Endovascular thrombectomy is recommended for treatment of severe ischemic stroke caused by large-vessel occlusion in the anterior circulation. Optimal management of sedation and airway during the procedure is controversial. Schönenberger and colleagues assessed the effect of conscious sedation without intubation vs general anesthesia with intubation on early neurological improvement in a randomized open-label clinical trial involving 150 patients undergoing thrombectomy for acute ischemic stroke. The authors found that compared with general anesthesia, use of conscious sedation did not result in greater improvement in neurological status at 24 hours.
This US Preventive Services Task Force (USPSTF) recommendation statement addresses the use of statins to treat dyslipidemia in adults aged 40 to 75 years who do not have a history of cardiovascular disease (CVD) and whose low-density lipoprotein cholesterol level is less than 190 mg/dL. Based on an updated evidence review, the USPSTF recommends initiating low- to moderate-dose statin therapy in adults aged 40 to 75 years who have 1 or more CVD risk factors and a calculated 10-year CVD event risk of 10% or greater. Statins may be selectively offered to patients with a 10-year CVD event risk of 7.5% to 10%. The evidence was insufficient to assess the balance of benefits and harms of statins for primary prevention of CVD among adults aged 76 years and older. Three Editorials comment on the USPSTF recommendations for statin use, highlight gaps in the evidence supporting the recommendations, and emphasize the importance of shared decision making when applying the recommendations in clinical practice.
Editorials 1, 2, and 3, Related Article, and JAMA Patient Page
Author Audio Interview, Author Video Interview, and CME
Chou and colleagues summarize findings from the USPSTF review and analysis of evidence from 19 clinical trials (71 344 participants) that compared statins with placebo or no statin for prevention of CVD in adults at increased CVD risk but without prior CVD events. Statin therapy was associated with reduced risk of all-cause and cardiovascular mortality and CVD events, with greater absolute benefit in patients at higher baseline risk.
Carson and colleagues report results of an evidence review to inform an update of the AABB red blood cell (RBC) transfusion guidelines. Evidence from 31 clinical trials (12 587 participants) supports the safety of a restrictive transfusion threshold (a hemoglobin level of 7 g/dL) in most clinical settings. Evidence from 13 randomized trials (5515 patients) that examined RBC storage duration and patient outcomes supports use of RBC units at any time within the licensed dating period. An Editorial by Yazer and Triulzi discusses implications of the guideline recommendations for patient care.
Editorial and Related Article
An article in JAMA Pediatrics reported that an intervention promoting developmentally appropriate, prompt, and responsive parenting was associated with less rapid infant weight gain from birth to age 6 months and fewer overweight infants at age 1 year. This From the JAMA Network article by Lumeng discusses infants’ hunger-related eating behaviors, parental response, and managing the risk of childhood obesity.
This JAMA Clinical Guidelines Synopsis article by Alexander and Cifu summarizes the 2015 UK National Institute for Health and Care Excellence guideline on blood transfusion. Based on an evidence review (34 studies; 17 553 total patients), major recommendations in the guideline address RBC transfusion hemoglobin thresholds for patients without major hemorrhage or acute coronary syndrome, patients with acute coronary syndrome, and patients needing regular transfusions for chronic anemia.
Highlights. JAMA. 2016;316(19):1945–1947. doi:10.1001/jama.2015.14588
* * SCHEDULED MAINTENANCE * *
The JAMA Network Sites will be conducting routine maintenance from 10/20/2017 through 10/21/2017. During this window access to content and authentication may be intermittently available. The JAMA Store will be completely unavailable during the maintenance window.