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This Week in JAMA
June 20, 2012

This Week in JAMA

JAMA. 2012;307(23):2461. doi:10.1001/jama.2012.3048

To assess whether routinely used cardiovascular disease (CVD) risk prediction scores can be improved by replacing or supplementing traditional cholesterol measurements with emerging lipid-related markers, investigators from the Emerging Risk Factors Collaboration analyzed data from 165 544 individuals (37 prospective cohort studies) who did not have CVD at baseline. Among the study findings were that the addition of information on the combination of apolipoprotein B and A-I, lipoprotein A, or lipoprotein-associated phospholipase A2 mass to risk scores containing total cholesterol and high-density lipoprotein cholesterol resulted in slight improvement in CVD risk prediction. In an editorial, Grundy discusses lipoprotein measures and CVD risk prediction.

ArticleArticle AND AUTHOR AUDIO INTERVIEW

Hemmelgarn and colleagues assessed whether age influences the likelihood of being treated for kidney failure in an analysis of data from a community-based cohort of 1.8 million Canadian adults. During a median 4.4 years of follow-up, the authors found significantly higher rates of untreated kidney disease among older individuals. In an editorial, Tamura and Winkelmayer discuss the challenge of finding the right balance between overtreatment and undertreatment of kidney failure in older adults.

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Anecdotal reports suggest that patients may be at increased risk of alcohol use disorder (AUD) after bariatric surgery. In a longitudinal cohort of 1945 bariatric surgery patients, King and colleagues found that the prevalence of AUD was greater in the second postoperative year than preoperatively or in the first year after surgery and was associated with a preoperative AUD diagnosis, regular alcohol consumption preoperatively, and undergoing Roux-en-Y gastric bypass.

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The acute respiratory distress syndrome (ARDS) was defined in 1994 by the American-European Consensus Conference; however, issues regarding the validity and reliability of the definition have emerged. In this issue, members of the ARDS Definition Task Force—an international expert panel tasked with updating the definition of ARDS—describe the process undertaken for developing the Berlin Definition for ARDS. Specifically, using a consensus process, a draft definition was proposed and then empirically assessed in a meta-analysis of clinical and physiologic data from more than 4000 patients. In an editorial, Angus discusses essential aspects of the Berlin definition and the value of empiric validation when developing disease definitions.

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Ventilator-associated pneumonia (VAP) is reported to occur in 9% to 27% of patients who undergo mechanical ventilation. O’Grady and colleagues discuss the pathogenesis of VAP, and consider the evidence associated with prevention strategies, including patient positioning, interruption of sedation, and oral decontamination. The authors found little evidence that reducing VAP with recommended prevention strategies is associated with improvements in clinical outcomes.

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Although more effective than “morning-after pills” for emergency contraception, intrauterine devices are an underused option in protection from unwanted pregnancies, researchers report.

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US Food and Drug Administration approval and regulatory action: a lifecycle approach

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Designing health care for multimorbidity

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Clopidogrel efficacy and smoking status

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“Physicians need to help create electronic systems that allow us to record our thinking—be that algorithmic, expansive, or focused on a patient's unique story and experience.” From “The Cost of Technology.”

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How would you manage a 76-year-old woman who experienced delirium after 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 Peter B. Bach, MD, MAPP, and George T. O'Connor, MD, Wednesday, July 18, from 2 to 3 PM eastern time to discuss the benefits and harms of computed tomographic screening for lung cancer. To register, go to http://www.ihi.org/AuthorintheRoom.

For your patients: Information about kidney stones.

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