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A ventilation strategy using low tidal volumes may limit pulmonary complications in patients receiving intensive care. The PReVENT Investigators randomized 961 patients without acute respiratory distress syndrome who were receiving invasive ventilation and found that a low tidal volume strategy did not result in a greater number of ventilator-free days than an intermediate tidal volume strategy. In an Editorial, Rubenfeld and Shankar-Hari discuss the challenges of achieving optimal tidal volumes in patients requiring invasive ventilation.
Noninvasive mechanical ventilation may allow some patients to be extubated who are not yet able to breathe without assistance. Perkins and colleagues for the Breathe Collaborators randomized 364 patients receiving invasive mechanical ventilation for more than 48 hours in whom a spontaneous breathing trial had failed and found that early extubation to noninvasive ventilation did not shorten the time to liberation from any ventilation. In an Editorial, Munshi and Ferguson suggest that noninvasive ventilation may be a reasonable alternative in some patients who do not respond to a trial of spontaneous breathing.
Inappropriate prescriptions in older adults can lead to adverse drug events, falls, cognitive impairment, and emergency hospitalizations. Martin and colleagues randomized 489 adults aged 65 years and older who were prescribed a sedative-hypnotic, first-generation antihistamine, glyburide, or a nonsteroidal anti-inflammatory drug, and found that a pharmacist-led educational intervention resulted in greater discontinuation of prescriptions for inappropriate medication than usual care. In an Editorial, Steinman and Landefeld suggest that interventions are more likely to be effective if they engage patients, physicians, and pharmacists in the deprescribing process.
Editorial and Related Article 1 and 2
CME and Summary Video
Excessive alcohol use is associated with increased risks of motor vehicle crashes, liver disease, birth defects, and developmental disabilities. This US Preventive Services Task Force statement recommends screening for unhealthy alcohol use in primary care settings and providing patients engaged in risky or hazardous drinking with brief behavioral counseling. In an Editorial, Bazzi and Saitz suggest that addressing the stigma of heavy alcohol use may promote screening for this risky behavior.
Editorial, Related Article, and JAMA Patient Page
Author Audio Interview and CME
In a review of 113 studies, O’Connor and colleagues found that screening in primary care can identify individuals with unhealthy alcohol use and that counseling interventions for those who screen positive are associated with reductions in unhealthy alcohol use.
Author Audio Interview
In the evaluation of a patient with a suspected genetic disease, the finding of a genetic variant may not be diagnostic. This JAMA Insights article by Biesecker and colleagues discusses how genetic test results are integrated with clinical characteristics and family history to arrive at a clinical-molecular diagnosis.
Highlights. JAMA. 2018;320(18):1833–1835. doi:10.1001/jama.2017.12625
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