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In This Issue of JAMA |

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JAMA. 2015;314(16):1669-1671. doi:10.1001/jama.2014.12047.
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RESEARCH

Emerging data suggest that intravenous saline may contribute to acute kidney injury (AKI) among critically ill patients and that buffered crystalloid solutions may be associated with a decreased risk of AKI. In a cluster randomized trial that enrolled 2278 intensive care unit patients requiring crystalloid fluid therapy, Young and colleagues found no difference in AKI risk among patients randomly assigned to receive a buffered crystalloid compared with those assigned to receive saline. In an Editorial, Kellum and Shaw discuss unresolved questions regarding the toxicity of intravenous crystalloids in critically ill patients.

Noninvasive ventilation has been recommended to decrease mortality among immunocompromised patients with acute hypoxemic respiratory failure. In a multicenter randomized trial that enrolled 374 adult patients with immune system compromise and acute hypoxemic respiratory failure, Lemiale and colleagues found that compared with oxygen therapy alone, early noninvasive ventilation did not reduce 28-day mortality rates. In an Editorial, Patel and Kress discuss advances in noninvasive ventilation technology and implications for patient care.

CME

A long-acting β-agonist (LABA) in combination with inhaled corticosteroids is recommended for patients with poor asthma control. However, concerns exist about the safety and efficacy of LABA therapy among black patients with asthma. Whether a long-acting anticholinergic can substitute for LABAs is unclear. Wechsler and colleagues investigated these treatment-related concerns in 1070 black adults with moderate or severe asthma. The authors found no difference in time to asthma exacerbation among patients randomly assigned to either a LABA or tiotropium—a long-acting anticholinergic—combined with inhaled corticosteroid.

Ma and colleagues analyzed 1969-2013 national vital statistics data to assess temporal trends in mortality in the United States. Among the findings was a decreasing trend in the age-standardized death rate for all causes combined, as well as for heart disease, cancer, stroke, unintentional injures, and diabetes. The mortality rate for chronic obstructive pulmonary disease increased from 1969 to 2013. In an Editorial, McGinnis discusses limitations of mortality trends to assess health status in the United States.

CLINICAL REVIEW & EDUCATION

A 73-year-old woman with a history of pulmonary sarcoidosis had a widespread scaly rash that did not improve with topical triamcinolone. Her medications included amlodipine, hydroxychloroquine, and pantoprazole. Laboratory testing revealed an antinuclear antibody titer of 1:80, with no elevation of double-stranded DNA, Smith, or antihistone antibodies. Skin biopsy revealed an inflammatory pattern of vacuolar interface dermatitis. What would you do next?

In a JAMA Diagnostic Test Interpretation article, Tritos and Klibanski present a 47-year-old man with recent-onset fatigue, vision loss, and low libido. The patient denied headache, erectile dysfunction, or breast tenderness. Physical examination was significant for bitemporal visual field defects; the patient did not have acromegalic features, gynecomastia, or galactorrhea. Laboratory evaluation revealed low testosterone and thyrotropin levels and elevated serum prolactin. How would you interpret the test results?

This Medical Letter on Drugs and Therapeutics article provides information about 3 available oral opioid formulations having 1 or more properties that make their intentional nontherapeutic use more difficult or less rewarding. Results of trials comparing abuse-deterrent opioids with original formulations and postmarketing epidemiological study data 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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