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In This Issue of JAMA |

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JAMA. 2016;316(4):369-371. doi:10.1001/jama.2015.14393.
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In a multicenter randomized trial that enrolled 213 adults with 1 to 3 brain metastases amenable to radiosurgery, Brown and colleagues assessed cognitive function 3 months after stereotactic radiosurgery (SRS) alone vs SRS plus whole brain radiotherapy (WBRT). The authors report that patients experienced less cognitive deterioration after SRS alone compared with SRS plus WBRT—with no difference in overall survival. In an Editorial, Kaidar-Person and colleagues discuss radiotherapy for brain metastases.

Richards and colleagues assessed 2006-2015 trends in late preterm and early term birth rates and their association with labor induction and prelabor cesarean delivery in an analysis of data from more than 30 million singleton live births in 6 high-income countries (Canada, Sweden, Norway, Denmark, Finland, and the United States). Among the authors’ findings was a decline in early term birth rates associated with decreasing rates of clinician-initiated obstetric interventions in the United States. An Editorial by Spong discusses timing delivery to optimize birth outcomes.

Infants with trisomy 13 and 18 often die shortly after birth, and surgery for associated congenital anomalies is controversial. In a retrospective cohort study involving 174 children with trisomy 13 and 254 children with trisomy 18, Nelson and colleagues found that 10% of the children with trisomy 13 and 18% of those with trisomy 18 survived for 10 years. Among children who underwent surgical interventions—ranging from myringotomy to complex cardiac repair—1-year survival was high. In an Editorial, Lantos discusses treatment decisions in gray zones of neonatal bioethics.


This US Preventive Services Task Force (USPSTF) Recommendation Statement addresses skin cancer screening with a clinical visual skin examination. Based on an updated evidence review, the USPSTF concluded that the evidence is insufficient to assess the balance of benefits and harms of visual skin examination by a clinician to screen for skin cancer in adults. In an Editorial, Tsao and Weinstock discuss the need for evidence to better assess benefits and harms of skin cancer screening.

Wernli and colleagues summarize findings from the US Preventive Services Task Force (USPSTF) evidence review relating to the effectiveness and associated benefits and harms of screening for skin cancer in asymptomatic adults. Thirteen unique studies were included in the review. The USPSTF considered the available evidence limited, particularly regarding any potential benefit of skin cancer screening on melanoma mortality.


An article in JAMA Surgery reported that positive changes in eating behaviors and weight control practices after bariatric surgery were associated with greater weight loss at a 3-year follow-up. In this From The JAMA Network article, Minami and colleagues discuss the potential for postoperative behavioral modification interventions to improve outcomes of bariatric surgery.

A 22-year-old woman presented with a 2-day history of skin lesions on her ears and a 2-month history of fevers, shortness of breath, and pleuritic chest pain. Laboratory findings included anemia and abnormal coagulation studies. Imaging studies revealed an above-knee deep venous thrombosis and a large pleural effusion but no pulmonary embolus. What would you do next?



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