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In This Issue of JAMA
September 22/29, 2015


JAMA. 2015;314(12):1197-1199. doi:10.1001/jama.2014.11991


Safe and effective treatments for agitation among patients with Alzheimer disease are lacking. In a 10-week, randomized, placebo-controlled study that enrolled 220 patients with probable Alzheimer disease and clinically significant agitation, Cummings and colleagues found that the combination of dextromethorphan and quinidine demonstrated clinically relevant efficacy for agitation and was generally well-tolerated. In an Editorial, Ballard and colleagues discuss pharmacologic management of agitation among patients with dementia.


Author Video Interview and Continuing Medical Education

Strategies to improve adoption of healthful lifestyle behaviors among patients at risk of cardiovascular events are needed. Chow and colleagues assessed the effect of lifestyle-focused semipersonalized mobile phone text messages on cardiovascular risk factors in a randomized trial that enrolled 710 patients with coronary heart disease (CHD). The authors report that compared with usual care, use of the text messaging program, which provided advice, motivational reminders, and behavior change support, resulted in modest improvement in low-density lipoprotein cholesterol levels as well as improvement in other cardiovascular risk factors. In an Editorial, Eapen and Peterson discuss the need for evidence that mobile technologies can facilitate improvements in health.


After patients survive an in-hospital cardiac arrest, discussion should focus on prognosis and preferences for future resuscitative efforts. In an analysis of data from 26 327 patients who were successfully resuscitated after an in-hospital cardiac arrest, Fendler and colleagues found that although do-not-resuscitate (DNR) orders were generally aligned with patients’ likelihood of favorable neurological survival after cardiac arrest, only one-third of patients with the worst prognosis—an estimated 4% likelihood of favorable neurological survival—had DNR orders. In an Editorial, Angus discusses patient prognosis and decisions regarding care after an in-hospital cardiac arrest.


Author Audio Interview and Continuing Medical Education

In a retrospective cohort study involving more than 1.1 million Medicare beneficiaries with pneumonia who were admitted to 2988 acute care hospitals from 2010 to 2012, Valley and colleagues found that compared with general ward admission, ICU admission was associated with improved survival and no significant difference in Medicare spending or hospital costs. In an Editorial, Barbash and Kahn discuss the value of ICU admission for low-risk patients.


Clinical Review & Education

An article in JAMA Internal Medicine reported that between 2001 and 2010, a substantial proportion of older adults with diabetes and multiple serious comorbidities or functional limitations achieved tight glycemic control targets—suggesting potential overtreatment. In this From the JAMA Network article, Huang discusses diabetes treatment goals for older patients with multiple coexisting illnesses.

This JAMA Clinical Evidence Synopsis article by Schmidt-Hansen and colleagues summarizes a Cochrane review (17 clinical trials; 1390 patients total) that examined the efficacy and safety of oxycodone compared with placebo or an active drug for cancer pain in adults. The available evidence was of low quality due to methodological quality and small size of the studies. The evidence review found that oxycodone is not associated with better pain relief or fewer adverse events than other strong opioids.

This Medical Letter on Drugs and Therapeutics article provides information about alirocumab, a subcutaneously injected PCSK9 (proprotein convertase subtilisin kexin type 9) inhibitor, which has been approved as an adjunct to diet and maximally tolerated statin therapy for adults with heterozygous familial hypercholesterolemia or individuals with atherosclerotic cardiovascular disease who require additional lowering of low-density lipoprotein (LDL) cholesterol. Efficacy and safety data from clinical trials of alirocumab are summarized.