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In This Issue of JAMA |

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JAMA. 2015;313(7):643-645. doi:10.1001/jama.2014.11581.
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In a randomized placebo-controlled trial that enrolled 120 patients with severe community-acquired pneumonia and evidence of a high inflammatory response at hospital admission, Torres and colleagues assessed the effect of adjunctive therapy with corticosteroids on treatment failure. The authors report that compared with placebo, acute use of intravenous methylprednisolone decreased the risk of treatment failure. In an Editorial, Wunderink discusses appropriate use of corticosteroids in patients with severe community-acquired pneumonia.

Ebbert and colleagues assessed the efficacy and safety of varenicline for increasing smoking abstinence rates through smoking reduction in a multicenter trial that enrolled 1510 individuals not willing or able to quit smoking in the next month but willing to reduce smoking and make a quit attempt within 3 months of study enrollment. Participants were randomly assigned to receive varenicline or placebo for 24 weeks. The authors found that compared with placebo-assigned participants, those who received varenicline for 24 weeks had significantly increased smoking abstinence rates at 1 year.

Standard treatment of Gaucher disease type 1 requires lifelong, biweekly, intravenous infusions of enzyme replacement therapy. In a randomized placebo-controlled trial that enrolled 40 adults with untreated Gaucher disease type 1, Mistry and colleagues investigated the efficacy of eliglustat—a novel oral substrate-reduction therapy—on clinical manifestations of the disease. The authors report that compared with placebo, 9 months’ treatment with eliglustat resulted in reductions in spleen volume and improvements in hemoglobin level, liver volume, and platelet count.

A clinical trial involving patients with non–ST-segment elevation myocardial infarction (NSTEMI) found fondaparinux to be noninferior to low-molecular-weight heparin (LMWH) in reducing ischemic outcomes, with fewer severe bleeding events in the fondaparinux group. In an analysis of Swedish registry data from 40 616 consecutive patients with NSTEMI treated with either fondaparinux or LMWH, Szummer and colleagues found that fondaparinux was associated with lower risk of major bleeding events and death both in-hospital and through 180 days of follow-up and had similar rates of recurrent myocardial infarction and stroke.


An article in JAMA Internal Medicine reported that more than 18% of lung cancers detected with low-dose computed tomography screening in the National Lung Cancer Screening Trial were probably indolent and unlikely to cause clinical symptoms. In this From the JAMA Network article, Harris encourages open discussion of the benefits, harms, and costs of wide-scale screening for lung cancer and discusses the role of screening in reducing lung cancer deaths.

This JAMA Clinical Guidelines Synopsis summarizes the 2014 Advisory Committee for Immunization Practices recommendations for use of pneumococcal vaccine in adults. Among the recommendations is that all adults aged 65 years or older should receive the 13-valent pneumococcal conjugate vaccine in series with the 23-valent pneumococcal polysaccharide vaccine.

A 67-year-old woman presented to the emergency department with dyspnea and in respiratory distress. Two hours prior, she choked while eating, and the Heimlich maneuver successfully dislodged a piece of food. A chest radiograph and computed tomographic scan of the chest were obtained. What would you do next?



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