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This Week in JAMA
October 27, 2010

This Week in JAMA

JAMA. 2010;304(16):1749. doi:10.1001/jama.2010.1545

In an analysis of data from a subset of participants in the Health and Retirement Study—a nationally representative and longitudinal survey of older community-dwelling adults—who had baseline assessments of cognitive and functional status and whose survey data were linked with Medicare claims information, Iwashyna and colleagues Article found that an incident episode of severe sepsis was independently associated with substantial and persistent new cognitive impairment and functional disability. In an editorial, Angus Article discusses the longer-term consequences of sepsis and implications for patient care and research.

Goodpaster and colleagues Article assessed the effects of a 1-year intensive lifestyle intervention on weight and cardiometabolic risk among adults with severe obesity who were enrolled in a randomized trial that assigned participants either to 12 months of a reduced-calorie diet plan and prescribed moderate-intensity physical activity or to the same 12-month dietary intervention with the physical activity program delayed for 6 months. The authors report that participants in both groups experienced clinically significant weight loss and favorable changes in cardiometabolic risk factors. In an editorial, Ryan and Kushner Article discuss obesity treatment and the state of obesity research.

Rock and colleagues Article report results of a clinical trial that enrolled 442 overweight or obese women and randomly assigned them to a structured (and commercial) weight loss program that included prepared calorie-reduced meals, physical activity recommendations, and weekly in-person one-to-one weight counseling; or to receive 2 individualized weight loss counseling sessions with a dietetics professional and monthly contacts (usual care). The authors assessed weight loss at a 2-year follow-up and found that compared with usual care, the structured commercial weight loss program was associated with greater weight loss. In an editorial, Wing Article discusses commercial weight loss programs and the importance of evaluating their cost-effectiveness.

Cetuximab is not considered effective therapy for KRAS -mutated metastatic colorectal tumors; however, anecdotal reports suggest that a minority of patients may respond—some with long-term stabilization. De Roock and colleagues examined the association between KRAS mutation status and survival in a retrospective study of 579 patients with chemotherapy-refractory metastatic colorectal cancer treated with cetuximab and found that patients with KRAS p.G13D mutations had longer overall and progression-free survival than patients with other KRAS- mutations.

The antiplatelet agent clopidogrel requires biotransformation by cytochrome P450 (CYP) isoenzymes, and evidence suggests that reduced-function variants in CYP2C19 may be associated with diminished platelet inhibition. Mega and colleagues Article analyzed patient-level data from 9 studies that evaluated CYP2C19 genotype and clinical outcomes in patients treated with clopidogrel (primarily for percutaneous coronary intervention in acute coronary syndrome) and found that carriage of even 1 reduced-function CYP2C19 allele was associated with an increased risk of major cardiovascular events—particularly stent thrombosis. In an editorial, Fuster and Sweeny Article discuss the clinical implications of the study findings.

“You probably don't remember me, but I remember you so well. You were my first ICU admission.” From “Red Sox Cap.”

A move to add a test for severe combined immunodeficiency to newborn screening panels nationwide may help more patients with the disorder receive early life-saving treatment.

The business case for quality improvement

Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

Join Michael A. Steinman, MD, Wednesday, November 17, from 2 to 3 PM eastern time to discuss managing medications for elders with clinically complex medical conditions. To register, go to http://www.ihi.org/AuthorintheRoom.

Theme Issue on Caring for an Aging Population

For your patients: Information about sepsis.