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This Week in JAMA
June 17, 2009

This Week in JAMA

JAMA. 2009;301(23):2413. doi:10.1001/jama.2009.879

Abdominal sepsis is associated with high levels of circulating endotoxin—a component of the outer membrane of gram-negative bacteria. Polymyxin B, an antibiotic with high affinity for endotoxin, has been incorporated in a medical device for hemoperfusion. In a preliminary study, a randomized trial involving 64 patients with severe sepsis and septic shock due to intra-abdominal infection, Cruz and colleagues Article assessed whether polymyxin B hemoperfusion added to conventional medical therapy would be associated with improved medical outcomes and lower mortality rates compared with conventional therapy alone. The authors found that the addition of polymyxin B hemoperfusion to conventional therapy was associated with improved hemodynamics and organ dysfunction and reduced 28-day mortality. In an editorial, Kellum and Uchino Article discuss international differences in the management of patients with sepsis and in the interpretation of the evidence from sepsis treatment trials.

Among individuals who have an average risk of colorectal cancer, computed tomographic (CT) colonography is considered a valid alternative to colonoscopy for colorectal cancer screening. In a multicenter study that enrolled individuals who were at increased risk of colorectal cancer based on personal or family history and who underwent same-day CT colonography and colonoscopy, Regge and colleagues Article found that compared with colonoscopy, CT colonography had an overall negative predictive value of 96.3%. In analyses limited to persons with a positive fecal occult blood test, the negative predictive value was 84.9%. In an editorial, Finlayson Article discusses the role of CT colonography for cancer screening and surveillance.

Some data have suggested that an interaction between the serotonin transporter gene (5-HTTLPR) and stressful life events increases the risk of major depression. Risch and colleagues sought to replicate this finding in a meta-analysis of published data and individual-level original data from studies that assessed 5-HTTLPR genotype, stressful events, and depression risk. The authors found that the number of stressful life events was associated with depression. They found no evidence that the serotonin transporter genotype alone or in interaction with stressful life events is associated with an elevated risk of depression.

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Testing for genetic mutations associated with venous thromboembolism (VTE) is common, but the utility of testing is not established. In a systematic review of the predictive value of 2 prothrombotic mutations—factor V Leiden (FVL) and prothrombin G20210A—Segal and colleagues found that patients who are homozygous or heterozygous for FVL have an increased risk of recurrent VTE compared with patients without this mutation. The authors also report that there are insufficient data to assess the predictive value of prothrombin G20210A homozygosity, that G20210A heterozygosity is not predictive of recurrent VTE, and that it is unknown whether testing for these mutations will improve outcomes among individuals with a prior VTE or their family members.

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“It's just like when you turn off your television. Everything gets black from the edges and converges toward the center until there's just a little pinpoint of light.” From “Heart, Attacked.”

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Ongoing patient safety problems as well as persistent disparities between the care received by minority or poor patients vs that of other groups undermine the quality of US health care, according to 2 recent reports.

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Science of health care reform

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Comparative effectiveness research

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Health disparities across the life span

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Estrogen plus progestin for secondary prevention of CHD in postmenopausal women

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Arthur Miller, Henrik Ibsen, and enemies of the people

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Join Charles M. Morin, PhD, Wednesday, July 15, from 2 to 3 PM eastern time to discuss cognitive behavioral therapy alone or with medication to treat persistent insomnia. Register at http://www.ihi.org/AuthorintheRoom.

How would you manage a 70-year-old woman with shingles? Go to www.jama.com to read the case, and submit your response. Submission deadline is June 28.

For your patients: Information about sepsis.

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