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This Week in JAMA
JAMA. 2008;299(6):607.
Ventilation Strategies in Acute Lung Injury
Two articles in this issue report results of 2 clinical trials that compared the effects of different ventilation strategies on mortality in patients with acute lung injury (ALI). In the first article, Meade and colleagues (SEE ARTICLE) randomly assigned patients with ALI to either an established low-tidal-volume (6 mL/kg of predicted body weight) strategy or an experimental strategy combining low-tidal-volume ventilation and higher levels of positive end-expiratory pressure (PEEP) than the established strategy, and recruitment maneuvers to open collapsed lung tissue. The authors found that all-cause hospital mortality rates were similar in both patient groups. In an investigation of the optimal level of PEEP in patients with ALI, Mercat and colleagues (SEE ARTICLE) randomly assigned patients to a minimal alveolar distension–moderate-PEEP strategy (5 to 9 cm H2O) or to a high-PEEP (maximum plateau pressure, 28 to 30 cm H2O) lung-recruitment strategy. The authors found that the increased-recruitment PEEP strategy was not associated with significant improvements in 28-day or 60-day mortality compared with the moderate PEEP strategy. In an editorial, Gattinoni and Caironi (SEE ARTICLE) discuss the implications of the study outcomes for improved care of patients with ALI. In a second editorial, Chiche and Angus (SEE ARTICLE) discuss study design challenges in the investigation of complex interventions in critically ill patients.
Spine Problems and Health Expenditures and Status
Back and neck pain are common reasons for adults to seek medical care. In an analysis of data from the nationally representative Medical Expenditure Panel Survey (1997-2005), Martin and colleagues examined trends in expenditures for back and neck problems ("spine problems") and associated trends in self-reported health status. The authors found that persons with spine problems had higher medical expenditures than those without, and spine-related medical expenditures increased more rapidly than overall health expenditures from 1997 to 2005. Respondents to the 2005 survey reported more physical function limitations and worse self-reported health status compared with respondents in 1997.
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Responses to Institutional Conflicts of Interest
Institutional financial conflicts of interest may affect research results and compromise institutional integrity and the public's trust. In a 2006 survey of medical school deans, Ehringhaus and colleagues (SEE ARTICLE) assessed the extent of formal efforts to address institutional conflicts of interest. In an analysis of responses from 86 deans (69%), the authors report that a minority of institutions (30 of 79 [38%]) had policies that addressed potential financial conflicts of interest of the institution, while at least two-thirds had policies applicable to financial interests of institutional officials. In an editorial, Rothman (SEE ARTICLE) discusses sources of individual and institutional conflicts of interest and efforts to address them.
CLINICIAN'S CORNER
Medical Treatment of Advanced Testicular Cancer
Testicular cancer is the most common cancer diagnosed in men between the ages of 15 and 35 years. Progress in the medical treatment of testicular cancer has increased overall cure rates to more than 95%, and cure rates approach 80% in men with metastatic disease at diagnosis. Feldman and colleagues review current treatment recommendations for advanced testicular germ-cell tumors and the associated short-term and long-term complications.
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(Photo credit: Ariadne M. Bach, MD/Robert J. Motzer, MD)
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(SEE ARTICLE)
A Piece of My Mind
"Dementia has been described as a cunning thief, robbing the innocents of their memory, their intellect, their being." From "In the Here and Now."
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Medical News & Perspectives
A growing body of research is providing evidence that the immune system plays a role in normal brain development and in healthy adult brains.
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Commentaries
Evaluating root cause analysis
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Strategy for healthy aging
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Author in the Room Teleconference
Join Mark Pletcher, MD, MPH, on February 20 from 2 to 3 PM eastern time to discuss opioid prescribing by race/ethnicity. To register, go to http://www.ihi.org/AuthorintheRoom.
Audio Commentary
Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.
Readers Respond
How would you manage a 74-year-old man who has moderate daily alcohol use, memory loss, and progressive neuropathy? Go to www.jama.com to read the case and submit your response. Your response may be selected for online publication. Submission deadline is February 27.
JAMA Patient Page
For your patients: Information about testicular cancer.
(SEE ARTICLE)
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