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This Week in JAMA
November 17, 2010

This Week in JAMA

JAMA. 2010;304(19):2095. doi:10.1001/jama.2010.1693

Automated external defibrillators (AEDs) improve survival from out-of-hospital cardiac arrest, but whether they improve survival of hospitalized patients who experience a cardiac arrest is not clear. In an analysis of data from a national registry of hospitalized patients with cardiac arrest, Chan and colleagues Article examined survival to hospital discharge in relation to AED use and found that use of AEDs was not associated with improved survival. In an editorial, Haines Article discusses unexpected consequences associated with routine AED use in the inpatient setting.

Myocardial perfusion imaging (MPI) is associated with a high radiation burden. It is of concern that patients may undergo multiple tests involving ionizing radiation, thereby increasing their overall radiation burden. In a retrospective cohort study of patients at a medical center who underwent an index MPI in 2006, Einstein and colleagues estimated patients' cumulative effective dose of radiation from imaging procedures performed between October 1988 and June 2008. Among the authors' findings was that multiple testing with MPI was very common and in many patients was associated with a very high cumulative estimated radiation dose.


Studies from Australia and the United Kingdom report the presence of common transmissible strains of Pseudomonas aeruginosa among patients with cystic fibrosis. In a prospective cohort study of adult patients with cystic fibrosis in Ontario, Canada, Aaron and colleagues found that a common strain (Liverpool strain) of P aeruginosa infects patients with cystic fibrosis in Canada and the United Kingdom and that it is associated with a greater risk of death or lung transplantation than infection with unique strains of P aeruginosa.


Patients with unresectable hepatocellular carcinoma have a median survival of only a few months. Despite lack of a clear survival benefit, doxorubicin is widely used in the treatment of advanced hepatocellular carcinoma and a recent randomized placebo-controlled trial demonstrated increased survival among patients who received sorafenib. In a phase 2 randomized trial that enrolled 96 patients with advanced hepatocellular carcinoma, Abou-Alfa and colleagues compared the combination treatment sorafenib plus doxorubicin with doxorubicin monotherapy and found improvement in median time to progression and progression-free survival in the combination-therapy group.


In a systematic review and meta-analysis, Coker and colleagues examined the evidence related to the diagnosis and treatment of acute otitis media in children. Among the authors' findings are that a red and immobile or bulging tympanic membrane is predictive of acute otitis media, use of the heptavalent pneumococcal conjugate vaccine has been associated with changes in microbial epidemiology, and antibiotics are modestly more effective than no treatment, with most antibiotics demonstrating similar rates of clinical success among children at normal risk.


“Although many physicians are terrible patients, I did not want to be.” From “Secret Shopper.”


A new award honors Frances Oldham Kelsey, a long-time US Food and Drug Administration employee credited with preventing thalidomide-related birth defects in thousands of US children and with shaping the regulation of clinical trials.


Radiation risks associated with CT scans


FDA reversal of midodrine withdrawal


Kava hepatotoxicity and FDA consumer advisory


US global health initiative: strengthening health systems


Join Julia Neily, RN, MS, MPH, and James P. Bagian, MD, Wednesday, December 15, from 2 to 3 PM eastern time to discuss implementation of a medical team training program and surgical mortality. 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 acute otitis media.