Clinical Question Are Echinacea products associated with a reduced incidence and a shorter duration of common colds compared with placebo?
Bottom Line Individual prophylaxis trials show no association with prevention of the common cold, but exploratory meta-analysis suggests that Echinacea products may be associated with a small reduction in cold incidence. In treatment trials, there was no association of Echinacea products with a shorter duration of colds.
Preparations of the plant Echinacea are widely used in North America and Europe for prevention and treatment of the common cold.1 This JAMA Clinical Evidence Synopsis summarizes the results of a Cochrane review2 regarding the association ofEchinacea products with prevention and treatment of colds.
Over the last 2 decades, adults around the world modestly increased their intake of healthy dietary items, but this trend was exceeded by increases in consumption of unhealthy items, according to an analysis of global dietary patterns (Imamura F et al.Lancet Glob Health. 2015;3:e132-e142).
Study finds global diet quality declined, despite increased consumption of healthy foods.
UCLA stakes an early claim to leadership in clinical genomic sequencing.
A. Eugene Washington, MD, MSc Vice Chancellor, UCLA Health Sciences Dean, David Geffen School of Medicine at UCLA Gerald S. Levey, MD, Endowed Chair
Yes, the future does often exist somewhere. In the case of genomic medicine, that place is UCLA. I witnessed it firsthand when I participated last July in the eye-opening weekly case conference of our Clinical Genomics Center (CGC). This collaboration among multiple departments in the David Geffen School of Medicine at UCLA and UCLA Health System has set the standard for the transformation of molecular medicine to the new era of genomic medicine.
Moving beyond traditional genetic testing of one or a few genes at a time, the CGC utilizes so-called “next-generation” or “massively parallel” DNA sequencing to obtain full DNA sequences of all the protein-coding regions in the human genome, about 30-million nucleotides of genetic code comprising about 20,000 genes.
Clinical Question Are pharmacological interventions associated with better-quality sleep and alertness in shift workers?
Bottom Line Low-quality evidence shows that melatonin is associated with 24 minutes longer daytime sleep after the shift but not with faster falling asleep compared with placebo. There is no association between hypnotics, such as zopiclone, and sleep outcomes, alertness, or harms. The alertness-promoting medications armodafinil and modafinil are associated with improved alertness during shift work but are also associated with headache and nausea.
In the United States, 29% of workers do not work regular daytime shifts.1 Shift work is associated with reduced sleep duration, impaired daytime sleep quality, and reduced alertness during night shifts.2,3 Workers frequently use pharmacological products to ameliorate the adverse effects of shift work.4,5 This JAMA Clinical Evidence Synopsis summarizes data from a Cochrane review6 of pharmacological interventions for sleepiness and sleep disturbances caused by shift work.
I think the world has become fascinated by drones. I know I have. I got one for Christmas and it’s really fun to play with. The one I got is really hard to fly, but in many ways that makes it more fun.
What a lot of people don’t realize is how many ways drones are going to be part of our future life. No, I’m not talking about the military drones. In fact, using the term drones is so tied to the military that it’s almost not right to use the term. However, many people have become more familiar with drones thanks to Go pro cameras that are attached and bring us some really amazing footage even from amateurs. Read more →
Breast cancer is not one disease, and eliminating the disparities in outcomes requires improved understanding of biology and implementation of systemwide clinical innovation to deliver high-quality care to all women, one woman at a time. Representing 14.0% of all new cancer diagnoses, an estimated 232 670 new cases of breast cancer will occur in 2014, and an estimated 40 000 women will die of the disease.1,2 Despite significant gains in the treatment of the disease, leading to an overall reduction in breast cancer mortality, black women continue to die disproportionately from aggressive forms of breast cancer. There has been no fundamental shift in the approach to treatment for early-stage breast cancer based on biology.
In this issue of JAMA, Iqbal and colleagues3 found significant differences in the likelihood of diagnosis with stage I breast cancer and risk of death among 8 ethnic/racial groups in the United States using the Surveillance, Epidemiology, and End Results (SEER) 18 registries database. Based on their analysis of 373 563 women with invasive breast cancer, including 268 675 non-Hispanic white, 34 928 Hispanic white, 38 751 black, 25 211 Asian, and 5998 other ethnicities, the authors found that black women were less likely to be diagnosed with stage I breast cancer (non-Hispanic white women, 50.8%; black women, 37.0%) and were twice as likely to die of breast cancer with small-sized tumors than non-Hispanic white women (7-year actuarial risk for death from stage I breast cancer of 6.2% vs 3.0% for white women). Asian women had the highest likelihood of being diagnosed with stage I breast cancer and a lower risk of dying compared with white women (0.8% vs 1.5%, respectively; hazard ratio, 0.60 [95% CI, 0.49-0.73]; P < .001). The difference between black women and non-Hispanic white women remained after adjusting for income and estrogen receptor (ER) status and was statistically significant after excluding patients with triple-negative breast cancer (ie, breast cancer cells testing negative for ER, progesterone receptor [PR], and ERBB2).
