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This Week in JAMA
December 23 2009

This Week in JAMA

JAMA. 2009;302(24):2625. doi:10.1001/jama.2009.1916

The herbal product Ginkgo biloba is widely marketed for improvement or maintenance of cognitive health; however, empirical evidence of its effect on cognitive function is lacking. In the multicenter, randomized, and placebo-controlled Ginkgo Evaluation of Memory Study, Snitz and colleagues assessed whether use of G biloba (120 mg twice daily) slows the rate of cognitive decline in community-dwelling older adults who had normal cognition or mild cognitive impairment at study enrollment. The investigators report that compared with placebo, use of G biloba did not slow the rate of older adults' cognitive decline during a median 6.1 years of follow-up.

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A shortage of intensivists has led to increased use of telemedicine technology to extend the reach of intensivists to patients hospitalized in geographically distant intensive care units (ICUs), but evidence to support this practice is limited. To assess the impact of remote monitoring on patient outcomes, Thomas and colleagues Article examined hospital and ICU mortality rates and patient length of stay before and after implementation of remote monitoring of 6 ICUs that are part of a large health care system in the United States. In analyses that adjusted for severity of illness, the authors found that remote monitoring of ICU patients was not associated with improvements in mortality or length of stay. In an editorial, Article Yoo and Dudley discuss the implementation and evaluation of telemedicine in the ICU.

The US Food and Drug Administration (FDA) drug approval process has come under scrutiny in recent years, but less attention has been paid to the FDA's medical device approval process. In a systematic review of the evidence presented in summaries of safety and effectiveness data—publicly available reports of the evidence that serves as the basis for FDA decisions to grant premarket approval for medical devices—Dhruva and colleagues found that FDA premarket approval for 78 high-risk cardiovascular devices was often based on data from studies that lacked adequate strength or may have been prone to bias. For example, only a minority of the studies were randomized or blinded, and 65% of the premarket device approvals were based on data from a single study.

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In the inaugural article of a new JAMA series, Care of the Aging Patient: From Evidence to Action, Reuben Article discusses the case of Mr Z, a relatively robust 83-year-old man who has experienced several falls in the past year and who is the primary caregiver for his wife who has Alzheimer disease. Reuben presents a prognosis-guided, evidence-based approach for addressing short-term, midrange, and long-term issues confronting patients in their final years of life and suggests system-related changes to accommodate the needs of elderly patients. Readers may submit comments for online posting at http://www.jama.com. A commentary by Cassel Article discusses policy and social issues associated with the care of elderly patients, and an editorial by Landefeld and colleagues Article describes the rationale and goals for this new JAMA series.

“[B]y definition, my role as an initial caregiver means that I rarely know the endings to the stories, many of them joyful, some tragic.” From “The Heart of the Matter.”

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Scientists are identifying promising strategies to block the reinforcing effects of cocaine and to help prevent relapse to drug-seeking behavior.

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Intergenerational depression: translating research into practice

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Strengthening institutional review board review of innovative interventions

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Preventive services for Medicare beneficiaries

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Join Hussein Hollands, MD, MSc, Wednesday, January 20, from 2 to 3 PM to discuss acute-onset floaters and flashes and risk of retinal detachment. 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 ECG? Go to www.jama.com, read the case, and submit a response by January 3, which may be selected for online publication.

For your patients: Information about preventive care for older adults.

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