Some data suggest that placement of a chlorhexidine-impregnated sponge over the insertion site of intravascular catheters decreases the risk of catheter colonization and may decrease catheter-related bloodstream infections. In a 2 × 2 factorial randomized trial involving adult patients in the intensive care unit, Timsit and colleagues Article compared use of chlorhexidine-impregnated sponges vs regular dressings at the catheter insertion site and scheduled changes of unsoiled adherent dressings every 7 days vs the standard practice of every 3 days on the rate of major catheter-related infections and catheter colonization rates, respectively. The authors report that use of chlorhexidine-impregnated sponges to dress intravascular catheters was associated with a reduced risk of catheter-related infections. Reducing the frequency of changing unsoiled adherent dressings from every 3 days to every 7 days was not associated with an increased rate of catheter colonization. In an editorial, Perencevich and Pittet Article discuss interventions to reduce catheter-related bloodstream infections.
Chronic noncancer pain is commonly reported by primary care patients. In a cluster randomized controlled trial at a Veterans Affairs medical center, Dobscha and colleagues assessed the effects of a collaborative care intervention—which included patient and clinician education, patient assessment by a psychologist care manager, symptom monitoring, and feedback to the primary care clinician—on chronic pain-related outcomes. Over a 12-month follow-up, the authors found that compared with patients assigned to usual care, patients who received the collaborative care intervention demonstrated modest but statistically significant improvements in pain-related disability and intensity and among patients with depression at baseline, a reduction in depression severity.
Mutations in an X-linked lysosome-associated membrane protein gene (LAMP2; Danon disease) result in a cardiomyopathy that resembles severe hypertrophic cardiomyopathy. Maron and colleagues report the clinical course and representative pathological findings from a cohort of 7 patients with LAMP2 mutations who were classified as New York Heart Association functional class I at diagnosis. During a mean (SD) 7.3 (3) years of follow-up, there were 5 deaths: 4 patients died of acute heart failure, progressive heart failure, or both and 1 patient died suddenly from ventricular fibrillation refractory to implantable cardioverter-defibrillator (ICD) therapy. Two patients were alive at the end of follow-up in October 2008: 1 patient had undergone a heart transplant and 1 patient had experienced a cardiac arrest that was successfully aborted with appropriate ICD therapy.
Mr R, a 41-year-old African American man, has a long history of poorly controlled hypertension. Although he recognizes the seriousness of his disease, Mr R has had difficulty adhering to recommended treatments. Cooper discusses the epidemiology and impact of hypertension among African Americans; the patient-related, system-related, and clinician-related barriers to effective hypertension control; and the role of the patient-physician relationship in improving outcomes and overcoming racial disparities in hypertension control.
“[P]erhaps because I am a teacher of writing, and a linguistic fascist, I am frequently in the position of finding the speech of physicians wanting.” From “Me and My Fibroid.”
New guidelines, research, and government-mandated safety plans for extended-release opioid medications aim to reduce overdose and injury associated with these products while facilitating appropriate pain management.
Measuring preventable harm
Implications of IT vendors' “held harmless” clause
Communicating with seriously ill patients
Ownership of medical information
Join Michael K. Kearney, MD, April 15, from 2 to 3 PM eastern time to discuss self-care of physicians who care for patients at the end of life. To register, go to http://www.ihi.org/AuthorintheRoom.
For your patients: Information about intensive care units.
This Week in JAMA . JAMA. 2009;301(12):1201. doi:10.1001/jama.2009.387