Triple-negative breast cancer is associated with a poor prognosis, especially among black women.4 These cancers are more likely to be diagnosed at an early age (and therefore not detected by screening if current population guidelines to initiate screening at age 50 years are followed), to have metastasized to lymph nodes even when tumors are less than 2 cm in size, and to rapidly acquire resistance to chemotherapy, leading to shortened overall survival. As Iqbal et al3 rightly concluded, the racial/ethnic disparities in breast cancer outcomes can in part be accounted for by differences in the biological aggressiveness of triple-negative breast cancer in black women compared with other racial/ethnic groups.
With more granular data collection by SEER that includes race/ethnicity as well as ER, PR, and ERBB2 status, ethnic minorities in the United States can no longer be grouped together. The biological differences in breast cancer by race/ethnicity, and failures in the US health care delivery system that lead to suboptimal care for black women and women of other races/ethnicities, can now begin to be addressed. Based on the findings of Iqbal et al,3 biology alone cannot be the contributing factor creating the survival gap in breast cancer. Instead, this report should be viewed in the context of known tumor differences between black and white women, and this knowledge should be integrated into innovative quality improvement efforts in breast cancer management across the continuum of care.
High-risk children who consumed peanut products from infancy until they were 5 years old were significantly less likely to develop a peanut allergy than those who avoided peanuts, according to the LEAP randomized trial (Du Toit G et al. N Engl J Med. 2015;372:803-813).
The 640 infants in the trial were aged 4 to 11 months at enrollment, and all had severe eczema, egg allergy, or both. Results of a skin-prick test to peanut protein separated the participants into 2 cohorts: one with no measurable wheal after testing (nonsensitized) and the other with a wheal 1 to 4 mm in diameter (mildly sensitized). Participants in each cohort were randomly assigned to consume a peanut protein–containing bar or to avoid peanuts. Infants in the group that consumed peanuts ate at least 6 g of peanut protein per week until age 5 years.
Among the 530 infants in the non-sensitized cohort that could be evaluated for the primary outcome, the prevalence of peanut allergy at 60 months was 13.7% in the avoidance group and 1.9% in the consumption group. The absolute difference in risk of 11.8% represents an 86.1% relative reduction in the prevalence of peanut allergy.
In the mildly sensitized cohort (98 infants), the prevalence of peanut allergy was 35.3% in the avoidance group and 10.6% in the consumption group.
The LEAP-ON study is currently investigating whether immune tolerance will persist after children stop eating peanuts.
Naltrexone Extended-Release Plus Bupropion Extended-Release for Treatment of Obesity
In September 2014, a proprietary formulation of naltrexone extended-release (ER) plus bupropion-ER (brand name Contrave) was approved by the US Food and Drug Administration (FDA),1 becoming the fourth medication approved for long-term weight management in patients with obesity.2 Liraglutide (brand name Saxenda), a glucagon-like peptide 1 receptor agonist, was also approved for obesity treatment in December 2014. This Viewpoint discusses naltrexone-bupropion ER and its potential use for the adjunctive treatment of patients with obesity.
A Deadly Case of MANOPAUSE A quest for the Fountain of Youth may cost more years than it gains.
The Case “I told him he never should have started that medication,” said the patient’s worried wife. Several hours earlier, her husband had presented to the emergency department for chest pain and shortness of breath. He first noticed it over the past week when doing routine chores such as cleaning and moving furniture. “It didn’t stop him, even though it was bothering him. He never had any serious health problems,” she said. Other than diabetes and sleep apnea, her 62-year-old husband was healthy. His primary doctor sent him to the ED for further evaluation after a concerning ECG was obtained in his office. He was tachycardic but seemed relatively stable. We proceeded with a chest pain and dyspnea work-up, which included cardiac enzymes, chest X-ray, and a d-dimer. He waited patiently, charming the staff with his small talk and affable personality. Enzymes were negative, and d-dimer was positive. I took him for his CT angiogram. As soon as it was done, the tech and I immediately noticed the large bilateral pulmonary emboli on the screen in front of us (see Figure 1). I was preparing to take him back to the ED when he asked, “Is there a bathroom over here? I’d rather use it here before going back to the ED. It’s pretty crowded over there.” He had a point. The ED could be a madhouse with just two bathrooms. His wife and I assisted him to the bathroom. It was only seconds before I heard her scream. I opened the door, and he was sitting on the toilet, a glazed look on his eyes. “I think he just passed out,” she exclaimed.
The Culture of Organs, a book published in 1938 by Nobel Laureate Alexis Carrel and well-known aviator Charles Lindbergh, described how organs could be kept “alive” in culture for months, with the intent to reuse them. Decades later, regenerative medicine, a field of science that aims to restore or establish normal function by replacing or regenerating human cells, tissues, and organs affected by disease, is becoming a reality. The field is a progression of previous efforts to restore function, ranging from prosthetics to organ transplants. Advances in cell biology, biomaterial science, and biological molecule discovery have led to new options for cellular therapies, engineered tissues and organs, and new strategies to stimulate endogenous repair and regeneration.