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Daily bathing of critically ill patients with chlorhexidine is commonly undertaken with the intent of reducing health care–associated infections. In a cluster randomized, crossover study involving 9340 patients admitted to intensive care units at a single medical center, Noto and colleagues found that daily bathing with chlorhexidine did not reduce the incidence of a composite outcome of central line–associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated pneumonia, and Clostridium difficile infections. In an Editorial, Pittet and Angus discuss bacterial resistance and other risks of universal decontamination strategies.
Sedation protocols improve outcomes among critically ill adults undergoing mechanical ventilation. In a multicenter cluster randomized study that enrolled 2449 children undergoing mechanical ventilation for acute respiratory failure, Curley and colleagues found that compared with usual care, use of a nurse-implemented sedation protocol did not reduce the duration of mechanical ventilation. In an Editorial, Mehta discusses sedation management in critically ill children.
Advances in imaging have led to development of targeted prostate biopsy techniques that combine magnetic resonance imaging and transrectal ultrasound images (MR/ultrasound fusion; targeted biopsy). In a prospective cohort of 1003 men with suspected prostate cancer, Siddiqui and colleagues compared targeted biopsy with standard extended-sextant ultrasound guided biopsy for the detection of intermediate- to high-risk prostate cancer. The authors report that MR/ultrasound fusion biopsy was associated with increased detection of high-risk prostate cancer and decreased detection of low-risk prostate cancer. In an Editorial, Schwartz and Basch discuss implications of the study findings for prostate cancer staging and treatment.
Editorial and Related Article
Author Video Interview
The incidence and severity of Clostridium difficile infection have increased in recent years. Bagdasarian and colleagues report results of a systematic review of current evidence regarding the diagnosis and treatment of C difficile infection in adults. Based on a review and synthesis of the data from 116 articles, the authors discuss laboratory testing, performance characteristics of multistep testing algorithms, and treatment strategies—which should be based on disease severity, history of prior C difficile infection, and patient risk of recurrent infection.
Continuing Medical Education
Decision curve analysis is a method for evaluating the benefits of a diagnostic test across a range of patient preferences for accepting the risk of undertreatment or overtreatment. In this JAMA Guide to Statistics and Methods article, Fitzgerald and colleagues discuss use of decision curve analysis, interpretation of the results, and limitations of the method.
An article in JAMA Internal Medicine reported that nonleg venous thrombosis may be found in approximately 2% of critically ill patients. In this From the JAMA Network article, Castellucci and colleagues discuss the epidemiology of venous thrombosis at sites other than the lower extremity. The authors note that further study is needed to assess clinical consequences of nonleg venous thrombosis and optimal treatment strategies.
Antiviral drugs can be used for treatment of influenza and as an adjunct to influenza vaccination for prophylaxis. This Medical Letter on Drugs and Therapeutics article summarizes recommendations for antiviral treatment and chemoprophylaxis during the 2014-2015 influenza season.
Highlights. JAMA. 2015;313(4):329–331. doi:10.1001/jama.2014.11539