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Csaba P. Kovesdy, MD; Anthony J. Bleyer, MD; Miklos Z. Molnar, MD, PhD; Jennie Z. Ma, PhD; John J. Sim, MD; William C. Cushman, MD; L. Darryl Quarles, MD; and Kamyar Kalantar-Zadeh, MD, PhD

The ideal blood pressure for adults with chronic kidney disease (CKD) is unclear. This study of U.S. veterans with non–dialysis-dependent CKD found that systolic blood pressure (SBP) of 130 to 159 mm Hg and diastolic blood pressure (DBP) of 70 to 89 mm Hg were associated with the lowest mortality rates. Those with moderately elevated SBP combined with DBP no less than 70 mm Hg had lower mortality rates than those with ideal SBP and DBP less than 70 mm Hg. Achieving ideal SBP at the expense of lower-than-ideal DBP could be harmful in adults with CKD.

Topics: kidney failure, chronic, blood pressure, veterans
Laura N. Gitlin, PhD; Lynn Fields Harris, MPA; Megan C. McCoy, MSS, MLSP; Nancy L. Chernett, MPH; Laura T. Pizzi, PharmD, MPH; Eric Jutkowitz, BA; Edward Hess, MS; and Walter W. Hauck, PhD

African Americans often have limited mental health care options because of system- or patient-level factors. This trial randomly assigned older African Americans with depressive symptoms to a home-based intervention delivered by a social worker or to a wait list. Participants who received the intervention had greater reductions in depressive symptoms and improved quality of life than wait-listed participants. A home-based intervention delivered by social workers could reduce depressive symptoms and enhance quality of life in some older African Americans.

Topics: depressive disorders, home care services, quality of life, elderly, african american
Joel Kremer, MD; Zhan-Guo Li, MD, PhD; Stephen Hall, MD; Roy Fleischmann, MD; Mark Genovese, MD; Emilio Martin-Mola, MD, PhD; John D. Isaacs, PhD; David Gruben, PhD; Gene Wallenstein, PhD; Sriram Krishnaswami, PhD; Samuel H. Zwillich, MD; Tamas Koncz, MD; Richard Riese, MD, PhD; and John Bradley, MD

Many patients with rheumatoid arthritis have an inadequate response to disease-modifying antirheumatic drugs. This randomized trial of patients with rheumatoid arthritis and an inadequate response to such therapy found that the addition of tofacitinib improved symptoms and physical function compared with placebo. Tofacitinib may be an option for some patients with rheumatoid arthritis who have an inadequate response to other treatments.

Topics: rheumatoid arthritis, antirheumatic drugs, disease-modifying, methotrexate, tofacitinib
Despoina Vasilakou, MD, MSc; Thomas Karagiannis, MD, MSc; Eleni Athanasiadou, MSc; Maria Mainou, MD; Aris Liakos, MD; Eleni Bekiari, MD, PhD; Maria Sarigianni, MD, PhD, MSc; David R. Matthews, MD, DPhil; and Apostolos Tsapas, MD, PhD, MSc

Sodium–glucose cotransporter 2 (SGLT2) inhibitors are a new class of antidiabetic drugs. This systematic review and meta-analysis found that SGLT2 inhibitors had favorable effects on hemoglobin A1c, body weight, and blood pressure in adults with type 2 diabetes. However, urinary and genital tract infections were more common, and results for cardiovascular outcomes and death were inconclusive. Most trials were rated at high risk of bias. In adults with type 2 diabetes, SGLT2 inhibitors may improve short-term outcomes, but effects on long-term outcomes and safety are unclear.

Topics: diabetes mellitus, type 2, dapagliflozin, sglt2 inhibitors, antidiabetics
Soheir S. Adam, MD; Jennifer R. McDuffie, PhD; Paul F. Lachiewicz, MD; Thomas L. Ortel, MD, PhD; and John W. Williams Jr., MD, MHS
Includes: CME

This systematic review evaluated the evidence on the benefits and risks of new oral anticoagulants versus standard thromboprophylaxis after total hip or knee replacement. Six good-quality reviews compared thromboprophylaxis with the newer agents versus low-molecular-weight heparin (LMWH). Clinical benefits of new oral anticoagulants over LMWH were marginal and offset by increased risk for major bleeding. Indirect comparisons suggest only small differences among the various newer oral anticoagulants. For hip and knee replacement recipients, new oral anticoagulants may be reasonable thromboprophylaxis options but should be used with caution in patients at increased risk for bleeding.

