Cardiac complications are the most common cause of mortality among patients
undergoing elective noncardiac surgery. In this prospective observational
study, Polanczyk and colleaguesArticle evaluated the relationship between use of
perioperative right heart catheterization (RHC) for hemodynamic monitoring
and rates of postoperative cardiac complications among patients aged 50 years
or older undergoing major elective noncardiac procedures. No association was
found between perioperative RHC use and reduction in postoperative cardiac
or noncardiac complications. In multivariate analyses and in an analysis of
a subset of matched patients who did and did not undergo RHC, RHC was associated
with an increased risk of major postoperative cardiac events. In an editorial,
DalenArticle notes that most research has not shown any clinical benefit of pulmonary
artery catheter use in critically ill or perioperative patients and concludes
that RHC is not indicated for routine monitoring of patients undergoing major
Evidence supporting an association between regular analgesic use and
increased risk of chronic renal disease has been inconsistent. Using data
from 11 032 healthy men followed up for an average of 14 years in the
Physicians' Health Study, Rexrode and colleagues found no significant associations
between self-reported use of aspirin, acetaminophen, or other nonsteroidal
anti-inflammatory drugs and either elevated creatinine levels or reduced creatinine
Observational studies have suggested that pacifier use is associated
with early weaning. To test whether this association is causal, Kramer and
colleagues randomly assigned breastfeeding women to 1 of 2 breastfeeding promotion
interventions—an experimental counseling intervention that recommended
avoidance of pacifier use and offered alternative ways to comfort a crying
or fussing infant or a control intervention that included pacifier use as
an option for comforting an infant. Pacifier use was significantly lower in
the experimental group compared with the control group, but there was no significant
difference in risk of weaning before age 3 months. Reanalysis of the data
according to exposure to pacifier use regardless of randomized allocation
showed a strong observational association between daily pacifier use and weaning
by 3 months, suggesting that pacifier use is a marker of breastfeeding difficulties
or reduced motivation to breastfeed.
Systemic inflammation may play an intermediary role in the pathogenesis
of type 2 diabetes mellitus (DM). In this case-control study using data from
the prospective Women's Health Study, Pradhan and colleagues found that median
baseline levels of 2 inflammatory biomarkers—C-reactive protein and
interleukin 6—were significantly higher among women who developed type
2 DM over 4 years of follow-up compared with women who did not develop DM.
Meta-analyses of randomized trials of selective decontamination of the
digestive tract (SDD) have shown significant reductions in the incidence of
nosocomial pneumonia among mechanically ventilated patients receiving SDD.
van Nieuwenhoven and colleagues analyzed the relationship between methodological
quality of 32 studies of SDD and the reported effects on pneumonia and mortality.
Significant reductions in the incidence of pneumonia were reported in 21 studies,
but a significant decrease in mortality was not found in any individual trial.
Methodological quality was inversely related to the benefit of SDD on the
incidence of nosocomial pneumonia. No association between trial quality and
impact of SDD on mortality was observed.
Physician-astronauts have played an important role during the 20 years
of NASA space shuttle missions. Their efforts, and new technologies developed
to support them, have advanced space medicine and are assisting down-to-earth
How to determine if a patient has digital clubbing.
Announcing a new monthly JAMA feature, On Call, a forum for discourse
on educational, professional, and scientific topics of special relevance to
residents and fellows.
For your patients: Information about pacifier use.
This Week in JAMA. JAMA. 2001;286(3):269. doi:10.1001/jama.286.3.269