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In low- and middle-income countries, few adults with hypertension have adequate blood pressure (BP) control. A randomized clinical trial by He and colleagues in 18 primary care centers found that a multicomponent intervention resulted in greater decreases than usual care in systolic and diastolic BP. The intervention was led by community health workers and included health coaching, home BP monitoring, and BP audit and feedback. In an Editorial, Huffman and colleagues suggest that focusing efforts on a priority health condition such as BP can lead to systematic improvements in cardiovascular health.
The risk of surgical site infection (SSI) after cesarean delivery is greater for women who are overweight or obese. Valent and colleagues randomized 403 obese women with cesarean deliveries to receive a postoperative 48-hour course of oral cephalexin and metronidazole or placebo and found that postoperative antimicrobial prophylaxis decreased the rate of SSI. In an Editorial, Calfee and Grünebaum suggest that some subgroups of overweight or obese women may be more likely than others to benefit from this intervention.
Advances in surgical and medical management may have altered the outcomes of carotid revascularization. In a cross-sectional analysis of 937 111 patients who underwent carotid endarterectomy and 231 077 patients who underwent carotid artery stenting, Lichtman and colleagues found that rates of both procedures have declined in recent years and that outcomes have improved despite increases in the prevalence of vascular risk factors.
Delirium with agitation can be distressing and hazardous to patients, caregivers, and health care professionals. In a randomized clinical trial that enrolled 93 patients with advanced cancer and agitated delirium, Hui and colleagues found that haloperidol plus lorazepam was superior to haloperidol alone in decreasing the symptom of agitation. In an Editorial, Pandharipande and Ely suggest that physicians caring for patients at the end of life should try to keep them comfortable and as awake as they and their families would like them to be.
In patients with dementia, psychotic symptoms are common and distressing. Yohanna and Cifu discuss in this JAMA Clinical Guidelines Synopsis a 2016 guideline of the American Psychiatric Association that recommends the cautious use of antipsychotic medications in patients who have dementia with severe manifestations of agitation or psychosis.
This JAMA Clinical Challenge by Liu and colleagues presents the case of a 4-year-old boy who had a pink, dome-shaped nodule with central erosions on his left cheek. What would you do next?
This JAMA Diagnostic Test Interpretation article by Haymond and colleagues presents the case of a 53-year-old woman with chronic low back pain who requested a refill of her prescription for hydrocodone-acetaminophen. Her physician reviewed the state prescription drug monitoring program database and ordered a urine immunoassay drug screen. How do you interpret these results?
Highlights. JAMA. 2017;318(11):979–981. doi:10.1001/jama.2016.13311
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