Observational data suggest there is an association between homocysteine levels and cardiovascular disease risk. In a randomized, placebo-controlled trial, Ebbing and colleagues assessed the effects of the homocysteine-lowering B vitamins—folic acid, vitamin B12, and vitamin B6—on total mortality and prevention of cardiovascular events in patients with coronary artery disease. During a median 38 months of follow-up, the authors found no effect of treatment with folic acid plus vitamin B12 or vitamin B6 on total mortality or the prevention of cardiovascular events compared with placebo.
Patients with ventilator-associated pneumonia have high rates of morbidity and mortality. Kollef and
colleagues Article report results of a prospective, multicenter randomized trial that investigated whether a silver-coated endotracheal tube would reduce the incidence of culture-confirmed ventilator-associated pneumonia in patients requiring mechanical ventilation for 24 hours or longer. The authors found that patients receiving the silver-coated endotracheal tube had a lower incidence of ventilator-associated pneumonia and delayed time to ventilator-associated pneumonia compared with patients who received an uncoated tube. In an editorial, Chastre Article discusses interventions to reduce the risks of ventilator-associated pneumonia and implications of the study findings for patient care.
Chronic exposure to high levels of inorganic arsenic in drinking water has been associated with an increased risk of diabetes. Whether exposure to lower levels of inorganic arsenic or to organic arsenic compounds primarily found in seafood increases diabetes risk is not known. Navas-Acien and colleagues Article assessed the prevalence of type 2 diabetes in a cohort of adult participants in the 2003-2004 National Health and Nutrition Examination Survey who had urine arsenic determinations. The authors found that compared with persons without diabetes, persons with type 2 diabetes had significantly higher levels of total urine arsenic and similar levels of the organic arsenic compound arsenobetaine. In an editorial, Kile and Christiani Article discuss environmental arsenic exposure and type 2 diabetes risk.
Neuropsychological tests are used to predict and diagnose dementia. In a population-based longitudinal study of aging and dementia that enrolled persons aged 70 years or older at baseline, Holtzer and colleagues investigated whether within-person across-neuropsychological-test variability—conceptualized as a single representation of variability across multiple cognitive domains, such as memory, attention/executive function, and verbal IQ, demonstrated on tests administered in a single session—predicts incident dementia. The authors report that during the mean follow-up period of 3.3 (SD, 2.4) years, there were 61 incident dementia cases (6.8%). In analyses that adjusted for performance on each individual test, the authors found that within-person across-neuropsychological test variability was associated with development of dementia.
Fosarelli discusses the role of spirituality in patient care and the importance of discerning patients' spiritual needs.
“[A]s we walked up the stairs, I did wonder, medically and otherwise, what or who I would find. And then I saw him.” From “About a Boy.”
A worldwide initiative seeks to better understand the roles that microbial communities play in health and disease.
Pharmaceutical promotion and physician education
The need to test the patient-centered medical home
Join H. George Nurnberg, MD, September 17 from 2 to 3 PM eastern time to discuss sildenafil for women with antidepressant-associated sexual dysfunction. To register, go to http://www.ihi.org/AuthorintheRoom.
How would you manage a 39-year-old man with HIV-associated lipodystrophy? Go to www.jama.com, read the case, and submit your response, which may be selected for online publication. Submission deadline is August 27.
For your patients: Information about ventilator-associated pneumonia.
This Week in JAMA . JAMA. 2008;300(7):765. doi:10.1001/jama.300.7.765