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This Week in JAMA
April 21, 2010

This Week in JAMA

JAMA. 2010;303(15):1451. doi:10.1001/jama.2010.470

Tracheotomy to replace endotracheal intubation is recommended for patients who are expected to require prolonged mechanical ventilation; however, the optimal time to perform tracheotomy is not clear. Terragni and colleagues Article assessed the incidence of ventilator-associated pneumonia among adult intensive care unit (ICU) patients who were randomly assigned to receive tracheotomy after 6 to 8 days or 13 to 15 days of endotracheal intubation and found that early compared with late tracheotomy did not result in statistically significant improvement in the incidence of ventilator-associated pneumonia. In an editorial, Scales and Ferguson Article discuss the implications of the study results for the care of patients who may require prolonged mechanical ventilation.

In an analysis of data from the National Health and Nutrition Examination Survey, Welsh and colleagues assessed the association between the consumption of caloric sweeteners—sugars added to ingredients in processed or prepared foods—and blood lipid levels in US adults. The authors report that increased consumption of added sugars was associated with lower high-density lipoprotein cholesterol (HDL-C) levels, higher triglyceride levels, and higher ratios of triglycerides to HDL-C.

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Niparko and colleagues assessed spoken language acquisition in a prospective study of children with severe to profound sensorineural hearing loss who underwent cochlear implantation before 5 years of age. The authors found that cochlear implantation was associated with greater growth in spoken language comprehension and expression than would be predicted from the children's scores before implantation.

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Maternal stature is associated with intrauterine growth restriction and low birth weight, particularly in developing countries. Özaltin and colleagues Article examined the association between maternal stature and offspring mortality and anthropometric failure in an analysis of data from nationally representative surveys conducted in 54 low- to middle-income countries. The authors found that maternal stature was inversely associated with mortality, underweight, and stunting among children younger than 5 years. In an editorial, Christian Article discusses the intergenerational risks of maternal undernutrition.

Siston and colleagues analyzed data from all cases of 2009 influenza A(H1N1) involving pregnant women reported to the US Centers for Disease Control and Prevention with symptom onset from April through December 2009. The authors report that pregnant women were disproportionately represented among deaths caused by 2009 influenza A(H1N1). Antiviral treatment initiated within 2 days of symptom onset was associated with fewer admissions to the intensive care unit and fewer deaths.

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In a systematic review of the literature, Kanji and colleagues found that abnormal results on monofilament testing and vibratory perception (alone or in combination with the appearance of the feet, ulceration, and ankle reflexes) were the most useful physical examination findings to identify patients with diabetes-related asymptomatic large-fiber peripheral neuropathy.

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“[Deb] is our patients' first point of contact, their guide through an often-baffling health care system, and their unyielding defender who takes upon herself the burden of setting injustices right.” From “For Those on Whom We Rely.”

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Effects of a report written a century ago by educator Abraham Flexner that stressed rigorous medical training based on scientific methods still reverberate today.

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Obstacles in translational research

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Primary care and health care reform

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Join Roger Chou, MD, Wednesday, May 19, from 2 to 3 PM eastern time to discuss predicting whether low back pain may become persistent and disabling. 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 peripheral neuropathy.

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