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This Week in JAMA
JAMA. 2002;288:2505.
Diuretic Use and Outcomes of Acute Renal Failure
Acute renal failure is often treated with diuretic agents despite the lack of evidence supporting their benefit. Mehta and colleagues (SEE ARTICLE) evaluated outcomes of critically ill patients with acute renal failure according to diuretic use on the day of nephrology consultation (day 1). Diuretic use on the day of consultation was significantly associated with increased in-hospital mortality and nonrecovery of renal function. In an editorial, Lameire and coauthors caution against the routine administration of loop diuretics to critically ill patients with oliguria.
(SEE ARTICLE)
Nut, Peanut Butter Consumption and Risk of Diabetes
Evidence suggests that specific types of dietary fat rather than total fat predict risk of type 2 diabetes. Jiang and colleagues analyzed data from women aged 34 to 59 years prospectively followed up for 16 years in the Nurses' Health Study to examine the association between consumption of nuts and peanut butter, which are high in unsaturated fat and other nutrients, and risk of type 2 diabetes. Consumption of nuts and peanut butter was significantly associated with a decreased risk of type 2 diabetes.
(SEE ARTICLE)
Mechanical Ventilation Weaning Protocols for Children
The use of evidence-based protocols for several critical care interventions has been shown to improve patient mortality and morbidity and reduce costs. Randolph and colleagues (SEE ARTICLE) conducted a randomized trial to evaluate mechanical ventilation weaning protocols for infants and children. Infants and children who had received ventilator support for more than 24 hours and who failed a test for extubation readiness on minimal pressure support were randomized to a volume support weaning protocol using continuous automated adjustment of pressure support by the ventilator, a pressure support protocol using adjustment of pressure support by clinicians, or no protocol. Extubation failure rates and duration of weaning time among those successfully extubated were not significantly different in the 3 study groups. Increased sedative use in the first 24 hours of weaning was associated with extubation failure and increased duration of weaning among those successfully extubated. In an editorial, Meade and Ely (SEE ARTICLE) emphasize the importance of recognizing when a patient is ready to be weaned from mechanical ventilation by minimizing sedation and routinely assessing ability to breathe spontaneously and without support.
Dietary Strategies for Coronary Heart Disease Prevention
In this review of evidence from metabolic studies, epidemiologic investigations, and clinical trials, Hu and Willett identify 3 dietary strategies effective in preventing coronary heart disease.
(SEE ARTICLE)
CLINICIAN'S CORNER
A 15-Month-Old Child With Recurrent Otitis Media
Clinical Crossroads
Sam, a 15-month-old child, has been receiving prophylactic amoxicillin for the past month for recurrent ear infections since age 5 months. He has not had another episode of acute otitis media while receiving prophylaxis, and his ear examination results are normal. Paradise discusses the epidemiology, diagnosis, and management of acute otitis media, recurrent acute otitis media, and otitis media with effusion.
(SEE ARTICLE)
A Piece of My Mind
"The wonders of medicine are ubiquitous but . . . fleeting and easily missed if one is preoccupied." From "Playing the Moonlight Sonata From Memory: Celebrating the Wonders of Our Difficult Life."
(SEE ARTICLE)
Medical News & Perspectives
For the first time, the National Library of Medicine is displaying some of its rare anatomical books and prints to the public in an exhibition entitled "Dream Anatomy."
(SEE ARTICLE)
Molecular Basis of Diabetic Complications
Sheetz and King review the major microvascular complications of diabetes and discuss the molecular mechanisms through which hyperglycemia can cause cell damage and dysfunction.
(SEE ARTICLE)
Effect of Treatment on Glaucoma Progression
From the Archives Journals
Lichter discusses a randomized trial recently reported in the Archives of Ophthalmology that compared immediate therapy to lower intraocular pressure with no initial treatment on the progression of newly detected open-angle glaucoma.
(SEE ARTICLE)
Resident Preparedness
On Call: Issues in Graduate Medical Education
Results of a national survey of internal medicine and family practice residents in their final year of residency indicate that there are differences in self-perceived preparedness to diagnose and treat common adult medical conditions consistent with the emphasis on inpatient vs outpatient settings during training.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about acute renal failure.
(SEE ARTICLE)
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