0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
In This Issue of JAMA |

Highlights FREE

JAMA. 2014;311(19):1939-1941. doi:10.1001/jama.2013.279500.
Text Size: A A A
Published online

McEvoy and colleagues compared the effectiveness of paliperidone palmitate—a long-acting injectable second-generation atypical antipsychotic—with the older long-acting injectable agent haloperidol decanoate as maintenance therapy for schizophrenia or schizoaffective disorder in a randomized trial that enrolled 311 patients who were at high risk of relapse. The authors found the 2 medications did not differ in the rate of efficacy failure—defined as inadequate control of psychopathology assessed by a blinded adjudication committee. In an Editorial, Goff discusses maintenance treatment of schizophrenia with injectable long-acting antipsychotic medications.

Evidence is limited on the efficacy of physical therapy to reduce pain and improve physical function among patients with hip osteoarthritis. In a randomized, participant- and assessor-blinded 12-week trial involving 102 patients with painful hip osteoarthritis, Bennell and colleagues compared physical therapy (education/advice, manual therapy, home exercise, and gait aid if appropriate) with sham treatment (inactive ultrasound and inert gel application) and found that physical therapy did not result in greater improvement in pain or function compared with sham treatment.

Kris and colleagues report results of a study that used multiplex genotyping to assess the frequency of oncogenic drivers—genomic alterations critical to cancer development, maintenance, or both—in 1007 patients with lung adenocarcinomas; the utility of assay results to select genotype-directed therapy; and the effect on patient survival. The authors report actionable oncogenic drivers were detected in 466 of 733 tumors tested (64%) with the complete (10 driver) multiplex assay. Assay results were used to select a targeted therapy or clinical trials for 28% of the patients, and individuals who received driver-targeted drugs lived longer. In an Editorial, Pasche and Grant discuss genomic testing to guide cancer treatment and enhance clinical trial design.

CLINICAL REVIEW & EDUCATION

Ms W, a 62-year-old woman with initial symptoms of stress urinary incontinence, now reports urge incontinence symptoms as well, a condition termed mixed urinary incontinence. In a discussion of this case, Myers reviews the prevalence, diagnosis, treatment, and outcomes of mixed urinary incontinence. In a literature review of 73 articles, the author found high-quality evidence to support treatment of urinary incontinence with weight loss; surgical treatment of stress urinary incontinence; and managing urge incontinence with anticholinergic medications. High-quality evidence for the treatment of mixed urinary incontinence was lacking, as are clear diagnostic criteria. Thus, treatment of mixed urinary incontinence typically begins with conservative management of the most bothersome component.

An 8-year-old boy was found outside, unconscious on a rainy day. He was observed to be fine 1 hour before and was previously healthy. The boy was amnesic for events leading to his injuries. On examination he had trismus, left leg pain, and mild erythema of the left foot with dry, black punctate lesions. Similar lesions were noted on the forearms. Venous blood gas analysis revealed severe lactic acidosis. What would you do next?

In this JAMA Diagnostic Test Interpretation article, Wagner and Hiatt present the case of a 92-year-old man who, 3 days after undergoing laparoscopic right hemicolectomy for adenocarcinoma of the cecum, developed atrial fibrillation. Breath sounds were diminished and a chest x-ray showed pulmonary edema. Serum troponin and B-type natriuretic peptide (BNP) levels were elevated. How would you interpret the test results? In an Editorial, Livingston and McDermott discuss the format and goals of this new JAMA series.

Tables

References

Letters

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.