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In This Issue of JAMA |

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JAMA. 2014;312(21):2187-2189. doi:10.1001/jama.2013.279865.
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Sodium zirconium cyclosilicate selectively binds potassium in the intestine. In a randomized clinical trial that enrolled 258 ambulatory patients with hyperkalemia, Kosiborod and colleagues found that compared with placebo, zirconium cyclosilicate (5 g, 10 g, or 15 g daily for 28 days) resulted in lower serum potassium levels and a higher proportion of patients who were normokalemic at study day 29. In an Editorial, Dixon discusses treatment of hyperkalemia.

In a randomized trial that enrolled 900 patients with diabetes and no symptoms of coronary artery disease (CAD), Muhlestein and colleagues found that compared with guideline-based optimal diabetes care, CAD screening using coronary computed tomographic angiography did not reduce the rate of a composite outcome of all-cause mortality, nonfatal myocardial infarction, or unstable angina requiring hospitalization during a mean 4 years’ follow-up. In an Editorial, Gibbons discusses benefits of optimal medical therapy for cardiac risk reduction in patients with diabetes.

Fenoldopam—a selective dopamine receptor agonist that induces vasodilatation of renal arteries—has been promoted for the prevention of acute kidney injury. In a randomized trial that involved 667 patients with early acute kidney injury after cardiac surgery, Bove and colleagues found that compared with placebo, fenoldopam infusion did not reduce the need for renal replacement therapy or risk of 30-day mortality but was associated with an increased rate of hypotension. In an Editorial, Winkelmayer and Finkel discuss the challenge of preventing acute kidney injury among surgical patients.

Editorial and Related Article

Some studies suggest that perioperative aspirin or clonidine reduces the risk of acute kidney injury. In a 2 × 2 factorial randomized, placebo-controlled clinical trial involving 6905 patients undergoing major noncardiac surgery, Garg and colleagues found that neither aspirin nor clonidine administered perioperatively reduced the risk of acute kidney injury.

Editorial and Related Article


Diagnosis and treatment of chronic lymphocytic leukemia (CLL) has improved in the past decade. Nabhan and Rosen discuss diagnosis and risk stratification of patients with CLL and review evidence-based treatment recommendations based on their analysis of data from 24 articles (published from 2000-2014) evaluating first-line treatment of CLL. The authors found that chemoimmunotherapy is standard first-line treatment. Treatment should be initiated when the disease becomes symptomatic.

An article in JAMA Psychiatry reported that compared with their peers, individuals who attempt suicide in adolescence or young adulthood are at increased risk of persistent mental health, physical health, and social problems. In this From The JAMA Network article, Grisham and Williams discuss implications of the study findings for suicide prevention interventions and for treatment of individuals who survive a suicide attempt.

Cervical cancer screening has led to declines in incidence and mortality; however, many women diagnosed with cervical cancer have never undergone routine screening. This JAMA Clinical Guidelines Synopsis article by Volerman and Cifu summarizes the evidence base supporting the 2012 American College of Obstetricians and Gynecologists cervical cancer screening guidelines. Key recommendations address when to begin and stop screening, screening frequency, and co-testing with cytology and a human papillomavirus assay.

An elderly man presented with generalized red and purplish plaques, erosions, and blisters—without fever or other constitutional symptoms—approximately 8 hours after taking diclofenac. He reported a similar but less severe eruption after diclofenac ingestion 4 months earlier. What would you do next?



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