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From the JAMA Network
October 20, 1999

Contraceptive Effectiveness

Author Affiliations

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor

JAMA. 1999;282(15):1423-1425. doi:10-1001/pubs.JAMA-ISSN-0098-7484-282-15-jac90009

In Reply: We acknowledge that the National Institutes of Health, American Society for Parenteral and Enteral Nutrition, and American Society for Clinical Nutrition sponsored review of nutritional support concluded that preoperative TPN is beneficial in malnourished patients.1 The focus of our review article was on critically ill patients managed in the intensive care unit, not the preoperative management of surgical patients. Our findings suggest that the results of studies of surgical patients are not generalizable to critically ill patients. Even if the aggregated estimate of overall treatment effect is ignored (which we recommend because of the heterogeneity present in the analysis), our review has made clear that the limited amount of data for critically ill patients suggests that the best estimate of treatment effect of TPN is consistent with doing more harm than good.