Blood transfusion in cardiac surgery is the focus of 2 articles in this issue. Hajjar and colleagues Article report that among patients who were undergoing elective cardiac surgery with cardiopulmonary bypass and were randomly assigned to either a restrictive transfusion strategy (to maintain hematocrit ≥24%) or a more liberal strategy (to maintain hematocrit ≥30%), the restrictive strategy was associated with comparable rates of a combined outcome of 30-day all-cause mortality and severe morbidity. In a second article, Bennett-Guerrero and colleagues Article analyzed data from an observational cohort composed of 102 470 patients who underwent coronary artery bypass graft surgery during 2008 and found wide hospital-level variation in rates of red blood cell, plasma, and platelet transfusion that were independent of hospital characteristics and patient case mix. In an editorial, Shander and Goodnough Article discuss the need to address variability in transfusion practice.
Sublingual buprenorphine—a partial opioid agonist—is effective in the treatment of opioid dependence, but its use is limited by poor adherence and concerns about medication diversion. In a randomized placebo-controlled trial involving 163 adults with opioid dependence, Ling and colleagues Article assessed the efficacy of an implantable formulation of buprenorphine that provides a low and steady level of buprenorphine delivery. The authors report that compared with placebo, the use of buprenorphine implants resulted in less opioid use—assessed by urine drug screening—over 16 weeks. In an editorial, O’Connor Article discusses advances and challenges in the pharmacological treatment of opioid dependence.
Cancer screening benefits most individuals, but its value is less certain among persons with limited life expectancy. In an analysis of population-based cancer registry data linked with Medicare claims, Sima and colleagues assessed the utilization of common cancer screening tests among patients with advanced cancers that are associated with a median survival of less than 2 years. The authors report that following a diagnosis of advanced cancer, a small percentage of patients continued to undergo cancer screening, which was unlikely to provide meaningful benefit.
Mr L, an 84-year-old man with moderately severe cognitive impairment, atrial fibrillation, diabetes mellitus, hypertension, hyperlipidemia, chronic kidney disease, and gastroesophageal reflux, has a medication regimen that includes 13 medications at 16 scheduled doses each day. Steinman and Hanlon Article summarize the evidence-based literature related to medication management for clinically complex elderly patients and describe a systematic approach to identify and address medication overuse, underuse, and misuse. Readers may submit comments for online posting at http://www.jama.com. A commentary by Avorn Article discusses medical education, drug evaluation, and organization of care policies that could contribute to improvements in medication use by elderly patients.
“I was not ready to give in to that tangible reminder of my aging, especially one that is so highly stigmatized. Eyeglasses have become a fashion statement, but hearing aids pejoratively signify ‘old person.’” From “Sounds of My Father.”
New research is providing insights into age-related macular degeneration and other ocular disorders.
Wisdom and empathy—neurobiological perspectives
Human recovery from disasters
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.
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 cancer: the basics.
This Week in JAMA . JAMA. 2010;304(14):1525. doi:10.1001/jama.2010.1484