Topics: anticoagulants, oral, hemorrhage, low-molecular-weight heparin, hip replacement arthroplasty, knee replacement arthroplasty, thromboprophylaxis, ...
Catharine B. Stack, PhD, MS; A. Russell Localio, PhD; Michael E. Griswold, PhD; Steven N. Goodman, MD, PhD, MHS; and Cynthia D. Mulrow, MD, MSc

Evidence from meta-analysis is only as strong as the findings of its underlying studies. This limitation is present in Vasilakou and colleagues' article in this issue, because many of the included trials did not handle patient withdrawal and rescue medication properly. This article discusses how methods for handling data collected after rescue produces unreliable summary estimates. It suggests that future reports focus on precise questions about the treatment effect of interest and implement appropriate statistical methods to account for missing data, patient withdrawal, and use of rescue medication.

Topics: meta-analysis, data interpretation, statistical, interpretation of findings, sglt2 inhibitors

This recommendation from the U.S. Preventive Services Task Force concludes that current evidence is insufficient to assess the balance of benefits and harms of primary care interventions to prevent child maltreatment. The recommendation applies to children who do not have signs or symptoms of maltreatment.

Topics: primary health care, child abuse, neglect of child
Robert P. Kocher, MD; and Ezekiel J. Emanuel, MD, PhD

The Affordable Care Act made preliminary efforts to collect and disseminate data on health care price, utilization, and quality in the United States. This commentary proposes that all such data need to be publicly available to achieve a health care system that delivers high value.

Topics: quality of care, government, health care costs, medicare, health care systems, data ...
Robert Cook-Deegan, MD

This commentary reviews the events leading to the Supreme Court decision regarding Myriad Genetics patents on the BRCA1 and BRCA2 genes. Those developing molecular diagnostics will have to comport with a new rule for U.S. patent jurisprudence: Yes, complementary DNA can be patented—genomic DNA cannot.

Topics: genes, genes, brca1, brca2 gene, molecular diagnostic techniques, dna, patents, united states ...
Matthew S. Simon, MD; Don Weiss, MD, MPH; and Roy M. Gulick, MD, MPH

This commentary discusses the New York City Department of Health and Mental Hygiene's recommendation for meningococcal vaccination for all men who have sex with men in New York City who have had intimate contact with a man met through an online Web site or digital application or at a bar or party.

Topics: meningococcal vaccines, neisseria meningitidis, meningococcal infections, men who have sex with men ...
Dena E. Rifkin, MD, MS; and Mark J. Sarnak, MD, MS

Studies report an association between SBP and death in kidney failure and late-stage CKD, and the ideal blood pressure for adults with CKD is unclear. In this issue, Kovesdy and colleagues examine the optimal targets in such patients. The editorialists discuss the study and its findings and conclude that translating them into practice is challenging.

Topics: kidney failure, chronic, blood pressure
Daniel E. Epner, MD
Includes: Audio/Video

Within seconds of meeting her, I knew she would not be a candidate for experimental therapy. I was about to embark on the heart-wrenching task of discussing goals of care with a woman approaching the end of her life.

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Shannon Frattaroli, PhD, MPH; Daniel W. Webster, ScD, MPH; and Garen J. Wintemute, MD, MPH
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Richard G. Malish, MD; Robert L. Czech, MD; and David W. Cole, MD
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Elizabeth A. O'Connor, PhD; Evelyn P. Whitlock, MD, MPH; and Bradley N. Gaynes, MD
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Topics: anxiety, diagnostic techniques and procedures, physically well but worried
Topics: deep vein thrombosis, ischemic stroke, pneumatic compression therapy
Topics: ischemic stroke, patent foramen ovale, closure of patent foramen ovale, medical management ...
Topics: patent foramen ovale, embolism, closure of patent foramen ovale, medical management
Topics: endarterectomy, carotid, carotid stenosis, carotid angioplasty and stenting
Topics: artificial cardiac pacemaker, heparin, warfarin, pacemaker hematoma, myocardial bridging, implantable defibrillators
Topics: depression, postpartum, psychotherapy, psychosocial treatment method
Topics: amputation, diabetic foot ulcer, hyperbaric oxygenation
Topics: alzheimer's disease, exercise
Topics: cytisine, smoking abstinence
Topics: magnetic resonance imaging, sciatica
Topics: pregnancy, autistic disorder, valproic acid, autism spectrum disorder
Topics: depressive disorders, home care services, quality of life, elderly, african american
Topics: rheumatoid arthritis, tofacitinib
Topics: primary health care, child abuse, neglect of child
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