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In This Issue of JAMA |

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JAMA. 2016;315(17):1811-1813. doi:10.1001/jama.2015.14240.
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RESEARCH

In an open-label randomized trial that enrolled 449 patients with locally advanced pancreatic cancer that was controlled after induction chemotherapy, Hammel and colleagues found no significant difference in overall survival with chemoradiotherapy vs chemotherapy alone and found no significant difference in overall survival with gemcitabine vs gemcitabine plus erlotinib used as maintenance therapy. In an Editorial, Schrag discusses challenges in treating locally advanced pancreas cancer

In a randomized trial involving 406 self-selected adults with subthreshold depression, Buntrock and colleagues found that use of a web-based guided self-help intervention—consisting of cognitive-behavioral and problem-solving therapy supported by an online trainer—compared with a web-based psychoeducational intervention reduced the incidence of major depressive disorder over 12 months.

Fleming-Dutra and colleagues analyzed national survey data representing 184 032 ambulatory care visits in the United States in 2010 and 2011 to determine rates of total and appropriate antibiotic prescriptions. The authors report an estimated annual antibiotic prescription rate of 506 per 1000 population, of which 353 antibiotic prescriptions per 1000 population were likely appropriate. In an Editorial, Tamma and Cosgrove discuss interventions to improve outpatient antibiotic use.

In an analysis of claims from 2 employer-based health plans that offered access to an online tool providing out-of-pocket health care cost information (n=148 655 individuals) and claims from matched controls (n=295 983 individuals) employed elsewhere and without tool access, Desai and colleagues found that availability of a price transparency tool was not associated with lower health care spending. In an Editorial, Volpp discusses reasons price transparency tools may not effect health spending.

CLINICAL REVIEW & EDUCATION

Pancreatic cysts are increasingly diagnosed as an incidental finding on abdominal imaging and are often of uncertain clinical significance. Based on a review of 226 articles, Stark and colleagues present a systematic approach for risk stratification of pancreatic cysts. Factors to consider include the presence or absence of symptoms and high-risk features such as main pancreatic duct dilatation, a solid component, or a mural nodule on initial imaging.

Outdoor workers experiencing chronic exposure to solar ultraviolet radiation are at increased risk of skin cancer. An article in JAMA Dermatology reported that occupational sun-safety policies are uncommon at the local governmental level. In this From The JAMA Network article, Crane and Dellavalle discuss sun exposure as an occupational safety concern.

A 79-year-old man with a history of hypertension and stroke was found unresponsive and brought to the emergency department. He was cold to the touch with no detectable temperature on multiple measurement attempts. His blood pressure was 85/55 mm Hg, heart rate 36/min, and pulse oximetry 100% on ambient air. An electrocardiogram was obtained. What would you do next?

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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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