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This Week in JAMA
October 17, 2012

This Week in JAMA

JAMA. 2012;308(15):1501. doi:10.1001/jama.2012.3273

High-dose micronutrient supplementation has been reported to reduce human immunodeficiency (HIV) disease progression and mortality among individuals not receiving highly active antiretroviral therapy (HAART). To assess the safety and efficacy of high-dose multivitamin supplementation in patients initiating HAART, Isanaka and colleagues randomly assigned 3418 Tanzanian patients to receive either high-dose or standard-dose oral supplements of vitamin B complex, vitamin C, and vitamin E. The authors report that high-dose multivitamin supplementation was not associated with a decrease in HIV disease progression or death and may increase alanine transaminase levels.


Carroll and colleagues examined trends in serum lipid levels among US adults in an analysis of data from 3 National Health and Nutrition Examination Surveys. Overall, the authors found favorable trends in lipids among US adults, including decreases in mean total cholesterol and low-density lipoprotein cholesterol levels and an increase in mean high-density lipoprotein cholesterol levels. Prevalence of lipid-lowering medication use increased significantly from 1988-2010.


Lynch syndrome—caused by germline mutations in DNA mismatch repair (MMR) genes—is the most common form of hereditary colorectal cancer. In a pooled-data analysis that included 10 206 probands with newly diagnosed colorectal cancer, Moreira and colleagues assessed performance characteristics of selected strategies—including the Bethesda guidelines and Jerusalem recommendations—to identify carriers of the MMR gene mutation. The authors report that universal tumor MMR testing demonstrated a greater sensitivity for the identification of Lynch syndrome than the alternative strategies. In an editorial, Ladabaum and Ford discuss screening for Lynch syndrome in patients with colorectal cancer.


Intravenous (IV) chloride administration is associated with decreased renal function and acute kidney injury. In a prospective, open-label, sequential period pilot study, Yunos and colleagues assessed the incidence of acute kidney injury in critically ill patients who received IV fluids that were either chloride-liberal (control period, 760 patients) or chloride-restrictive (intervention period, 773 patients). The authors report that implementation of the chloride-restrictive strategy was associated with a significant decrease in the incidence of acute kidney injury and the need for renal replacement therapy. In an editorial, Waikar and Winkelmayer discuss the effects of chloride on renal function and the need to consider the formulation of IV fluids and potential effects on patient outcomes.


Evidence suggests that most smokers want to quit; however, many quit attempts fail—often because smokers use no treatment when trying to quit. Rigotti discusses strategies for treating tobacco use, with a particular focus on individuals with chronic, relapsing tobacco dependence. In an editorial, Schroeder discusses the evidence base for treatment of tobacco dependence.


An international panel of experts has developed a new definition of myocardial infarction that features the use of highly sensitive biomarkers along with other clinical criteria.


Peripherally inserted central catheters: risk of complications


Family matters in health care delivery


Engaging patients in shared decision making


“To name this injury was to remove its mystery, reveal its true nature, and give me a sense of cognitive mastery and consequent serenity.” From “Do We Really Need to Know?”


Dr Bauchner summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

Join Nancy A. Rigotti, MD, Wednesday, November 14, from 2 to 3 PM eastern time to discuss strategies to help patients quit smoking. To register, go to http://www.ihi.org/AuthorintheRoom.

For your patients: Information about smoking cessation.