Patients receiving mechanical ventilation experience significant levels of anxiety. In a multicenter randomized trial that enrolled 373 patients receiving mechanical ventilatory support, Chlan and colleagues assessed the effects of listening to music that was self-initiated and patient-directed on anxiety and the intensity and frequency of sedative exposure. The authors found that patient-directed music resulted in greater reductions in anxiety and sedation intensity than usual care but not compared with noise-cancelling headphones and greater reduction in sedation frequency than either usual care or noise-cancelling headphones. In an editorial, Azoulay and colleagues discuss the potential of music therapy to reduce anxiety in critically ill, mechanically ventilated patients.
See Article and Editorial
In a cluster randomized trial involving 18 pediatric primary care practices and 162 clinicians, Gerber and colleagues examined the effect of an antimicrobial stewardship intervention—composed of clinician education, audit, and feedback—on rates of broad-spectrum (off-guideline) antibiotic prescribing for bacterial acute respiratory tract infections (ARTIs) and viral ARTIs. The authors report that compared with usual practice, the intervention improved adherence to prescribing guidelines for bacterial ARTIs but did not affect antibiotic prescribing for viral infections. In an editorial, Finkelstein discusses interventions to promote judicious antibiotic prescribing.
See Article, Editorial, and
Some patients with stable chronic obstructive pulmonary disease (COPD) have elevated levels of inflammatory biomarkers. In a prospective cohort of 6574 patients with COPD, Thomsen and colleagues found that simultaneously elevated levels of C-reactive protein (≥3 mg/L) and fibrinogen (≥14 μmol/L) and an elevated leukocyte count (≥9 × 109/L) were associated with an increased risk of a COPD exacerbation. In an editorial, Mador and Sethi discuss the identification of patients at high risk of COPD exacerbations.
In an analysis of 1992-2010 data from nearly 1.6 million singleton pregnancies in Sweden, Cnattingius and colleagues found that maternal overweight and obesity during early pregnancy were associated with increased risks of preterm delivery, particularly extreme preterm deliveries at 22 to 27 weeks' gestation.
Adult survivors of childhood cancer are at risk of treatment-related adverse health outcomes. Hudson and colleagues assessed the general health status and age-specific cumulative prevalence of adverse outcomes by organ system in a cohort of 1713 long-term survivors of childhood cancer. The authors found that the percentage of survivors with 1 or more chronic health conditions was very high, reaching 95% at age 45 years.
JAMA Clinical Challenge
A previously healthy 63-year-old man is seen in the emergency department with ptosis, limited ocular motility, and rapidly decreasing vision. Serum glucose is 690 mg/dL. Maxillofacial computed tomography imaging reveals sinusitis and orbital stranding. What would you do next?
Researchers are trying to tease out risk factors for homelessness among veterans to allow better targeting of preventive services.
Encouraging patients to ask questions
Patient-centered communication and the electronic health record
Encouraging smokers to ask for help in quitting
Patients' responsibility to participate in decision making and research
Talking to patients in the 21st century
“High-functioning teams create structures—like daily huddles—that ensure that all relevant patient information is incorporated into the treatment plan and shared with all team members who ‘touch’ the patient.” From “The Columbo Phenomenon.”
Dr Bauchner summarizes and comments on this week's issue, including Viewpoints, Editorials, Original Contributions, and clinical content. Go to www.jama.com
For your patients: Information about head lice.
This Week in JAMA. JAMA. 2013;309(22):2295. doi:10.1001/jama.2013.5825