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In This Issue of JAMA |

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JAMA. 2014;312(3):207-209. doi:10.1001/jama.2013.279613.
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Pain is a common problem among primary care patients, and evidence-based, primary care interventions for chronic pain are needed. Kroenke and colleagues assessed the efficacy of a telephone-delivered collaborative care (telecare) pain management intervention in a randomized trial involving 250 patients with chronic musculoskeletal pain. The authors report that compared with usual care, the telecare intervention, which included automated symptom monitoring and an algorithm-guided stepped care approach to optimizing analgesics, increased the proportion of patients whose pain improved. In an Editorial, Ohl and Rosenthal discuss telecare management of chronic pain.

Hydroxychloroquine is the most frequently prescribed immunosuppressant for primary Sjögren syndrome but evidence regarding its efficacy is limited. In a multicenter randomized trial involving 120 patients with primary Sjögren syndrome, Gottenberg and colleagues found that compared with placebo, treatment with hydroxychloroquine (400 mg/d) for 24 weeks did not improve symptoms of mouth and eye dryness, pain, or fatigue.

In an analysis of data from a multicenter cohort of 14 357 black and white adults who were free of stroke at baseline and enrolled in a prospective study of cardiovascular disease risk, Koton and colleagues found that stroke incidence and subsequent mortality rates decreased from 1987 to 2011. The declines were similar across sex and race and varied somewhat across age groups. In an Editorial, Sacco and Dong discuss trends in cardiovascular risk factors likely associated with declines in stroke incidence and mortality.

In a population-based cohort study that included 481 183 Danish patients who underwent noncardiac, elective surgery, Jørgensen and colleagues assessed the association between prior ischemic stroke (including time elapsed between stroke and surgery) and the risk of perioperative cardiovascular events and mortality. The authors report that patients with a history of ischemic stroke were at increased risk of adverse outcomes—particularly when the time between stroke and surgery was less than 9 months.

Editorial and Related Article

CLINICAL REVIEW & EDUCATION

Early identification of human immunodeficiency virus (HIV) infection is associated with reduced HIV-associated morbidity and mortality and lower HIV transmission rates. Wood and colleagues assessed the accuracy of symptoms and signs of early HIV infection in an analysis of data from 16 studies (24 745 adult patients). The authors found that genital ulcers, weight loss, vomiting, and swollen lymph nodes were associated with early HIV infection; however, these findings had limited utility to detect or rule out HIV infection.

A recent article in JAMA Otolaryngology–Head & Neck Surgery reported that patients undergoing surgery for head and neck cancer who did not receive anticoagulation therapy were at increased risk of postoperative venous thromboembolism (VTE). In this From the JAMA Network article, Kinnier and colleagues discuss modification of quality measures for VTE prophylaxis to optimize practice across diverse patient populations.

A 61-year-old man presents with a 1.5-year history of a painless and slowly enlarging plaque with an erosive surface on his scrotum. What would you do next?

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