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Agitation is common, persistent, and difficult to treat in patients with Alzheimer disease. In a randomized trial involving 186 patients with probable Alzheimer disease and clinically significant agitation, Porsteinsson and colleagues assessed the effects of a psychosocial intervention plus either citalopram or placebo for 9 weeks. The authors report that patients who received citalopram had significantly reduced agitation and caregiver distress; however, citalopram at the target dose of 30 mg/d was associated with worsening of cognitive score and adverse cardiac effects. In an Editorial, Small discusses the treatment of agitation in patients with dementia.
Author Video Interview
Radiofrequency catheter ablation is an accepted second-line therapy in patients with paroxysmal atrial fibrillation (AF) who do not respond to antiarrhythmic drug therapy. Morillo and colleagues assessed whether the ablation procedure is superior to antiarrhythmic drug therapy as first-line therapy in a randomized trial that enrolled 127 treatment-naive patients with paroxysmal AF. The authors report that compared with drug treatment, ablation resulted in a lower rate of recurrent atrial tachyarrhythmias at 2 years. In an Editorial, Calkins discusses implications of the study findings for patient care.
In a randomized trial that enrolled 232 functionally limited older adults who had completed traditional rehabilitation after a hip fracture, Latham and colleagues assessed whether a home exercise program that included functionally oriented exercises and minimal contact with a physical therapist would improve patients’ physical function. The authors report that compared with the control group patients (who received in-home and telephone-based nutrition education), intervention group patients had improved physical function 6 and 9 months after randomization.
To assess the incidence of clinically significant surgical site infections following ambulatory surgery, Owens and colleagues analyzed 2010 data from 8 states (284 098 procedures). The authors report that rates of clinically significant surgical site infections were relative low—approximately 3.0 per 1000 procedures at postsurgical day 14—however, given the large number of ambulatory procedures performed annually, the absolute number of infections may be substantial.
Interview, Continuing Medical Education
Wells and colleagues report results of a systematic review examining the etiology and treatment of venous thromboembolism (VTE). The authors consider the risks and benefits of treatment and summarize treatment recommendations during 3 phases of VTE—acute (first 5-10 days), long-term (the end of acute treatment through 3-6 months), and extended treatment—and by VTE etiology—whether provoked (by transient risk factors), unprovoked, or associated with malignancy.
Related Articles 1 and 2
Di Nisio and Middeldorp summarize a 2013 Cochrane review of 30 randomized trials (6462 patients) that examined the safety and efficacy of treatments for lower extremity superficial thrombophlebitis. Among the findings was that compared with placebo, fondaparinux, 2.5 mg subcutaneously once daily for 45 days, is associated with fewer symptomatic venous thromboembolic events and no increase in major bleeding.
This Medical Letter article reviews the clinical data on the safety and efficacy of 4 new oral anticoagulants for acute venous thrombosis: rivaroxaban, dabigatran etexilate, apixaban, and edoxaban. All appear to be effective and safe; however, data in older and sicker patients are limited.
Highlights. JAMA. 2014;311(7):647–649. doi:10.1001/jama.2013.279332