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This Week in JAMA
JAMA. 2008;299(10):1105.
Strategies for Sustaining Weight Loss
Behavioral weight loss interventions may be associated with short-term success, but participants tend to regain weight. Thus, effective strategies for sustaining weight loss are needed. Svetkey and colleagues report results of the Weight Loss Maintenance Randomized Trial, in which overweight and obese participants who lost at least 4 kg during a 6-month behavioral weight loss program were randomly assigned to either monthly personal contact, unlimited access to an interactive technology–based intervention, or self-directed control. At the 30-month follow-up, the investigators found that although weight regain was common, 71% of participants weighed less than they had at study entry. Persons who had been randomly assigned to monthly personal-contact sessions regained less than those who were assigned to the interactive technology–based intervention or the self-directed control condition.
(SEE ARTICLE)
Universal MRSA Screening and Nosocomial Infections
Universal screening on hospital admission to identify patients colonized with methicillin-resistant Staphylococcus aureus (MRSA) has been recommended as one potential means to control MRSA in hospitals. To determine the effect of early MRSA detection on nosocomial MRSA infection rates in surgical patients, Harbarth and colleagues (SEE ARTICLE) compared 2 strategies—rapid screening on admission plus standard infection control measures vs standard infection control alone—in a prospective cohort study of 21 754 surgical patients at a single teaching hospital. The authors report that compared with standard infection control procedures alone, universal, rapid MRSA admission screening was not associated with reduced MRSA surgical site infections or rates of MRSA nosocomial acquisition. In an editorial, Diekema and Climo (SEE ARTICLE) discuss the importance of research investigating novel MRSA prevention strategies and interventions to reduce health care–associated infections.
Minimally Interrupted Cardiac Resuscitation
Minimally interrupted cardiac resuscitation (MICR), a novel protocol for out-of-hospital cardiac arrest, includes an initial series of 200 uninterrupted chest compressions, rhythm analysis with a single shock, early administration of epinephrine, and delayed endotracheal intubation. To investigate whether MICR is associated with improved patient survival, Bobrow and colleagues (SEE ARTICLE) instructed emergency medical service personnel from 2 urban Arizona fire departments in MICR and assessed patient survival before and after instruction. In a second analysis, the authors reviewed data from 62 Arizona fire departments (12 trained in MICR) and compared survival among patients who received MICR vs those who did not. The authors report that survival to hospital discharge increased after implementation of MICR and was higher among patients who received MICR compared with those who did not. In an editorial, Peberdy and Ornato (SEE ARTICLE) discuss critical determinants of cardiac arrest survival and progress in resuscitation techniques and protocols.
CLINICIAN'S CORNER
Performing and Analyzing a Paracentesis
The Rational Clinical Examination
Wong and colleagues review the evidence for paracentesis techniques designed to reduce the risk of adverse events or improve diagnostic yield. Laboratory results helpful in differentiating bacterial peritonitis from portal hypertension are identified.
(SEE ARTICLE)
A Piece of My Mind
"Working in the emergency department can be a very sad job." From "The Only Thing That Matters."
(SEE ARTICLE)
Medical News & Perspectives
Temporomandibular disorders are underrecognized by clinicians, and patients face difficulties related to diagnosis and treatment of these painful musculoskeletal conditions.
(SEE ARTICLE)
Commentaries
Disadvantages of instant communication
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Evaluating health care improvement
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Lipid overload and type 2 diabetes
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Literatim
The Principles and Practice of Medicine
Osler, Rockefeller, and the modern medical and public health industrial-research complex.
(SEE ARTICLE)
Readers Respond
How would you manage a 21-year-old man with chronic idiopathic pancreatitis? Go to www.jama.com to read the case and submit your response. Your response may be selected for online publication. Submission deadline is March 28.
NEXT WEEK
Theme Issue on Genetics and Genomics
JAMA Patient Page
For your patients: Information about abdominal paracentesis.
(SEE ARTICLE)
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