Malignant glioma has a poor prognosis, and the lack of evidence-based
treatment guidelines may lead to variations in care. Chang and colleagues Article collected data on patterns of care for patients with a newly diagnosed malignant glioma. They found that most patients received diagnostic
magnetic resonance imaging and an attempt at tumor resection and that most
received adjuvant radiation therapy. A majority of patients received antiepileptic
medication, about half received chemotherapy, and very few, antidepressant
therapy—all in conflict with expert recommendations. In an editorial, Article Fisher and Buffler discuss these findings and suggest new directions for brain
When clinical information is missing during a patient encounter, care
may be jeopardized. Smith and colleagues Article surveyed 253
primary care physicians to assess the characteristics of missing information and the relationship of missing information to patient, visit, or clinician
factors. Missing information was reported in 1 in 7 patient visits. Associated factors were that the patient was new, had immigrant status, or was experiencing an increasing number of medical problems. Physicians practicing in rural vs
urban locations and those using electronic vs paper patient records were less likely to report missing information. In an editorial, Article Elder and Hickner discuss the relationship of missing information to medical
errors and poor patient-physician communication.
The ability to estimate mortality risk for patients with acute decompensated
heart failure (ADHF) could improve clinical decision making and treatment.
Fonarow and colleagues used data from a national registry of patients with ADHF to develop a risk-stratification model for all-cause mortality during
hospitalization. They found that admission blood urea nitrogen and serum creatinine levels and systolic blood pressure categorized patients with ADHF as having a low, intermediate, or high risk of in-hospital mortality.
Pseudomonas aeruginosa is a common respiratory
pathogen in patients with cystic fibrosis, but details about P aeruginosa acquisition, progression, and clinical effects are lacking. Li and colleagues conducted a prospective investigation of the epidemiology
of P aeruginosa and related pulmonary morbidity in 56 children with cystic fibrosis. They found the median
age of infection with nonmucoid P aeruginosa was
1 year. After a median of 10.9 years, colonization with a mutant mucoid phenotype
of P aeruginosa was documented. Clinical deterioration
was seen with nonmucoid P aeruginosa infection, but
deterioration was greater with transition to the mucoid strain.
Serious postoperative hypoxemia requiring intubation and mechanical
ventilation is associated with increased morbidity and mortality. Squadrone
and colleagues investigated the effects of continuous positive airway pressure
(CPAP) plus oxygen vs standard oxygen therapy on intubation rates, infectious
complications, and hospital mortality in patients who developed acute hypoxemia
after major abdominal surgery. They found that patients randomly assigned
to receive CPAP plus oxygen had a lower incidence of intubation, pneumonia,
infection, and sepsis but had a similar length of stay and similar in-hospital
mortality as patients assigned to receive oxygen alone.
Studies investigating how current mood-stabilizing drugs work are yielding
molecular clues that researchers hope will lead to better therapies for bipolar
Clinical Review Only a few pharmacological
agents have efficacy in treating neuropsychiatric symptoms of dementia.
The role of monetary compensation in the recruitment of research participants.
For your patients: Information about brain tumors.
This Week in JAMA . JAMA. 2005;293(5):523. doi:10.1001/jama.293.5.523