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This Week in JAMA
March 25, 2009

This Week in JAMA

JAMA. 2009;301(12):1201. doi:10.1001/jama.2009.387

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.

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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.

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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.

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“[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.”

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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.

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Measuring preventable harm

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Implications of IT vendors' “held harmless” clause

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Communicating with seriously ill patients

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Ownership of medical information

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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.

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