In a randomized trial that enrolled 50 adolescents with body mass index higher than 35, O’Brien and colleagues Article assessed the effects of laparoscopic adjustable gastric banding (gastric banding) compared with a program of optimal lifestyle management on weight loss, health status, and quality of life. Participants were followed up for 2 years, and the authors found that compared with intensive lifestyle management, use of gastric banding resulted in a greater percentage (84% vs 12%) of participants achieving a loss of 50% of excess weight (corrected for age) and in greater benefits to health and quality of life. In an editorial, Livingston Article discusses the surgical treatment of obesity in adolescence and the importance of randomized clinical trials to evaluate the benefits and risks of bariatric surgery.
In a population-based cohort study, Mook-Kanamori and colleagues Article assessed the contribution of maternal factors to the risk of early fetal growth restriction and the association of early growth restriction with adverse birth outcomes and postnatal growth. The authors identified maternal characteristics (including younger age, higher hematocrit, and higher diastolic blood pressure) and lifestyle factors (eg, cigarette use and nonuse of folic acid) that were independently associated with early fetal growth restriction. First-trimester growth restriction was associated with increased risks of preterm, low weight, and small size for gestational age births and growth acceleration in early childhood. In an editorial, Smith Article discusses the evidence that adverse pregnancy outcomes may originate during the early weeks of gestation.
To characterize clinically relevant differences in the underlying biology of non–small cell lung cancer, Mostertz and colleagues examined gene expression signatures of oncogenic pathway activation, markers of tumor biology/microenvironment status, and corresponding clinical data in a cohort of 787 patients with non–small cell lung cancer. In analyses stratified by age and sex, the authors identified distinct clusters of patients whose tumors demonstrated similar patterns of oncogenic and molecular pathway activation that were associated with increased or decreased recurrence-free survival. In multivariate analyses, the authors found the oncogenic pathway patterns were prognostically independent of relevant clinical variables including disease stage and histology.
Tube-feeding in patients with advanced dementia is of questionable benefit, yet a high percentage of patients will have a feeding tube inserted during an acute care hospitalization. To identify hospital characteristics associated with feeding tube placement, Teno and colleagues analyzed Medicare claims data for nursing home residents with advanced cognitive impairment who were admitted to acute care hospitals between the years 2000 and 2007. The authors found that the rate of feeding tube insertion varied from 0 to 38.9 per 100 hospitalizations (mean, 6.5; SD, 5.3). Hospital characteristics associated with an increased risk of feeding tube insertion included for-profit ownership, larger hospital size, and greater intensive care unit use by patients in the last 6 months of life.
“ ‘My belief is we all die when our time is up. I'm not afraid of death,’ he said. ‘We all have to die sometime.’ ” From “The Changing of the Seasons.”
To fulfill new federal requirements aimed at curbing opioid-related overdose deaths, industry groups have proposed additional training of clinicians who prescribe these drugs. But the proposal has met with resistance.
Perioperative β-blockers for cardiac risk reduction
Enhancing restaurant nutritional labeling
Replicating quality medical care organizations
Darwin on the origin of compassion
Join David Reuben, MD, Wednesday, February 17, from 2 to 3 PM eastern time to discuss medical care in the final years of life. To register, go to http://www.ihi.org/AuthorintheRoom.
Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.
For your patients: Information about bariatric surgery.
This Week in JAMA . JAMA. 2010;303(6):481. doi:10.1001/jama.2010.98