Tobacco use is common among persons with mental illness, yet many smokers with mental illness do not receive smoking cessation treatment. In a multisite clinical trial, McFall and colleagues Article assessed abstinence rates among smokers with military-related posttraumatic stress disorder (PTSD) who were randomly assigned to receive either smoking cessation treatment integrated with PTSD mental health care or were referred to Veterans Affairs smoking cessation clinics. The authors found that integrating rather than separating treatment for PTSD and nicotine dependence was associated with higher rates of prolonged smoking abstinence. In an editorial, Prochaska Article discusses the contribution of this study to improved treatment of tobacco dependence in mental health care settings.
Circulating cardiac troponins—often associated with cardiac disease and an increased risk of death—are rarely detectable in the general population using standard assays. Two articles in this issue report results of investigations that examined the utility of a highly sensitive cardiac troponin T (cTnT) assay to detect cardiac disease and predict mortality in middle-aged and older adults. In an analysis of data from a nationally representative cohort of older adults without heart failure at baseline, deFilippi and colleagues Article found that detectable cTnT levels were present in a majority of the study participants at baseline and that baseline cTnT levels and changes in cTnT levels were significantly associated with incident heart failure and cardiovascular death. In a population-based cohort of individuals aged 30 to 65 years, de Lemos and colleagues Article measured cTnT levels with a highly sensitive assay and assessed cardiac structure and function with magnetic resonance imaging studies. The authors found that detection of cTnT was associated with structural heart disease and an increased risk of all-cause mortality during a median follow-up of 6.4 years.
Low-dose aspirin use increases the risk of gastrointestinal bleeding, which may cause a false-positive result on a colorectal cancer screening fecal occult blood test (FOBT). In a cohort of individuals undergoing screening colonoscopy, Brenner and colleagues assessed the association of low-dose aspirin use with performance characteristics of 2 quantitative immunochemical FOBTs. Among the authors' findings was that compared with no aspirin use, use of low-dose aspirin was associated with a higher sensitivity for detection of advanced colorectal neoplasms, with only a slightly lower specificity.
Pipeling and Fan discuss the treatment of refractory hypoxemia in acute respiratory distress syndrome (ARDS) in a presentation of the case of Mr B, a 23-year-old man with no significant past medical history who, while being treated with oral trimethoprim and sulfamethoxazole for a methicillin-resistant Staphylococcus aureus infected bite, developed fever, a nonproductive cough, and dyspnea, which progressed to severe ARDS, unresponsive to a number of therapies.
“His death was stripped of both the nuisances and the anesthetizing distractions of the hospital: curtains that block views of the patient, uniforms that create a sense of order and control, machines that offer the allure of a technological triumph, jargon that keeps the medical team in on the hard truth and the family out.” From “A Perfect Place to Die, Revisited.”
A new guideline for depression emphasizes screening for suicide risk and focuses on the care of select groups of patients, such as those with hard-to-treat depression.
Emotion in medical communication
Violence in health care settings
Clinician mindfulness and patient safety
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 smoking cessation.
This Week in JAMA . JAMA. 2010;304(22):2441. doi:10.1001/jama.2010.1793