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In This Issue of JAMA |

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JAMA. 2015;314(7):643-645. doi:10.1001/jama.2014.11921.
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RESEARCH

The evidence supporting low-molecular-weight heparin (LMWH) as guideline-recommended therapy for venous thromboembolism (VTE) in patients with cancer is largely derived from the results of a single trial. To provide more contemporary and global evidence for the efficacy and safety of long-term LMWH therapy in patients with cancer and VTE, Lee and colleagues compared treatment with tinzaparin vs warfarin in a randomized, open-label study involving 900 patients from 164 centers on 5 continents. The authors report that use of tinzaparin compared with warfarin for 6 months did not significantly reduce a composite outcome of recurrent DVT, pulmonary embolism, and incidental VTE or reduce mortality or major bleeding, but was associated with lower rates of clinically relevant nonmajor bleeding.

In a randomized, placebo-controlled trial that involved 846 overweight or obese adults with type 2 diabetes, Davies and colleagues found that use of the incretin hormone-derived glucagon-like peptide 1 receptor agonist liraglutide (3.0 mg/d)—as an adjunct to diet and exercise for weight management—resulted in clinically relevant weight loss over 56 weeks. Additional study is needed to evaluate the longer-term efficacy and safety of liraglutide.

In a longitudinal and repeated assessment of a Los Angeles school-based cohort of 14-year-old adolescents (n = 2530) who reported never using combustible tobacco at baseline, Leventhal and colleagues found that adolescents who used electronic cigarettes (e-cigarettes) at baseline were more likely than nonusers to report initiation of combustible tobacco smoking over the next year. In an Editorial, Rigotti discusses public health concerns about e-cigarettes and strategies to reduce youth uptake.

Editorial and Related Article

CLINICAL REVIEW & EDUCATION

Septic shock occurs in more than 230 000 US patients each year. Based on data from 35 clinical trials, guidelines, and meta-analyses published between January 2010 and June 2015, Seymour and Rosengart address advances in the diagnosis and treatment of septic shock. The authors discuss the use of focused ultrasonography to recognize complex manifestations of shock, highlight the limitations of protocol-based therapy, and discuss areas of uncertainty, including the choice and timing of fluid administration and fluid removal after resuscitation.

Long-term smoking cessation rates associated with the recommended 8 to 12 weeks’ use of nicotine replacement therapy (NRT) are low. Whether extended use would improve quit rates is not clear. An article published in JAMA Internal Medicine reported no benefit from maintenance (52 weeks) use of the nicotine patch compared with standard or extended (24 weeks) therapy. In this From the JAMA Network article, Prochaska discusses smoking cessation interventions that might benefit subgroups of smokers.

This JAMA Clinical Evidence Synopsis article by McNab summarizes a Cochrane Review (10 randomized trials; 1106 patients) that assessed hyponatremia risk when isotonic vs hypotonic intravenous (IV) fluids are used for maintenance hydration in hospitalized children aged 3 months to 18 years. Findings included a lower risk of hyponatremia and no increased risk of hypernatremia or overhydration when isotonic fluids are used.

This Medical Letter on Drugs and Therapeutics article provides information about Sacubitril/Valsartan (Entreso), a recently approved fixed-dose combination medication for patients with heart failure and reduced ejection fraction. Efficacy and safety outcomes from the randomized trial on which approval was based and information on drug interactions are summarized.

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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.
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