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This Week in JAMA
January 16, 2013

This Week in JAMA

JAMA. 2013;309(3):207. doi:10.1001/jama.2012.145170

Among patients receiving mechanical ventilation and early enteral nutrition, monitoring of residual gastric volume is recommended to reduce the risk of aspiration of gastric contents and the subsequent risk of ventilator-associated pneumonia (VAP). However, no studies have established whether monitoring residual gastric volume actually decreases VAP risk. To address this question, Reignier and colleagues randomly assigned 452 patients requiring mechanical ventilation and receiving enteral nutrition within 36 hours of intubation to undergo or forgo routine gastric volume monitoring. The authors found that patients randomly assigned to not undergo residual gastric volume monitoring did not have a higher incidence of VAP. In an editorial, Rice discusses enteral feeding protocols and gastric residual volume measurement in the care of critically ill patients.

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In analysis of population-based registry data from 649 654 patients who experienced an out-of-hospital cardiac arrest and in whom resuscitation was attempted by emergency responders with subsequent transport to hospital, Hasegawa and colleagues assessed whether advanced airway management—such as endotracheal intubation or use of supraglottic airway devices—in the prehospital setting is associated with improved patient outcomes. The authors found that compared with conventional bag-valve-mask ventilation, advanced airway management in the prehospital setting was associated with a decreased likelihood of favorable neurological outcome. In an editorial, Wang and Yealy discuss implications of the findings for initial airway management in patients who experience an out-of-hospital cardiac arrest.

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To inform enrollment decisions and foster improvement in Medicare Advantage plans, the Centers for Medicare & Medicaid Services publishes star ratings, which are based on administrative and consumer data and intended to reflect plan quality. However, whether such quality ratings influence plan enrollment patterns among beneficiaries is not clear. In a cross-sectional study of 2011 Medicare Advantage enrollments (952 353 first-time enrollees and 322 699 enrollees switching plans), Reid and colleagues assessed the association between star ratings and plan enrollment. In analyses that controlled for beneficiary and plan characteristics, the authors found that higher star ratings were associated with increased likelihood of plan enrollment among both first-time enrollees and those switching plans. In an editorial, Hoadley discusses health plan performance ratings and consumers' choice among competing plans.

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Bacterial coinfection can complicate influenza and is associated with significant morbidity and mortality. Chertow and Memoli discuss the central role of bacterial coinfection in severe and fatal cases of influenza; host and pathogen factors that predispose to coinfection; and the clinical course and rational management of patients with both influenza and bacterial pneumonia.

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US hospitals affected by the fungal meningitis outbreak, including a 537-bed Michigan hospital that has treated more than 150 patients, continue to grapple with uncertainties in treating this rare condition.

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Mega-trials for blockbuster drugs

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Prespecified falsification hypotheses in observational studies

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Caffeine-related adverse effects of energy drinks

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Risks of mixing energy drinks with alcohol

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“Caring means commitment, but it also includes having fun; being friendly; and getting to know other people as human beings.” From “A Systems Engineer Meets the System.”

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

Join Daniel S. Chertow, MD, MPH, February 20, from 2 to 3 PM eastern time to discuss bacterial coinfection in influenza. To register, go to http://www.ihi.org/AuthorintheRoom.

For your patients: Information about energy drinks.

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