      PubDate: Wed, 17 Dec 2014 00:00:00 GMT
  • Effects of High vs Low Glycemic Index of Dietary Carbohydrate on
           Cardiovascular Disease Risk Factors and Insulin Sensitivity The OmniCarb
           Randomized Clinical Trial
    • Authors: Sacks FM; Carey VJ, Anderson CM, et al.
      Abstract: ImportanceFoods that have similar carbohydrate content can differ in the amount they raise blood glucose. The effects of this property, called the glycemic index, on risk factors for cardiovascular disease and diabetes are not well understood.ObjectiveTo determine the effect of glycemic index and amount of total dietary carbohydrate on risk factors for cardiovascular disease and diabetes.Design, Setting, and ParticipantsRandomized crossover-controlled feeding trial conducted in research units in academic medical centers, in which 163 overweight adults (systolic blood pressure, 120-159 mm Hg) were given 4 complete diets that contained all of their meals, snacks, and calorie-containing beverages, each for 5 weeks, and completed at least 2 study diets. The first participant was enrolled April 1, 2008; the last participant finished December 22, 2010. For any pair of the 4 diets, there were 135 to 150 participants contributing at least 1 primary outcome measure.Interventions(1) A high–glycemic index (65% on the glucose scale), high-carbohydrate diet (58% energy); (2) a low–glycemic index (40%), high-carbohydrate diet; (3) a high–glycemic index, low-carbohydrate diet (40% energy); and (4) a low–glycemic index, low-carbohydrate diet. Each diet was based on a healthful DASH-type diet.Main Outcomes and MeasuresThe 5 primary outcomes were insulin sensitivity, determined from the areas under the curves of glucose and insulin levels during an oral glucose tolerance test; levels of low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides; and systolic blood pressure.ResultsAt high dietary carbohydrate content, the low– compared with high–glycemic index level decreased insulin sensitivity from 8.9 to 7.1 units (−20%, P = .002); increased LDL cholesterol from 139 to 147 mg/dL (6%, P ≤ .001); and did not affect levels of HDL cholesterol, triglycerides, or blood pressure. At low carbohydrate content, the low– compared with high–glycemic index level did not affect the outcomes except for decreasing triglycerides from 91 to 86 mg/dL (−5%, P = .02). In the primary diet contrast, the low–glycemic index, low-carbohydrate diet, compared with the high–glycemic index, high-carbohydrate diet, did not affect insulin sensitivity, systolic blood pressure, LDL cholesterol, or HDL cholesterol but did lower triglycerides from 111 to 86 mg/dL (−23%, P ≤ .001).Conclusions and RelevanceIn this 5-week controlled feeding study, diets with low glycemic index of dietary carbohydrate, compared with high glycemic index of dietary carbohydrate, did not result in improvements in insulin sensitivity, lipid levels, or systolic blood pressure. In the context of an overall DASH-type diet, using glycemic index to select specific foods may not improve cardiovascular risk factors or insulin resistance.Trial Identifier: NCT00608049
      PubDate: Wed, 17 Dec 2014 00:00:00 GMT
  • Entecavir vs Lamivudine for Prevention of Hepatitis B Virus Reactivation
           Among Patients With Untreated Diffuse Large B-Cell Lymphoma Receiving
           R-CHOP Chemotherapy A Randomized Clinical Trial
    • Authors: Huang H; Li X, Zhu J, et al.
      Abstract: ImportanceHepatitis B virus (HBV) reactivation is a serious complication for patients with lymphoma treated with rituximab-containing chemotherapies, despite lamivudine prophylaxis treatment. An optimal prophylactic antiviral protocol has not been determined.ObjectiveTo compare the efficacy of entecavir and lamivudine in preventing HBV reactivation in patients seropositive for the hepatitis B surface antigen with untreated diffuse large B-cell lymphoma receiving chemotherapy treatment with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP).Design, Setting, and PatientsRandomized, open-label, phase 3 study conducted from February 2008 through December 2012 at 10 medical centers in China. This study was a substudy of a parent study designed to compare a 3-week with a 2-week R-CHOP chemotherapy regimen for untreated diffuse large B-cell lymphoma. Patients enrolled in the parent study who were seropositive for the hepatitis B surface antigen and had normal liver function, serum HBV DNA levels of less than 103 copies/mL, and no prior antiviral therapy were randomized to entecavir (n = 61) or lamivudine (n = 60).InterventionsDaily entecavir (0.5 mg) or lamivudine (100 mg) beginning 1 week before the initiation of R-CHOP treatment to 6 months after completion of chemotherapy.Main Outcomes and MeasuresThe primary efficacy end point was the incidence of HBV-related hepatitis. The secondary end points included rates of HBV reactivation, chemotherapy disruption due to hepatitis, and treatment-related adverse events.ResultsThere were 121 patients randomly assigned to receive entecavir (n = 61) or lamivudine (n = 60). The date of last patient follow-up was May 25, 2013. The rates were significantly lower for the entecavir group vs the lamivudine group for HBV-related hepatitis (0% vs 13.3%, respectively; difference between groups, 13.3% [95% CI, 4.7% to 21.9%]; P = .003), HBV reactivation (6.6% vs 30%; difference, 23.4% [95% CI, 10.2% to 36.6%]; P = .001), and chemotherapy disruption (1.6% vs 18.3%; difference, 16.7% [95% CI, 6.4% to 27.0%]; P = .002). Of the 61 patients in the entecavir group, 15 (24.6%) experienced treatment-related adverse events. Of 60 patients in the lamivudine group, 18 (30%) experienced treatment-related adverse events (difference between entecavir and lamivudine groups, 5.4% [95% CI, −10.5% to 21.3%]; P = .50).Conclusions and RelevanceAmong patients seropositive for the hepatitis B surface antigen with diffuse large B-cell lymphoma undergoing R-CHOP chemotherapy, the addition of entecavir compared with lamivudine resulted in a lower incidence of HBV-related hepatitis and HBV reactivation. If replicated, these findings support the use of entecavir in these patients.Trial Identifier: NCT01793844; Chinese Clinical Trial Registry Identifier: CTR-TRC-11001687
      PubDate: Wed, 17 Dec 2014 00:00:00 GMT
  • Optimal Antiviral Prophylaxis Against Hepatitis B Reactivation in Patients
           Receiving Rituximab-Based Chemotherapy for Lymphoma
    • Authors: Abramson JS; Chung RT.
