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In This Issue of JAMA |

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JAMA. 2014;311(20):2039-2041. doi:10.1001/jama.2013.279514.
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Maternal smoking during pregnancy has an adverse effect on infant lung development. Evidence from a primate model suggests vitamin C may mitigate some of the effect. To assess whether maternal vitamin C supplementation would improve pulmonary function of infants whose mothers smoked during pregnancy, McEvoy and colleagues randomly assigned 159 pregnant smokers to receive daily vitamin C supplements or placebo. The authors report that supplemental vitamin C improved newborn pulmonary function and decreased the incidence of wheezing in the first year of life. In an Editorial, Hall discusses maternal vitamin C supplementation and infant respiratory health.

Vitamin D insufficiency is associated with adverse outcomes in asthma and some data suggest that vitamin D may augment the effect of corticosteroid treatment. In a randomized trial that enrolled 408 adult patients with symptomatic asthma and a serum 25-hydroxyvitamin D concentration less than 30 ng/mL, Castro and colleagues found that compared with placebo, vitamin D3 added to inhaled corticosteroid therapy did not reduce the rate of asthma treatment failure or exacerbation.

To characterize variations in class I American College of Cardiology/American Heart Association (ACC/AHA) guideline recommendations (“procedure/treatment should be performed/administered”), Neuman and colleagues reviewed 11 guidelines published between 1998 and 2007 and revised between 2006 and 2013. The authors abstracted all class I recommendations from the first of the 2 most recent versions of each guideline and identified corresponding recommendations in the subsequent version. Among the authors’ findings was that of 619 index recommendations, 495 were retained in the subsequent guideline version, 57 were downgraded or reversed, and 67 were omitted. Durability of the recommendations varied across individual guidelines and levels of evidence. In an Editorial, Shekelle discusses updating practice guidelines and communicating changes to relevant stakeholders.

Abdominal pain after cholecystectomy attributed to sphincter of Oddi dysfunction is often managed with endoscopic sphincterotomy. In a sham-controlled randomized trial that involved 214 patients with pain after cholecystectomy and no significant abnormalities on imaging or laboratory studies, prior sphincter treatment, or pancreatitis, Cotton and colleagues found that compared with a sham procedure, endoscopic sphincterotomy did not result in fewer days with disability due to pain.

CLINICAL REVIEW & EDUCATION

Surgery in older patients is often associated with complications, functional decline, and mortality. In a systematic review of 28 studies (1 422 433 patients) that examined preoperative clinical features and mortality risk and 26 studies (136 083 patients) that examined factors associated with surgical complications, Oresanya and colleagues found that risk estimates relating preoperative clinical conditions to postoperative mortality and surgical complications varied widely. The authors present an approach to surgical decision making for older patients that considers treatment goals, preoperative assessment, and optimization of perioperative care.

Isotretinoin is the most effective treatment for acne; however, the ideal dosing regimen is not clear and relapse is common. A recent article in JAMA Dermatology reported that high cumulative-dose isotretinoin was associated with a decreased rate of relapse after treatment. In this From the JAMA Network article, Owen discusses the safety and efficacy of high cumulative-dose isotretinoin.

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This Medical Letter article briefly reviews adverse effects and costs of isotretinoin products for acne, including a recently approved product, Absorica, which may be taken without food.

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