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This Week in JAMA
December 2, 2009

This Week in JAMA

JAMA. 2009;302(21):2285. doi:10.1001/jama.2009.1773

The Extended Prevalence of Infection in the ICU (EPIC II) Study was a 1-day, point prevalence investigation in which demographic, physiologic, bacteriologic, therapeutic, and outcome data were collected from patients hospitalized in 1265 intensive care units (ICUs) in 75 countries on May 8, 2007. Vincent and colleagues Article report that 51% of the adult patients were considered infected and 71% were receiving antibiotics. Infection risk increased with longer duration of ICU stay, and infection was independently associated with in-hospital mortality. In an editorial, Opal and Calandra Article discuss principles of good antimicrobial stewardship in critically ill patients.

To evaluate the effectiveness of public report cards as a method of improving quality of care, Tu and colleagues randomly assigned 86 hospitals in Ontario, Canada, to either early or delayed feedback of their baseline performance on a set of established process-of-care quality indicators for acute myocardial infarction (MI) and congestive heart failure (CHF) care. The authors found that public release of hospital-specific clinical data on cardiac care quality indicators did not result in significant improvement in composite acute MI or CHF process-of-care indicators in the early feedback hospitals compared with delayed feedback hospitals.

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A noninvasive method to predict the response of colorectal cancer liver metastases to chemotherapy is lacking. In a cohort of patients who underwent hepatic resection after preoperative chemotherapy that included bevacizumab, Chun and colleagues evaluated morphologic changes on computed tomography (CT) obtained at the start and end of preoperative chemotherapy. They found that CT-based morphologic criteria of tumor response—defined as a change from heterogeneous masses with ill-defined margins into homogeneous lesions with sharp borders—were associated with pathologic response and overall survival.

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In an evaluation of 79 studies that claimed to have identified factors that improve the prediction of coronary heart disease beyond what can be achieved using the Framingham risk score (FRS), Tzoulaki and colleagues Article found that a majority of the studies did not calculate or use the FRS as proposed, and the authors suggest that caveats in study design, analyses, and reporting cast some doubt about the reliability of the claims for improved prediction. In an editorial, Wilson Article discusses the development and evaluation of tools to estimate coronary heart disease risk.

Mr A, a 37-year-old executive with a history of ST-elevation myocardial infarction, Prinz-metal angina, and a hypercoagulable state, is seeking a new physician affiliated with a high-quality hospital. Howell discusses consumer-accessible sources that provide information on physician and hospital quality and considers other factors when choosing a physician.

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“They say ten hugs a day are essential for mental health. But what if being held is terrifying, yet the only thing that might heal you?” From “Inside the Ward.”

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Concerns about student athletes using products containing anabolic steroids or their precursors have prompted calls for stronger regulation of such products and efforts to educate young people about healthier training strategies.

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Need for large-scale randomized evidence

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Bauhaus principles for health system redesign

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National preparedness for a catastrophic emergency

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Men in White: the operating room in American culture

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Join Laura Esserman, MD, MBA, Wednesday, December 16, from 2 to 3 PM eastern time to discuss the need to rethink screening for breast cancer and prostate cancer. To register, go to http://www.ihi.org/AuthorintheRoom.

How would you manage a 43-year-old man who has exertional nausea, elevated troponin levels, and lateral ST depression on EKG? Go to http://www.jama.com to read the case, and submit your response, which may be selected for online publication. Submission deadline is January 3.

For your patients: Information about coronary heart disease risk factors.

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