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High positive end-expiratory pressure (PEEP) with recruitment maneuvers improves respiratory function in obese surgical patients, but the effect on clinical outcomes is uncertain. The PROBESE Collaborative Group randomized 2013 obese surgical patients and found that an intraoperative mechanical ventilation strategy with high PEEP and recruitment maneuvers did not reduce postoperative pulmonary complications. In an Editorial, Godet and Futier discuss the challenges of providing ventilatory support for obese patients.
Postprocedural stroke is a serious complication of transcatheter aortic valve replacement. In a retrospective cohort study of 101 430 patients at 521 US hospitals, Huded and colleagues found that the rate of 30-day stroke following transcatheter aortic valve replacement remained stable between 2011 and 2017. In an Editorial, Messé and Ailawadi suggest that the study may have failed to identify some minor strokes, and the clinical importance of these events is uncertain.
Amyloid plaques, tau neurofibrillary tangles, and signs of neurodegeneration are neuropathologic indicators of Alzheimer disease. Jack and colleagues followed 480 adults without baseline dementia for a median of 4.8 years and found that a prediction model with imaging markers of amyloid, tau, and cortical thickness resulted in a small but statistically significant improvement in predicting memory decline over a model with more readily available clinical and genetic variables. In an Editorial, Wolk and colleagues suggest that biomarker profiles may be useful to classify subgroups of patients in clinical trials.
It has been estimated that 15% of US residents with HIV are unaware of their infection and are responsible for 40% of HIV transmission. The US Preventive Services Task Force recommends HIV screening for adolescents and adults aged 15 to 65 years, younger adolescents and older adults who are at increased risk of infection, and all pregnant women.
Editorial, Related Articles 1 and 2, and JAMA Patient Page
CME and Author Audio Interview
In a review of 40 studies with 485 105 participants, Chou and colleagues found no direct evidence on the clinical benefits and harms of screening for HIV infection, but confirmed the benefit of antiretroviral therapy for asymptomatic individuals with CD4 cell counts greater than 500/mm3.
Editorial, Related Article 1 and 2, and JAMA Patient Page
Author Audio Interview
In a review of 62 studies, Selph and colleagues found that prenatal screening accurately diagnosed HIV infection, and that combination antiretroviral therapy was highly effective at reducing risk of mother-to-child HIV transmission.
Highlights. JAMA. 2019;321(23):2255–2257. doi:10.1001/jama.2018.15377
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