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This Week in JAMA
January 11, 2012

This Week in JAMA

JAMA. 2012;307(2):115. doi:10.1001/jama.2011.1991

Practice guidelines recommend that serum potassium levels be maintained between 4.0 and 5.0 mEq/L in patients with acute myocardial infarction (MI). However, this guidance largely derives from small studies that predate modern management of patients with acute MI. In a retrospective cohort study that included 38 689 patients with confirmed acute MI (2000-2008), Goyal and colleagues assessed the relationship between serum potassium levels and hospital mortality. The authors report a U-shaped relationship between mean postadmission serum potassium level and mortality, with the lowest mortality observed among patients whose mean serum potassium levels were between 3.5 and less than 4.5 mEq/L. In an editorial, Scirica and Morrow discuss potassium repletion in patients with acute MI.

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Patients with dementia have increased rates of hospitalization, which may be related to suboptimal care in the outpatient setting. Phelan and colleagues analyzed hospitalization data from 3019 adults who were aged 65 years or older and without dementia at baseline and enrolled in an integrated health system. The study participants were followed up for 14 years. The authors found that participants with incident dementia had significantly higher rates of admissions for all causes and admissions for ambulatory care–sensitive conditions compared with those without dementia. In an editorial, Lyketsos discusses the importance of ambulatory care management of comorbid conditions to reduce the risk of hospitalization among patients with dementia.

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Marijuana smoke contains many of the same constituents as tobacco smoke, but whether smoking marijuana causes pulmonary damage similar to that caused by tobacco is unclear. In an analysis of data from 5115 participants in the Coronary Artery Risk Development in Young Adults study, which included repeated measures of pulmonary function and smoking habits during 20 years of follow-up, Pletcher and colleagues found that occasional or low cumulative marijuana use was not associated with adverse effects on pulmonary function.

Article AUTHOR VIDEO INTERVIEW

Clinical practice guidelines often incorporate life expectancy as a central factor in weighing the benefits and burdens of diagnostic tests and treatments. However, little is known about the quality of prognostic indices for mortality. Yourman and colleagues conducted a systematic literature review and identified 16 indices that predict mortality risk in older patients. The authors assessed the quality of the indices and found insufficient evidence to support their use in clinical practice. In an editorial, Gill discusses limitations of available prognostic indices and suggests alternative strategies for incorporating life expectancy in clinical decision making.

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An elderly woman with dementia and a permanent indwelling urinary catheter was hospitalized to replace a malfunctioning gastrostomy tube. At admission, a nurse noticed that urine in the catheter bag was purple. What would you do next?

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An independent analysis of the US Food and Drug Administration's adverse event reports suggests that the smoking cessation drug varenicline dramatically increases the risk of suicide and suicide-related behavior.

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Addressing requests for nonbeneficial interventions

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Courts and medical futility

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Pharmaceutical scarcity

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“There is balance in this world. Funk is tempered by humor, pessimism by unguarded joy, and need by generosity.” From “On Grace.”

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Join Harold C. Sox, MD, on January 18, at 2 PM eastern time to discuss the new American Cancer Society process for creating trustworthy cancer screening guidelines. To register, go to http://www.ihi.org/AuthorintheRoom.

Dr Chang summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

Ms K, a 14-year-old girl with a BMI of 40, experiences significant discord with her parents over food choices. How would you manage her clinical care. Go to www.jama.com to read the case. Submission deadline is January 29.

For your patients: Information about respiratory syncytial virus.

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