Evidence-based sedation protocols and daily sedation interruption are strategies to minimize sedation and reduce the duration of mechanical ventilation. In a randomized trial that involved 430 critically ill adults receiving mechanical ventilation, Mehta and colleagues found that compared with protocolized sedation alone, a combined strategy of protocolized sedation and sedation interruption did not reduce the duration of mechanical ventilation or intensive care unit stay. In an editorial, Kress and Hall discuss the evolution of sedation practice for patients undergoing mechanical ventilation.
ArticleArticle AND AUTHOR AUDIO INTERVIEW
Citicoline—an intermediate element in the biosynthesis of the neuronal membrane component phosphatidylcholine—is an approved therapy for traumatic brain injury (TBI) in many countries. To assess whether citicoline has positive effects on functional and cognitive status of patients with TBI, Zafonte and colleagues randomly assigned 1213 patients with complicated mild, moderate, or severe TBI to receive citicoline or placebo within 24 hours of injury and continued for 90 days. The authors report that compared with placebo, treatment with citicoline did not improve patients' functional or cognitive status assessed at 90 days. In an editorial, Ruff and Riechers discuss the treatment of patients with TBI and the design of trials investigating therapies for TBI.
Clinical and experimental evidence suggest that long-chain n-3-polyunsaturated fatty acids (n-3-PUFAs) found in fish oil may have antiarrhythmic effects. In a multicenter randomized trial that enrolled 1516 patients who were scheduled to undergo cardiac surgery, Mozaffarian and colleagues found that compared with placebo, perioperative n-3-PUFA supplementation (administered in the form of fish oil capsules) did not reduce the risk of postoperative atrial fibrillation.
Some evidence suggests that online access to personal health records and physicians (via secure e-mail) may substitute for traditional forms of clinician contact. In a retrospective cohort study that involved adult members of a large, integrated health care delivery system that offered patients online access to their health records and physicians, Palen and colleagues compared clinical service use between patients who did and did not use the online access opportunities. The authors found that compared with participants who did not use online service, those who did had higher rates of clinical services including office visits and telephone encounters. In an editorial, Bates and Wells discuss patient health portals and health care use.
Pharmacologic treatment of behavioral symptoms of dementia is often ineffective. In a discussion of the case of Mr P, a 93-year-old man with mild progressive dementia, Gitlin and colleagues discuss common behavioral symptoms observed in dementia and describe a strategy for selecting evidence-based nonpharmacologic treatments.
A South African research center plans to bring scientists to the front lines to fight HIV and tuberculosis coinfections.
Power to block the Affordable Care Act
The president's Global Health Initiative at midterm
Genomics and health care disparities
Mentoring translational science investigators
“Medical care can sometimes feel like a spiral, rather than a patient-centered circle, twisting and turning down a long, confusing, frustrating path.” From “No More Apologies.”
Call for Papers
Authors are invited to submit manuscripts for a JAMA theme issue.
Join Laura N. Gitlin, PhD, and coauthors December 19 from 2 to 3 PM eastern time to discuss nonpharmacologic management of behavioral symptoms in dementia. To register, go to http://www.ihi.org/AuthorintheRoom.
Dr Bauchner summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl
For your patients: Information about spinal injections.
This Week in JAMA. JAMA. 2012;308(19):1947. doi:10.1001/jama.2012.3333