Sepsis treatment protocols emphasize early resuscitation with intravenous fluid boluses and vasopressors. In a randomized clinical trial by Andrews and colleagues of 212 adults with sepsis and hypotension in a resource-limited setting, a protocol for early resuscitation with intravenous fluids and vasopressors increased in-hospital mortality compared with usual care. In an Editorial, Machado and Angus comment that interventions developed and tested in high-income settings may not be safe and effective for the treatment of patients in developing countries.
Most studies of the incidence of sepsis are based on claims data submitted for hospital reimbursement. In a retrospective cohort study of adult patients admitted to 409 US academic, community, and federal hospitals, Rhee and colleagues for the CDC Prevention Epicenter Program found substantive differences in sepsis outcomes based on clinical data as compared with data from administrative claims. In an Editorial, Rudd and colleagues note that electronic health records with clinical data are available in many high-income countries, but are seldom available in low- or middle-income countries.
Non–vitamin K oral anticoagulants (NOACs) are commonly prescribed with other medications that share metabolic pathways with NOACs. In a retrospective cohort study by Chang and colleagues of 91 330 patients who had nonvalvular atrial fibrillation treated with NOACs, those who were also treated with amiodarone, fluconazole, rifampin, or phenytoin had increased risks of major bleeding.
Antithrombotic agents are effective for the prevention of stroke and cardiovascular disease, but they are commonly associated with adverse events. In a population-based, retrospective cohort study of 2 518 064 patients aged 66 years and older, Wallis and colleagues found that the use of antithrombotic medications, compared with nonuse of these medications, was associated with higher rates of hematuria-related complications.
This JAMA Insights article by Husain and Velculescu explains that analyses of circulating tumor DNA can detect noninvasive cancers, predict treatment response, monitor disease relapse, and identify mechanisms of resistance to targeted therapies.
Author Audio Interview and CME
In this Clinical Evidence Synopsis summarizing a Cochrane review of 11 randomized clinical trials, Horita and colleagues conclude that the combination of long-acting β-agonists (LABAs) and long-acting muscarinic antagonists is superior to the combination of LABAs and corticosteroids for the treatment of stable chronic obstructive pulmonary disease.
This JAMA Diagnostic Test Interpretation article by Harel and colleagues presents a 62-year-old woman with hypertension, anemia, and an elevated serum creatinine. Urine tests were performed. How would you interpret these results?
Highlights. JAMA. 2017;318(13):1201–1203. doi:10.1001/jama.2016.13333
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