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This Week in JAMA
June 13, 2012

This Week in JAMA

JAMA. 2012;307(22):2345. doi:10.1001/jama.2012.3033

The most effective method to drain a malignant pleural effusion and relieve dyspnea has not been determined. Davies and colleagues randomly assigned 106 patients with symptomatic malignant pleural effusion and no previous pleurodesis to undergo either insertion of an indwelling pleural catheter, with initial large volume drainage and subsequent home drainage, or insertion of a chest tube and talc slurry pleurodesis. The authors found that both interventions were associated with improvement in patient-reported dyspnea, with no significant difference between the 2 procedures in symptom relief. In an editorial, Maskell discusses treatment options for malignant pleural effusions.

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To decrease the likelihood of inappropriate antimicrobial therapy in patients with severe sepsis, empirical combination therapy with at least 2 antibiotics is recommended; however, clinical data to support this recommendation are controversial. In a randomized, multicenter, open-label trial that enrolled 600 adult patients with severe sepsis or septic shock, Brunkhorst and colleagues found that the combination of meropenem and moxifloxacin did not result in less sepsis-related organ failure than did meropenem alone.

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In an analysis of 1996-2010 data from 6 geographically diverse integrated health care systems, Smith-Bindman and colleagues assessed trends in diagnostic imaging use and associated radiation exposure. The analyses included from 1 million to 2 million health plan enrollees each year and a total of 30.9 million imaging examinations. The authors report large increases in the use of advanced diagnostic imaging—including a tripling of computed tomography and quadrupling of magnetic resonance imaging—and increased radiation exposure between 1996 and 2010. In an editorial, O’Connor and Hatabu highlight the nontrivial radiation exposure from diagnostic testing.

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To examine whether there are gender-related differences in physician-researcher salaries, Jagsi and colleagues analyzed survey data from 800 National Institutes of Health K08 and K23 award recipients, who comprise a relatively homogeneous population of mid-career academic physician-researchers. The authors report gender differences in salary that persisted after adjustment for specialty, institutional characteristics, academic productivity and rank; work hours; and other factors.

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Bach and colleagues examined the benefits and harms of lung cancer screening using low-dose computed tomography (LDCT) in a systematic review and analysis of data from 8 randomized trials and 13 cohort studies. The authors found that LDCT screening may benefit some individuals who are at increased risk of lung cancer. However, uncertainty exists regarding the potential harms of screening and the use of LDCT in clinical practice. In an editorial, O’Connor and Hatabu discuss appropriate use and benefits and risks of CT scans for lung cancer screening.

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A 13-year-old girl who practices good oral hygiene is seen for evaluation of oral ulcers, gum erythema, and a “peeling off” sensation in her gums. What would you do next?

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New campaigns aim to boost global child survival by promoting simple interventions, reducing preterm delivery, and improving care to neonates.

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Cost of drug coupons

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Adaptive clinical trials

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“The importance of stories, or narrative, in clinical medicine is so commonly expressed that the idea often seems in danger of being reduced to a tagline.” From “A Moment's Thought: How to Tell a True Medical Story.”

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How would you manage a 76-year-old woman who experienced delirium following surgery? Go to www.jama.com to read the case. Submit your response by July 1 for possible online posting.

Dr Bauchner summarizes and comments on this week's issue. Go to http://jama.jamanetwork.com/multimedia.aspx#Weekly.

Join Mary Whooley, MD, on Wednesday, June 20, from 2 to 3 PM eastern time to discuss treating depression in adults with comorbid conditions. To register, go to http://www.ihi.org/AuthorintheRoom.

For your patients: Information about blood transfusion.

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