Vitamin E (alpha tocopherol) and memantine are beneficial for patients with moderately severe Alzheimer disease; however, there is limited evidence to support their use for patients in an earlier disease stage. In a randomized trial that enrolled 613 patients with mild to moderate Alzheimer disease who were taking an acetylcholinesterase inhibitor, Dysken and colleagues found that treatment with 2000 IU/d of vitamin E compared with placebo resulted in slower functional decline during a mean follow-up time of 2.3 years. Neither memantine alone nor memantine with vitamin E were more beneficial than placebo. In an Editorial, Evans and colleagues discuss drug treatment of Alzheimer disease.
Author Video Interview
Hospital-based induction of mild hypothermia improves outcomes after cardiac arrest. To assess the effect of prehospital induction of hypothermia on survival and neurological outcomes, Kim and colleagues randomly assigned 1359 adults with out-of-hospital cardiac arrest to standard care with or without prehospital infusion of 4°C normal saline. The authors report that prehospital cooling reduced core temperature at hospital arrival and the time to reach the temperature goal (34°C) but did not improve survival or neurological status at discharge. In an Editorial, Granger and Becker discuss the use of therapeutic hypothermia in cardiac arrest
An important factor in survival following cardiac arrest is delivery of high-quality chest compressions to achieve restoration of spontaneous circulation. It is estimated that manual cardiopulmonary resuscitation (CPR) provides only 30% of normal cardiac output, and manual compression devices have been developed to improve CPR effectiveness. In a multicenter randomized trial involving 2598 adults with out-of-hospital cardiac arrest, Rubertsson and colleagues found no difference in 4-hour survival among patients randomly assigned to receive mechanical chest compressions with defibrillation (mechanical CPR) compared with patients who received guideline-adherent manual CPR.
In a randomized, placebo-controlled study that enrolled 65 patients with chronic ischemic cardiomyopathy and left ventricular dysfunction, Heldman and colleagues assessed the safety of transendocardial injection of autologous bone marrow–derived mesenchymal stem cells or mononuclear cells. The authors report there were no treatment-emergent serious adverse events at day 30; however, larger studies are needed to determine safety and clinical efficacy.
Obese individuals are often unable to lose sufficient weight to improve health with lifestyle interventions alone. In a systematic review, Yanovski and Yanovski identified 20 clinical trials and 1 meta-analysis that investigated medications approved for long-term treatment of obesity (orlistat, lorcaserin, and phentermine plus topiramate–extended release). The authors review the evidence supporting the use of these medications and others under investigation or used off label to treat obesity and provide recommendations for medication use in obesity management.
Interview, Continuing Medical Education
In a JAMA Clinical Evidence Synopsis, Fernandes and Hartling summarize results of a systematic review and meta-analysis of data from 17 randomized trials (2596 infants and young children) that examined the use of glucocorticoids, alone or combined with bronchodilators, in the treatment of acute viral bronchiolitis. The authors found no difference in hospitalization rates or length of stay between glucocorticoids and placebo. Data from 1 trial suggested that treatment with dexamethasone and nebulized epinephrine may reduce hospitalization rates.
Highlights. JAMA. 2014;311(1):5-7. doi:10.1001/jama.2013.279248