Hypothermia reduces death or disability in neonatal hypoxicischemic encephalopathy. In a randomized clinical trial that enrolled 364 full-term infants with hypoxicischemic encephalopathy, Shankaran and colleagues found that compared with hypothermia at 33.5°C for 72 hours, longer duration (120 hours), deeper cooling (32.0°C), or both did not reduce rates of neonatal intensive care unit death. In an Editorial, Robertson and Marlow discuss hypothermia for perinatal hypoxicischemic encephalopathy.
Author Audio Interview
In a randomized trial that enrolled 201 children with complex chronic conditions and high health care use in the previous year, Mosquera and colleagues found that compared with usual care, an enhanced medical home—a clinic providing both primary and specialty care and features to promote prompt effective care—reduced serious illnesses and costs. In an Editorial, Perrin discusses the benefits and economics of comprehensive care for children with chronic conditions.
Author Video Interview
West and colleagues randomly assigned 44 567 pregnant women in rural Bangladesh to receive an antenatal supplement containing either 15 micronutrients or iron and folic acid alone. The authors report that all-cause infant mortality through 6 months of age did not differ by antenatal supplement type. Women who received the multiple micronutrient supplement had a non–statistically significant reduction in adverse birth outcomes.
To identify possible causes and risks of extreme heat-related hospital admissions among older adults, Bobb and colleagues analyzed 1999 to 2010 Medicare inpatient claims data and national daily temperature data from 1943 counties. The authors report that periods of extreme heat were associated with increased risk of hospitalization for fluid and electrolyte disorders, renal failure, urinary tract infection, septicemia, and heat stroke.
Metformin—considered the best initial pharmacological option to manage type 2 diabetes—is contraindicated in patients with impaired kidney function because of concerns about lactic acidosis. In a systematic review of 65 articles pertaining to metformin, kidney disease, and lactic acidosis, Inzucchi and colleagues found that lactate concentrations were not substantially increased when metformin was used in patients with mild to moderate chronic kidney disease and that the incidence of lactic acidosis in metformin users was generally indistinguishable from the overall rate in patients with diabetes.
Continuing Medical Education
An article in JAMA Dermatology reported high rates of treatment dissatisfaction and no treatment or undertreatment among patients with psoriasis. In this From The JAMA Network article, Mercy and colleagues discuss relationships between psoriasis treatment, outcomes, patient satisfaction, and quality of life.
Acute bronchitis is commonly caused by viral infections; however, antibiotics are often prescribed. This JAMA Clinical Evidence Synopsis article by Smith and colleagues summarizes a Cochrane review of 17 randomized trials (5099 adult and child patients) that compared antibiotic with placebo or no treatment for acute bronchitis. Antibiotics were associated with an approximate half-day reduction in duration of cough and feeling ill but no difference in overall clinical improvement or limitations in work or other activities.
This JAMA Diagnostic Test Interpretation article by Cusano and Bilezikian presents the case of a 54-year-old woman found to have hypercalcemia on routine testing. The patient underwent total thyroidectomy for papillary thyroid cancer 15 years earlier. An intact parathyroid hormone level is 57 pg/mL. How would you interpret these results?
Highlights. JAMA. 2014;312(24):2589-2591. doi:10.1001/jama.2013.279907