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Duloxetine for Chemotherapy-Induced Neuropathy
Effective treatment for painful chemotherapy-induced peripheral neuropathy, which affects 20% to 40% of patients who receive neurotoxic chemotherapy, is lacking. In a randomized, placebo-controlled, crossover trial that enrolled 231 patients with painful chemotherapy-induced peripheral neuropathy, Smith and colleagues found that compared with placebo, treatment with duloxetine (30 mg/d for 1 week, then 60 mg/d for 4 additional weeks) resulted in a greater reduction in patient-reported pain severity.
Vaccine to Prevent Poststernotomy S aureus Infection
Infections due to Staphylococcus aureus are serious complications of cardiothoracic surgery. Fowler and colleagues randomly assigned 8031 adult patients who were scheduled to undergo cardiothoracic surgery with median sternotomy within 14 to 60 days to receive either an investigational S aureus vaccine or placebo. The authors report that the vaccine did not reduce the rate of serious postoperative S aureus infections, and patients who received the vaccine and developed S aureus infections had an increased risk of mortality. In an editorial, Malani discusses challenges in postoperative infection prevention.
SEE Article and EDITORIAL
Mortality and Care at Critical Access Hospitals
Data on patient outcomes at hospitals with a critical access designation are limited. In an analysis of Medicare data from more than 10 million patients admitted to hospital with acute myocardial infarction, congestive heart failure, or pneumonia, Joynt and colleagues found that from 2002 to 2010, 30-day mortality rates increased among patients admitted to critical access hospitals compared with patients admitted to other acute care hospitals. In an editorial, Ioannidis discusses whether mortality differences detected in analyses of administrative data are reliable and sufficient for policy change.
Melatonin Secretion and Type 2 Diabetes
Some evidence suggests that melatonin has a role in glucose metabolism and that low secretion of melatonin may impair insulin sensitivity. In a case-control study—involving 370 matched case-control pairs—nested within the prospective Nurses' Health Study, McMullan and colleagues found that women with lower melatonin secretion at baseline had a higher risk of developing type 2 diabetes.
SEE Article and Author Audio Interview
CLINICIAN'S CORNER Management of HIV Infection in Advanced Age
Mr H is a 74-year-old man diagnosed with HIV infection in 1984. He has been adherent to his antiretroviral regimen (therapy initiated in 1988), and his HIV RNA level is undetectable. Greene and colleagues discuss emerging issues related to aging with HIV, including the diagnosis and treatment of comorbid medical illnesses, social isolation, polypharmacy, and factors associated with end-of-life care.
Preventing Falls in Community-Dwelling Older Adults
In a JAMA Clinical Evidence Synopsis, Robertson and Gillespie summarize results of a systematic review of 159 randomized controlled trials testing interventions to reduce the incidence of falls in community-dwelling persons aged 60 years or older. Fall-prevention exercise programs; home safety interventions; vitamin D supplementation for persons with low vitamin D levels; and individually targeted, multidisciplinary interventions were associated with lower fall rates.
Medical News & Perspectives
Preventing fake drugs from reaching patients will take global cooperation and a drug tracking system, according to the Institute of Medicine.
Bedaquiline approval decision: surrogate vs clinical end points
Application of big data to health care
Pushing the outpatient quality envelope
Open science through data sharing
A Piece of My Mind
“[A]s I have learned over the years, every patient has a unique story, and so did my clock.” From “The Clock Doctor.”
Editor's Audio Summary
Dr Livingston summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl
Author in the Room Teleconference
Join Phillip Boiselle, MD, Wednesday April 17, 2013, from 2 to 3 PM eastern time to discuss computed tomography screening for lung cancer. To register, go to http://www.ihi.org/AuthorintheRoom.
JAMA Patient Page
For your patients: Information about statins.
Theme Issue on Genomics
This Week in JAMA. JAMA. 2013;309(13):1313. doi:10.1001/jama.2012.145344
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