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This Week in JAMA
March 3, 2010

This Week in JAMA

JAMA. 2010;303(9):813. doi:10.1001/jama.2010.227

A low ankle brachial index (ABI) has been associated with an increased risk of incident cardiovascular and cerebrovascular events. In an analysis of data from the randomized, placebo-controlled Aspirin for Asymptomatic Atherosclerosis trial, Fowkes and colleagues Article examined the effectiveness of daily low-dose aspirin (100 mg) for the prevention of major cardiovascular and cerebrovascular events among persons aged 50 to 75 years who were free of clinical cardiovascular disease but had a low ABI (≤ 0.95) at a screening visit. The authors report that there was no statistically significant reduction in vascular events among persons who were randomly assigned to receive aspirin compared with persons who were assigned to receive placebo during a mean (SD) follow-up of 8.2 (1.6) years. In an editorial, Berger Article discusses aspirin therapy for prevention of cardiovascular events.

In an analysis of Medicare claims data, Wunsch and colleagues assessed 3-year outcomes among Medicare beneficiaries who were hospitalized in an intensive care unit (ICU) and survived to hospital discharge and compared these with 2 matched control groups: hospitalized patients who survived to discharge and the general population. The authors found that Medicare patients who survived an ICU stay had high rates of mortality over the subsequent 3 years, in excess of that seen in comparable controls. Patients who received mechanical ventilation had substantially increased mortality, particularly in the early months after hospital discharge.

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The optimal management of anemia in end-stage renal disease (ESRD) is not clear. In an analysis of data from Medicare's ESRD program, Brookhart and colleagues examined the safety of erythropoiesis-stimulating agents and iron therapy in patients with ESRD. The authors characterized each US dialysis center's typical use of erythropoiesis-stimulating agents and intravenous iron for patients in 4 hematocrit categories and found that mortality rates were highest among patients with hematocrit less than 30% and found that greater use of erythropoiesis-stimulating agents and iron was associated with decreased mortality risk among patients in this group. However, greater use of erythropoiesis-stimulating agents and iron was associated with an increased risk of mortality among patients with hematocrit levels of 36% or higher.

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In a meta-analysis of individual-patient data from 3 randomized clinical trials, Briel and colleagues Article examined the association of higher vs lower levels of positive end-expiratory pressure (PEEP) with mortality among adults with acute lung injury or acute respiratory distress syndrome (ARDS) who were receiving ventilation with low tidal volumes. Overall, the authors found that patients receiving higher levels of PEEP had similar hospital mortality as patients receiving lower levels of PEEP. However, among the subgroup of patients with ARDS, higher levels of PEEP were associated with improved survival. In an editorial, Rubenfeld Article discusses the implications of the analysis for critical care research and patient care.

“I wonder . . . if living in a condemned building with no utilities is the same as being homeless.” From “HIV Clinic.”

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In an interview with JAMA, A. Thomas McLellan, PhD, deputy director of the White House Office of National Drug Control Policy, explains US antidrug efforts are placing a new emphasis on prevention, screening, and treatment.

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The Healthcare Innovation Zone: a platform for reform

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Rethinking the sedation continuum

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Real-time investigation of influenza drugs

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Abraham Flexner and education

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Join Frank Davidoff, MD, Wednesday, March 17, from 2 to 3 PM eastern time to discuss how insights from health care improvement initiatives can reduce ambivalence about heterogeneity in determining efficacy of treatment. To register, go to http://www.ihi.org/AuthorintheRoom.

How would you manage a 31-year-old woman with a transformed low-grade glioma? Go to www.jama.com to read the case, and submit your response, which may be selected for online publication. Submission deadline is March 7.

For your patients: Information about mechanical ventilation.

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