Acute renal failure is often treated with diuretic agents despite the
lack of evidence supporting their benefit. Mehta and colleaguesArticle evaluated
outcomes of critically ill patients with acute renal failure according to
diuretic use on the day of nephrology consultation (day 1). Diuretic use on
the day of consultation was significantly associated with increased in-hospital
mortality and nonrecovery of renal function. In an editorial, Lameire and
coauthors caution against the routine administration of loop diuretics to
critically ill patients with oliguria.
Evidence suggests that specific types of dietary fat rather than total
fat predict risk of type 2 diabetes. Jiang and colleagues analyzed data from
women aged 34 to 59 years prospectively followed up for 16 years in the Nurses'
Health Study to examine the association between consumption of nuts and peanut
butter, which are high in unsaturated fat and other nutrients, and risk of
type 2 diabetes. Consumption of nuts and peanut butter was significantly associated
with a decreased risk of type 2 diabetes.
The use of evidence-based protocols for several critical care interventions
has been shown to improve patient mortality and morbidity and reduce costs.
Randolph and colleaguesArticle conducted a randomized trial to evaluate mechanical
ventilation weaning protocols for infants and children. Infants and children
who had received ventilator support for more than 24 hours and who failed
a test for extubation readiness on minimal pressure support were randomized
to a volume support weaning protocol using continuous automated adjustment
of pressure support by the ventilator, a pressure support protocol using adjustment
of pressure support by clinicians, or no protocol. Extubation failure rates
and duration of weaning time among those successfully extubated were not significantly
different in the 3 study groups. Increased sedative use in the first 24 hours
of weaning was associated with extubation failure and increased duration of
weaning among those successfully extubated. In an editorial, Meade and ElyArticle
emphasize the importance of recognizing when a patient is ready to be weaned
from mechanical ventilation by minimizing sedation and routinely assessing
ability to breathe spontaneously and without support.
In this review of evidence from metabolic studies, epidemiologic investigations,
and clinical trials, Hu and Willett identify 3 dietary strategies effective
in preventing coronary heart disease.
Sam, a 15-month-old child, has been receiving prophylactic amoxicillin
for the past month for recurrent ear infections since age 5 months. He has
not had another episode of acute otitis media while receiving prophylaxis,
and his ear examination results are normal. Paradise discusses the epidemiology,
diagnosis, and management of acute otitis media, recurrent acute otitis media,
and otitis media with effusion.
"The wonders of medicine are ubiquitous but . . . fleeting and easily
missed if one is preoccupied." From "Playing the Moonlight
Sonata From Memory: Celebrating the Wonders of Our Difficult Life."
For the first time, the National Library of Medicine is displaying some
of its rare anatomical books and prints to the public in an exhibition entitled
Sheetz and King review the major microvascular complications of diabetes
and discuss the molecular mechanisms through which hyperglycemia can cause
cell damage and dysfunction.
Lichter discusses a randomized trial recently reported in the Archives of
Ophthalmology that compared immediate therapy to lower intraocular
pressure with no initial treatment on the progression of newly detected open-angle
Results of a national survey of internal medicine and family practice
residents in their final year of residency indicate that there are differences
in self-perceived preparedness to diagnose and treat common adult medical
conditions consistent with the emphasis on inpatient vs outpatient settings
For your patients: Information about acute renal failure.
This Week in JAMA. JAMA. 2002;288(20):2505. doi:10.1001/jama.288.20.2505