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This Week in JAMA
JAMA. 2006;295:2577.
Fluoxetine After Weight Restoration in Anorexia
Antidepressant medications are often prescribed to patients with anorexia nervosa during the acute treatment phase, despite a lack of evidence of the efficacy of these drugs for this disorder. Walsh and colleagues (SEE ARTICLE) report results of a randomized placebo-controlled trial that assessed whether fluoxetine promotes recovery and prolongs the time to relapse after weight restoration in patients with anorexia. The authors found no benefit of fluoxetine relative to placebo for maintenance of minimum body mass index or time to relapse during the 12-month study. In an editorial, Crow (SEE ARTICLE) discusses treatment of anorexia nervosa, adherence with treatment, and relapse prevention.
Fish Oil, Risk of Tachyarrhythmia, and Death
Some data suggest that intake of very long-chain n-3 polyunsaturated fatty acids (omega-3 PUFAs) present in fish or fish oils is associated with a reduced risk of sudden cardiac death. Brouwer and colleagues report results of a multicenter randomized trial that assessed the effect of supplemental fish oil vs placebo on ventricular tachyarrhythmia or death in patients with an implantable cardioverter defibrillator (ICD). During a median follow-up of 1 year, the authors did not find strong evidence that intake of fish oil containing omega-3 PUFAs protects against ventricular tachyarrhythmia or death in patients with an ICD.
(SEE ARTICLE)
Automated vs Manual Compressions in Cardiac Arrest
Two articles in this issue of JAMA report resuscitation outcomes with a load-distributing band automated chest compression device vs manual compression in patients who experienced out-of-hospital cardiac arrest. In the first article, Hallstrom and colleagues (SEE ARTICLE) report results of a multicenter randomized trial of emergency medical services (EMS) personnel performing resuscitation using manual vs automated chest compressions. The authors found that 4-hour survival was similar in both groups, but survival to hospital discharge and neurological outcomes were worse in the patients whose resuscitation included the automated device. Ong and colleagues (SEE ARTICLE) compared outcomes before and after an urban EMS system switched from manual compression to the automated compression device for patients with an out-of-hospital cardiac arrest. These authors found higher rates of return of spontaneous circulation, survival to hospital admission and discharge, and comparable neurological outcomes in patients in whom the automated device was used vs manual compressions. In an editorial, Lewis and Niemann (SEE ARTICLE) explore potential explanations for the apparently contradictory results.
Long-term Renal Outcome in Primary Aldosteronism
To assess whether exposure to increased aldosterone levels is associated with persistent renal damage, Sechi and colleagues conducted a prospective study that compared renal function in patients diagnosed as having primary aldosteronism with renal function in patients with essential hypertension of similar severity and duration. The authors found that medical or surgical treatment of primary aldosteronism and adequate blood pressure control was associated with initial improvement in glomerular filtration rate and decline in albuminuria. During a mean follow-up of 6.4 years, patients with primary aldosteronism experienced a minor progressive loss of renal function similar to that occurring in patients with essential hypertension.
(SEE ARTICLE)
A Piece of My Mind
"With his moon-shaped face, toothless smile, twinkle in his eye, and rounded shoulders and full belly, Wilkey stood not more than five feet erect if you included the cockeyed dirty Yankees cap." From "Dining With Wilkey."
(SEE ARTICLE)
Medical News & Perspectives
With the waiting list growing for patients awaiting kidney transplantation, physicians are turning to novel approaches to increase the pool of donor organs.
(SEE ARTICLE)
CLINICIAN'S CORNER
Sudden Traumatic Death in Children
Perspectives on Care at the Close of Life
Truog and colleagues discuss the complex medical, communication, and personal challenges of caring for a child who experiences sudden traumatic death.
(SEE ARTICLE)
NIH Research Support
Divisiveness between clinical and basic biomedical researchers might be ameliorated if the mutual dependence of National Institutes of Health (NIH)–funded basic and clinical research was recognized and new trans-NIH programs were allowed to evolve.
(SEE ARTICLE)
Audio Commentary
Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.
JAMA Patient Page
For your patients: Information about anorexia nervosa.
(SEE ARTICLE)
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