We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Comment & Response |

What Constitutes an Adequate Evaluation of Device-Guided Breathing?—Reply

Gijs W. D. Landman, MD, PhD1; Kornelis J. J. van Hateren, MD1; Nanne Kleefstra, MD, PhD1,2,3
[+] Author Affiliations
1Diabetes Centre, Isala Clinics, Zwolle, the Netherlands
2Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands
3Langerhans Medical Research Group, Zwolle, the Netherlands
JAMA Intern Med. 2014;174(4):638. doi:10.1001/jamainternmed.2013.13790.
Text Size: A A A
Published online


In Reply We want to thank Huang and Subak for their interest in our study.1 They state that we should not have made strong conclusions concerning nonefficacy based on results extending outside the present study and that we performed an underpowered study with methodological limitations and unsuccessful randomization. We respectfully disagree with all their statements.

We do agree with their last sentence “broad conclusions about nonefficacy of device-guided breathing are not supported by this study alone.” Nonefficacy was also the result of 2 other trials performed by our research group.2,3 A recent meta-analysis, specifically in studies with sufficient methodological quality, confirmed that there is no evidence for short-term effects on blood pressure.4 Furthermore, there is absence of evidence for long-term blood pressure effects.4 The absence of short-term and long-term effects, let alone cardiovascular end points, justifies our conclusion. Consistent short-term benefits should first be established. It is not up to us to prove nonefficacy, there should be evidence for efficacy, not the other way around.


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





April 1, 2014
Alison J. Huang, MD, MAS; Leslee L. Subak, MD
1Department of Medicine, University of California, San Francisco
2Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
JAMA Intern Med. 2014;174(4):637. doi:10.1001/jamainternmed.2013.13791.
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
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.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...