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This Week in JAMA
October 6, 2010

This Week in JAMA

JAMA. 2010;304(13):1413. doi:10.1001/jama.2010.1428

Bystander chest compression–only cardiopulmonary resuscitation (CPR) is an alternative to conventional CPR with rescue breathing for individuals who experience an out-of-hospital cardiac arrest. In a prospective 5-year cohort study in Arizona—where a statewide campaign has taught, encouraged, and endorsed bystander compression-only CPR since 2005—Bobrow and colleagues Article assessed survival after out-of-hospital cardiac arrest and found that compared with layperson-performed conventional CPR or no CPR, layperson-performed compression-only CPR was associated with an increased likelihood of survival to hospital discharge. In an editorial, Cone Article discusses the evidence supporting compression-only CPR.

Among patients with severe traumatic brain injury, administration of hypertonic fluids has been associated with reduced cerebral edema and improved cerebral perfusion. In a randomized trial, Bulger and colleagues assessed whether early administration of hypertonic fluids might improve 6-month neurologic outcomes among patients with presumed severe traumatic brain injury (out-of-hospital Glasgow Coma Score ≤8) who were not in hypovolemic shock. Patients were randomly assigned to receive a single bolus of either hypertonic saline, hypertonic saline and dextran, or normal saline as the initial resuscitation fluid administered in the field. The authors found no improvement in 6-month neurologic outcome or survival among the patients who received a single bolus of hypertonic fluids compared with patients who received normal saline.

In an analysis of 1998-2007 data from the National Hospital Ambulatory Medical Care Survey, Korley and colleagues examined trends in the use of advanced radiology (computed tomography [CT] or magnetic resonance imaging [MRI] scans) during emergency department (ED) visits for injury-related conditions and examined trends in the prevalence of life-threatening cervical spine and skull fractures, intracranial bleeding, and liver and spleen lacerations. The authors found that the prevalence of CT or MRI scan use increased nearly 3-fold from 1998 to 2007 without a similar increase in the prevalence of the injury-related, life-threatening conditions assessed.

In the absence of a systematic framework to assess potential risks associated with participation in clinical research, investigators, funding agencies, and research review boards have relied on intuitive judgments of the likelihood that research participants might incur excessive risk. Rid and colleagues describe a systematic approach to evaluate the risks of research interventions, which delineates, quantifies, and compares clinical research risks with the risks posed by appropriate comparator activities.

Bisphosphonates decrease bone resorption and formation, and prolonged use of bisphosphonates has been associated with rare atypical fractures at sites infrequently affected by osteoporotic fractures. Sellmeyer discusses the case of a 58-year-old woman with osteopenia and a 10-year history of bisphosphonate use who experienced a nontraumatic subtrochanteric hip fracture and summarizes current knowledge regarding the prevention and treatment of low bone turnover in patients taking bisphosphonates.

“I watch my father compensate for his memory—he smiles at everyone at a party, in case he knows them; he laughs at jokes I’m pretty sure he doesn't think are funny.” From “Anticipatory Guidance.”

New reports from Army leaders and scientists suggest that mental health conditions and other factors contribute to the climbing suicide rate among soldiers and veterans.

The right to bear arms

Obesity and the food and beverage industry

What if physicians had to control medical costs?

Dual obligations of physician-investigators

Uniform disclosure of potential conflicts of interest

Calling Dr Kildare

Join Ralph Gonzales, MD, MSPH, Wednesday, October 20, 2010, from 2 to 3 PM eastern time to discuss whether adolescent or adult coughing may be a symptom of pertussis. To register, go to http://www.ihi.org/AuthorintheRoom.

For your patients: Information about cardiopulmonary resuscitation