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Techniques of oral and digestive tract decontamination are often used to prevent infections in intensive care units. Wittekamp and colleagues randomized 8665 patients receiving mechanical ventilation in intensive care units having moderate to high antibiotic resistance and found no reduction in the risk of bloodstream infections associated with the use of chlorhexidine mouthwash, oropharyngeal decontamination, or digestive tract decontamination. In an Editorial, Vandenbroucke-Grauls and van der Meer suggest that the prevalence of antibiotic-resistant organisms in these study sites may have precluded a positive effect of decontamination.
Intubation and mechanical ventilation are associated with complications that can be life-threatening for immunocompromised patients. Azoulay and colleagues randomized 778 immunocompromised patients with acute hypoxemic respiratory failure and found that high-flow oxygen therapy did not significantly decrease day-28 mortality compared with standard oxygen therapy. In an Editorial, Dugan and colleagues suggest that new alternatives to invasive ventilation are needed for immunosuppressed patients with acute hypoxemic respiratory failure.
In patients with hereditary angioedema, recurrent attacks of severe swelling are unpredictable and potentially life-threatening. Banerji and colleagues for the HELP Investigators randomized 125 patients with hereditary angioedema and found that treatment with subcutaneous lanadelumab reduced attack rates compared with placebo.
CME and Visual Abstract
Risk factors for child maltreatment include young age, special health care needs, and having a parent or caregiver who has experienced abuse. The US Preventive Services Task Force found inadequate evidence that interventions initiated in primary care can prevent maltreatment among children without signs or symptoms of abuse.
Editorial, Related Article, and JAMA Patient Page
Author Audio Interview and CME
In a review of 22 randomized trials, Viswanathan and colleagues found no benefit of interventions or referrals from primary care for the prevention of child maltreatment.
This JAMA Clinical Challenge by Medarov and colleagues presents a 38-year-old woman with multiple lung nodules consisting of smooth muscle tissue without necrosis, atypia, or mitotic activity. She recently underwent ovarian stimulation for in vitro fertilization. What would you do next?
Influenza vaccination benefits individuals and their communities. This excerpt from the Medical Letter on Drugs and Therapeutics discusses vaccination for the 2018-2019 influenza season.
Highlights. JAMA. 2018;320(20):2053–2055. doi:10.1001/jama.2017.12647
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