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In This Issue of JAMA
October 23/30, 2013


JAMA. 2013;310(16):1643-1645. doi:10.1001/jama.2013.5377


Caring for the critically ill patient

Sympathetic activation with tachycardia is common in septic shock. To investigate whether β-adrenergic blockade might be beneficial, Morelli and colleagues randomly assigned 154 patients with septic shock and a heart rate of 95/min or greater to receive either a continuous infusion of the short-acting β-blocker esmolol (titrated to maintain heart rate between 80/min-94/min) or standard treatment. The authors report that target heart rates were achieved in all esmolol-treated patients without an increase in adverse outcomes. In an Editorial, Pinsky discusses the use of β-blockers in severe sepsis.

Related Editorial

Caring for the critically ill patient

Observational data suggest that statins may improve outcomes among patients with various infections. In a multicenter randomized trial with a planned enrollment of 1002 patients, Papazian and colleagues investigated the effect of simvastatin compared with placebo on 28-day mortality among patients with suspected ventilator-associated pneumonia. A planned interim analysis was conducted after enrollment of 300 patients. The study was stopped for futility when the interim analysis revealed that compared with placebo, adjunctive simvastatin therapy did not improve 28-day survival of adults with suspected ventilator-associated pneumonia.

Routine human immunodeficiency virus (HIV) infection screening is generally recommended for patients aged 13 to 64 years, with no requirement for prevention counseling as part of screening. In a randomized trial that enrolled 5012 patients undergoing rapid HIV testing at 9 sexually transmitted disease clinics, Metsch and colleagues assessed the effect of brief patient-centered risk-reduction counseling vs HIV test information alone on subsequent acquisition of sexually transmitted infections (STIs). The authors report that 6-month acquisition rates of STIs were similar in the 2 groups. In an Editorial, Haukoos and Thrun discuss how eliminating HIV risk-prevention counseling can improve HIV screening rates.

Related Editorial

Recent influenzalike infection is associated with fatal and nonfatal atherothrombotic events. Udell and colleagues analyzed data from 6 randomized clinical trials (6735 patients; mean age, 67 years) to assess whether influenza vaccination is associated with prevention of cardiovascular events. Among the authors’ findings was that influenza vaccine was associated with a lower risk of adverse cardiovascular events—with the greatest treatment effect among the highest-risk patients with more active coronary disease. In an Editorial, Neuzil discusses benefits of increasing the influenza vaccine coverage rate.

Related Editorial

Author Video Interview

Clinical Review & Education

Conjunctivitis is estimated to affect 6 million people annually in the United States. In a systematic literature review, Azari and Barney identified 86 articles that provided evidence-based information relating to the diagnosis and treatment of conjunctivitis—particularly in primary care settings. Among the authors’ findings is that supportive care is appropriate for most cases of viral conjunctivitis and uncomplicated cases of bacterial conjunctivitis. Topical antibiotics are recommended for contact lens wearers and patients with suspected chlamydial and gonococcal conjunctivitis. Antihistamines and mast cell stabilizers may alleviate symptoms of allergic conjunctivitis.

Continuing Medical Education

A patient has an irregular, red plaque on his back, which has been present since he sustained a puncture wound at the site 4 years ago. He was initially diagnosed with eczema and treated with topical hydrocortisone cream without improvement. On examination, the plaque is elevated and covered in waxy white crusts. What would you do next?