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Early nutritional support for patients in the intensive care unit (ICU) is associated with reduced mortality rates, but early initiation of nutritional support is not universally practiced. In a cluster randomized trial, Doig and colleagues Article investigated whether evidence-based feeding guidelines that were implemented using a multifaceted practice change strategy and educational outreach could improve feeding practices and reduce ICU mortality. The authors found that ICUs in the intervention hospitals successfully implemented the evidence-based nutritional support guideline, but this was not associated with reductions in hospital mortality compared with ICUs in the control group hospitals. In an editorial, Jones and Heyland Article discuss nutrition treatment of ICU patients and the complexities of guideline implementation.
Some data suggest that a low–glycemic index diet may improve glycemic control and have beneficial effects on cardiovascular risk factors, but questions remain regarding the diet's effectiveness for patients with type 2 diabetes. Jenkins and colleagues randomly assigned patients with type 2 diabetes controlled by oral medications and no clinically significant cardiovascular, renal, or liver disease to receive either low–glycemic index or high–cereal fiber dietary advice and assessed the effect on glycemic control and cardiovascular risk factors. The authors found that 6 months' treatment with a low–glycemic index diet was associated with a moderate reduction in hemoglobin A1c and an increase in high-density lipoprotein cholesterol levels compared with a high–cereal fiber diet.
Some cancers are more common in persons with diabetes, but the association of preexisting diabetes with long-term, all-cause mortality in cancer patients is not clear. Barone and colleagues conducted a systematic review of the literature and meta-analysis to address this question and found that compared with normoglycemic individuals, persons with diabetes at the time of a cancer diagnosis had an increased risk of long-term, all-cause mortality across all types of cancer.
Whether cigarette smoking is associated with an increased risk of colorectal cancer has been a subject of controversy. In a systematic review and meta-analysis of data from observational studies, Botteri and colleagues assessed the relationship of smoking with colorectal cancer incidence and mortality. Comparing smokers with nonsmokers, the authors found the excess risk of colorectal cancer was 1.18 (95% CI, 1.11-1.25) and the excess risk of colorectal cancer mortality was 1.25 (95% CI, 1.14-1.37).
Berkoff and colleagues conducted a systematic review to determine the diagnostic utility of genital examination findings to identify nonacute sexual abuse in prepubertal girls. The authors found that the presence of vaginal discharge and hymenal transections, deep notches, or perforations raise the suspicion of sexual abuse. However, these findings cannot independently confirm or exclude sexual abuse as a cause of genital trauma in young girls.
“I can't even guess how many tests I’ve sat through in my educational lifetime. Hundreds? Could it be thousands by now?” From “A Testy Experience.”
All smokers should receive a pneumococcal vaccination to protect against infection, according to a new recommendation from advisors to the US Centers for Disease Control and Prevention.
Access to experimental drugs for terminally ill patients
Medicine discovers child abuse
Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.
How would you manage a 41-year-old woman with recurrent uterine fibroids? Go to www.jama.com, read the case, and submit your response, which may be selected for online publication. Submission deadline is December 31.
For your patients: Information about colon cancer.
This Week in JAMA . JAMA. 2008;300(23):2699. doi:10.1001/jama.2008.840