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Colloids vs Crystalloids and Mortality in Hypovolemic Shock
Caring for the critically ill patient
Evidence to support the choice of colloid vs crystalloid solutions for the management of hypovolemic shock remains unclear. In a multinational randomized trial that involved 2857 patients with hypovolemic shock admitted to 57 intensive care units, Annane and colleagues assessed the effect on mortality of fluid resuscitation with colloid vs crystalloid solutions. The authors found that use of colloids compared with crystalloids did not result in a difference in 28-day mortality. In an Editorial, Seymour and Angus discuss fluid resuscitation in critically ill patients.
Patient Engagement Programs for Depression Care
Depression remains underrecognized and undertreated in primary care settings. In a randomized clinical trial that enrolled 867 adult patients (559 with depression), Kravitz and colleagues assessed initial depression care after patients were exposed to a depression engagement video, a tailored interactive multimedia computer program, or a sleep hygiene informational video (control). The authors report that among depressed patients, the interactive multimedia computer program increased clinician recommendations for antidepressant drugs, a mental health referral, or both but had no effect on mental health at a 12-week follow-up. The possibility that the depression-related interventions increased patient-reported clinician recommendations for antidepressant drug use among nondepressed patients could not be excluded.
Testosterone Therapy, Cardiovascular Outcomes, and Mortality
Vigen and colleagues examined the relationship between testosterone therapy and adverse cardiovascular outcomes in a retrospective study of 8709 men who underwent coronary angiography and had low testosterone levels (< 300 ng/dL); 1223 of the men initiated testosterone therapy a median 531 days following angiography. The authors report that use of testosterone therapy was associated with increased risk of myocardial infarction, stroke, and all-cause mortality. In an Editorial, Cappola discusses testosterone use and cardiovascular risk.
Author Video Interview
Sleep Deficiency and Surgical Complication Rates
To assess whether insufficient sleep the night before operating compromises surgeon performance, Vinden and colleagues identified 2078 elective laparoscopic cholecystectomies performed by 331 different surgeons who had operated between midnight and 7 am the night before, randomly matched these at-risk procedures to 8312 elective laparoscopic cholecystectomies performed by the same surgeons when no evidence that they had operated the night before existed and assessed the risk of conversion from a laparoscopic to open cholecystectomy. The authors found no association between operating the night before and complications of elective daytime laparoscopic cholecystectomies. In an Editorial, Zinner and Freischlag discuss concerns that physician fatigue may increase surgical complication rates.
Clinical Review and Education
Glioblastoma and Other Malignant Gliomas
Malignant gliomas are the most common primary malignant brain tumors. Omuro and DeAngelis review genetic and environmental risk factors, clinical presentation, diagnostic mimics, symptom management, treatment, and common complications of malignant gliomas.
Continuing Medical Education
β-Blockers as Initial Therapy for Hypertension
The effect of β-blockers compared with placebo or other drugs as initial treatment for hypertension was examined in a recent Cochrane review (13 clinical trials; 91 562 participants). In this JAMA Clinical Evidence Synopsis, Wiysonge and Opie report that β-blockers were not associated with reduced all-cause mortality but were associated with modest reductions in cardiovascular events compared with placebo or no treatment. Calcium channel blockers and renin-angiotensin system inhibitors were associated with greater reductions in cardiovascular event rates than β-blockers.
Highlights. JAMA. 2013;310(17):1759–1761. doi:10.1001/jama.2013.5390
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