      Abstract: This Editorial discusses the optimal antiviral prophylaxis against hepatitis B reactivation in patients receiving rituximab-based chemotherapy for lymphoma.
      PubDate: Wed, 17 Dec 2014 00:00:00 GMT
  • Role of Glycemic Index in the Context of an Overall Heart-Healthy Diet
    • Authors: Eckel RH.
      Abstract: Randomized trials designed to assess possible effects of a dietary intervention on hard outcomes such as cardiovascular disease (CVD) events, cancer incidence, or all-cause mortality are nearly nonexistent. Clinical end point studies such as these require large sample sizes, long-term follow-up measured in years, and high levels of dietary adherence to attain a valid result. These studies are difficult and expensive to conduct and are consequently rare. An important exception was the PREDIMED Study wherein a Mediterranean diet supplemented with extravirgin olive oil or nuts reduced the incidence of major CVD events (mostly stroke) at 4.8 years in persons at high CVD risk. Based on many short-term studies and the few long-term studies such as PREDIMED, dietary recommendations currently favor an overall diet similar to the Mediterranean diet for CVD prevention.
      PubDate: Wed, 17 Dec 2014 00:00:00 GMT
  • Low-Dose Aspirin for Primary Prevention of Cardiovascular Events in
           Japanese Patients 60 Years or Older With Atherosclerotic Risk Factors A
           Randomized Clinical Trial
    • Authors: Ikeda Y; Shimada K, Teramoto T, et al.
      Abstract: ImportancePrevention of atherosclerotic cardiovascular diseases is an important public health priority in Japan due to an aging population.ObjectiveTo determine whether daily, low-dose aspirin reduces the incidence of cardiovascular events in older Japanese patients with multiple atherosclerotic risk factors.Design, Setting, and ParticipantsThe Japanese Primary Prevention Project (JPPP) was a multicenter, open-label, randomized, parallel-group trial. Patients (N = 14 464) were aged 60 to 85 years, presenting with hypertension, dyslipidemia, or diabetes mellitus recruited by primary care physicians at 1007 clinics in Japan between March 2005 and June 2007, and were followed up for up to 6.5 years, with last follow-up in May 2012. A multidisciplinary expert panel (blinded to treatment assignments) adjudicated study outcomes.InterventionsPatients were randomized 1:1 to enteric-coated aspirin 100 mg/d or no aspirin in addition to ongoing medications.Main Outcomes and MeasuresComposite primary outcome was death from cardiovascular causes (myocardial infarction, stroke, and other cardiovascular causes), nonfatal stroke (ischemic or hemorrhagic, including undefined cerebrovascular events), and nonfatal myocardial infarction. Secondary outcomes included individual end points.ResultsThe study was terminated early by the data monitoring committee after a median follow-up of 5.02 years (interquartile range, 4.55–5.33) based on likely futility. In both the aspirin and no aspirin groups, 56 fatal events occurred. Patients with an occurrence of nonfatal stroke totaled 114 in the aspirin group and 108 in the no aspirin group; of nonfatal myocardial infarction, 20 in the aspirin group and 38 in the no aspirin group; of undefined cerebrovascular events, 3 in the aspirin group and 5 in the no aspirin group. The 5-year cumulative primary outcome event rate was not significantly different between the groups (2.77% [95% CI, 2.40%-3.20%] for aspirin vs 2.96% [95% CI, 2.58%-3.40%] for no aspirin; hazard ratio [HR], 0.94 [95% CI, 0.77-1.15]; P = .54). Aspirin significantly reduced incidence of nonfatal myocardial infarction (0.30 [95% CI, 0.19-0.47] for aspirin vs 0.58 [95% CI, 0.42-0.81] for no aspirin; HR, 0.53 [95% CI, 0.31-0.91]; P = .02) and transient ischemic attack (0.26 [95% CI, 0.16-0.42] for aspirin vs 0.49 [95% CI, 0.35-0.69] for no aspirin; HR, 0.57 [95% CI, 0.32-0.99]; P = .04), and significantly increased the risk of extracranial hemorrhage requiring transfusion or hospitalization (0.86 [95% CI, 0.67-1.11] for aspirin vs 0.51 [95% CI, 0.37-0.72] for no aspirin; HR, 1.85 [95% CI, 1.22-2.81]; P = .004).Conclusions and RelevanceOnce-daily, low-dose aspirin did not significantly reduce the risk of the composite outcome of cardiovascular death, nonfatal stroke, and nonfatal myocardial infarction among Japanese patients 60 years or older with atherosclerotic risk factors.Trial Identifier: NCT00225849.
      PubDate: Wed, 17 Dec 2014 00:00:00 GMT
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