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This Week in JAMA
February 2, 2005

This Week in JAMA

JAMA. 2005;293(5):523. doi:10.1001/jama.293.5.523
Care Patterns of Malignant Glioma

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

Missing Information in Primary Care

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.

Mortality Risk in Acute Decompensated Heart Failure

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.

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Infection in Cystic Fibrosis

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.

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CPAP for Postoperative Hypoxemia

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.

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Medical News & Perspectives

Studies investigating how current mood-stabilizing drugs work are yielding molecular clues that researchers hope will lead to better therapies for bipolar disorder.

(Photo credit: Am Soc Biochem Mol Biol)

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CLINICIAN’S CORNER

Clinical Review Only a few pharmacological agents have efficacy in treating neuropsychiatric symptoms of dementia.

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Controversies: Paying Research Participants

The role of monetary compensation in the recruitment of research participants.

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JAMA Patient Page

For your patients: Information about brain tumors.

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