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In This Issue of JAMA |

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JAMA. 2014;311(13):1269-1271. doi:10.1001/jama.2013.279416.
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Erectile dysfunction (ED) is common after radiotherapy for prostate cancer. In a randomized trial that enrolled 242 men with intact erectile function who were to receive radiotherapy for prostate cancer, Pisansky and colleagues assessed whether daily treatment with the phosphodiesterase-5 inhibitor tadalafil—initiated at the onset of radiotherapy and continued for 24 weeks—could preserve erectile function. The authors report that compared with placebo, daily use of tadalafil did not result in improved off-drug, spontaneous erectile function assessed 28 to 30 weeks after starting radiotherapy.

To assess progress in reducing sepsis-related mortality among critically ill patients, Kaukonen and colleagues analyzed data from 101 064 patients with severe sepsis or septic shock who received care in 171 intensive care units in Australia and New Zealand in 2000-2012. The authors report that mortality from severe sepsis or septic shock decreased significantly in the 13-year period and was accompanied by changes in patterns of discharge to home, rehabilitation, and other hospitals. In an Editorial, Iwashyna and Angus discuss implications of reported declines in sepsis fatality rates.

Rohde and colleagues assessed whether red blood cell (RBC) transfusion was associated with health care–associated infection risk in a systematic review and meta-analysis of data from 18 randomized trials (7593 patients) that compared restrictive vs liberal hemoglobin thresholds for transfusion. The authors found that a restrictive RBC transfusion strategy was associated with a reduced risk of health care–associated infection. Leukoreduction of RBC units did not alter the association. In an Editorial, Carson discusses RBC transfusion thresholds and transfusion-associated infection risk.

CLINICAL REVIEW & EDUCATION

Pace and Keating report results of a systematic review of the evidence (1960-2014) addressing several important issues related to screening mammography: the mortality benefit; harms associated with screening, including false-positive results, unnecessary biopsies, and overdiagnosis; and the clinical challenges of incorporating individual patient characteristics in screening recommendations and communicating risks and benefits to patients. Among the authors’ findings was a modest 19% overall reduction in breast cancer mortality and an approximate 50% cumulative risk of a false-positive result during 10 years of annual mammograms. In an Editorial, Elmore and Kramer discuss how to ensure informed and individualized decision making about breast cancer screening.

Mrs M is a 91-year-old woman who has had annual screening mammograms since age 50 years. A mammogram performed in her 87th year showed microcalcifications (interpreted as probably benign); these increased in number over 2 years and a subsequent excisional biopsy revealed ductal carcinoma in situ. In this Caring for the Aging Patient article, Walter and Schonberg review risk factors for late-life breast cancer and discuss the benefits and harms of screening mammography for older women.

An article in JAMA Surgery reported that most patients seeking weight loss surgery have high weight loss expectations. In this From the JAMA Network article, Li and Heber discuss the importance of presurgical counseling to establish appropriate weight loss expectations and optimize bariatric surgery outcomes.

A 50-year-old woman reported a 10-year history of painless subungual and acral pigmentation of 1 finger, which began as a black streak and widened over time. Examination of the other nails is unremarkable. What would you do next?

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