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Research

Aliskiren and Coronary Artery Disease Progression 1135Renin inhibition has a protective effect against atherosclerosis in animal models. To assess the effect of renin inhibition on progression of coronary atherosclerosis in humans, Nicholls and colleagues randomly assigned 613 patients with coronary artery disease and systolic blood pressure in the prehypertensive range (between 125 and 139 mm Hg) to receive aliskiren—a renin inhibitor—or placebo for 2 years. Participants underwent coronary intravascular ultrasound at baseline and after treatment to assess change in atheroma volume, and the authors found that compared with placebo, use of aliskiren did not result in regression or slowing of progression of coronary atherosclerosis. In an Editorial, Tardif and Grégoire discuss renin-angiotensin system inhibition and secondary prevention of cardiovascular disease.

Related Editorial 1130

Otamixaban for Non–ST-Segment Elevation ACS 1145The optimal anticoagulant for patients with non–ST-segment elevation acute coronary syndromes (NSTE-ACS) managed with an invasive strategy is not clear. In a randomized trial that enrolled 13 229 patients with NSTE-ACS who were undergoing planned early percutaneous coronary intervention (PCI), Steg and colleagues found that otamixaban—a novel intravenous direct factor Xa inhibitor—did not reduce the rate of ischemic events but did increase bleeding compared with unfractionated heparin plus eptifibatide.

Chronic Care Management of Alcohol and Other Drug Dependence 1156Chronic care management (CCM)—a multidisciplinary and patient-centered model with proven efficacy for some chronic medical and mental health conditions—has been proposed as a potentially effective approach to treatment of patients with substance dependence. In a randomized trial involving 563 patients with alcohol and other drug dependence, Saitz and colleagues found that compared with usual primary care, CCM—which included longitudinal care, motivational therapy, relapse prevention counseling, and medical, addiction, and psychiatric treatment—did not increase self-reported abstinence over 12 months. In an Editorial, O’Connor discusses the management of substance dependence as a chronic disease.

Related Editorial 1132Author Video Interview jama.com

In This Issue of JAMASeptember 18, 2013

Volume 310, Number 11 Pages 1089-1196

Opinion

Viewpoint1121 The HIPAA Conundrum in the Era of Mobile Health and CommunicationsCJ Wang and DJ Huang

1123 A Trial-Based Approach to Statin GuidelinesPM Ridker and PWF Wilson

1125 Medicare Payment for Chronic Care Delivered in a Patient-Centered Medical HomeAB Bindman and Coauthors1127 PEPFAR’s Antiprostitution Pledge: Spending Power and Free Speech in TensionLO Gostin

A Piece of My Mind1129 Recon ManM Weaver

Editorial1130 Renin-Angiotensin System Inhibition and Secondary Cardiovascular PreventionJ-C Tardif and J Grégoire

1132 Managing Substance Dependence as a Chronic Disease: Is the Glass Half Full or Half Empty?PG O’Connor

LETTERS

Research Letter1181 Trends in Adult Emergency Department Visits in California by Insurance Status, 2005-2010 RY Hsia and Coauthors

Comment & Response 1183 Early Parenteral Nutrition in Critical Illness

1184 Statin Therapy for Hyperlipidemia

1186 Correction

Instructions for Authors jama.com/public /instructionsforauthors.aspx

130 YEARS OF CONTINUOUS PUBLICATION

Editor in ChiefHoward Bauchner, MD

1091JAMA September 18, 2013 Volume 310, Number 11

The Art of JAMA1100 Wassily Kandinsky (1866-1944), Landscape With Two Poplars, 1912, French.

PROOF: 09.04.13/10:11

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1195 JAMA Patient PageSeizures

NEWS & ANALYSIS

1109 Medical News & PerspectivesEfforts Stall to Curb Nursing Home Antipsychotic Use

CDC Estimates 300 000 US Cases of Lyme Disease Annually

Early Treatment of Ischemic Stroke With Intravenous tPA Reduces Disability Risk

1112 Visualizing Health Policy

Premium Subsidy Scenarios Under Obamacare

1113 Global HealthStreet Children and Drug Abuse

Lessons From New Malawian Pathology Laboratory

Genetic Damage Linked to Elevated Arsenic Levels in Rice

Improving the Mental Health of Perinatal Women

1114 News From the Centers for Disease Control and PreventionHPV Vaccination Appears Stalled

What Are Your Chances of Dying From a Norovirus Infection?

HEV Is Implicated in South Sudan Acute Jaundice Syndrome Cases

Vibrio Infections Down After California Restricts Oyster Sales

HUMANITIES

1187 Poetry and Medicine Blood War

1188 JAMA 100 Years Ago Environment and the Senses

Online @ jama.com

Clinical Review & Education

Mobility Limitations in Older Patients 1168Mobility limitation is common in older adults. In this Care of the Aging Patient article, Brown and Flood discuss risk factors for mobility limitation among community-dwelling older individuals and describe several validated tools to assess mobility in the ambulatory setting. The authors also consider the role of physical therapists in patient assessment and treatment planning; summarize the evidence relating to the efficacy of exercise interventions to improve strength and balance; and review the prescription and use of devices such as canes, walkers, wheelchairs, and scooters to improve function, safety, and quality of life among older patients with mobility limitations.

Author Audio Interview jama.com CME jamanetworkcme.com

Antioxidant Supplements to Prevent Mortality 1178Oxidative stress has been implicated in the etiology of a variety of diseases including Alzheimer disease and cardiovascular disease. Whether antioxidant supplements are associated with higher or lower all-cause mortality is not clear. In this JAMA Clinical Evidence Synopsis, Bjelakovic and colleagues report results of a meta-analysis of data from 78 randomized trials (296 707 adult patients) that compared the effect of oral antioxidant supplementation (beta carotene, vitamin A, vitamin C, vitamin E, and selenium) vs placebo or no intervention on all-cause mortality. The authors report that antioxidant supplements are not associated with a lower risk of all-cause mortality. Beta carotene, vitamin E, and higher doses of vitamin A may be associated with higher risks of all-cause mortality.

In This Issue of JAMASeptember 18, 2013

Volume 310, Number 11 Pages 1089-1196

jama.com

Editor’s Audio SummaryPhil B. Fontanarosa, MD, MBA, summarizes and comments on this week’s issue.

Author ReadingLawrence O. Gostin, JD, reads his Viewpoint, PEPFAR’s Antiprostitution Pledge.

The JAMA ForumInsightful commentary on the political aspects of health care from leading health economists, health policy experts, and legal scholars

Departments

1095 Staff Listing1180 CME Questions1189 JAMA Network Abstracts1191 Classified Advertising1193 Journal Advertiser Index1194 Contact Information

Author Interview VIDEO Interview with Richard Saitz, MD, MPH, the author of Chronic Care Management for Dependence on Alcohol and Other Drugs: The AHEAD Randomized Trial

1093JAMA September 18, 2013 Volume 310, Number 11

PROOF: 09.04.13/10:11

JAMA Clinical ChallengeScalp Pustules in a Patient Receiving Chemotherapy A patient with stage IV lung cancer developed erythematous follicular papules and pustules on the scalp while undergoing treatment with an epidermal growth factor inhibitor. Potassium hydroxide examination of the lesions was negative. What would you do next?

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