Variation in genotype or differences in insulin secretion may explain why some individuals respond better than others to weight-loss diets. Gardner and colleagues randomized 609 overweight adults to receive a low-fat diet or a low-carbohydrate diet and found that neither genotype pattern nor baseline insulin secretion was associated with dietary effects on weight loss.
In patients with critical illness, delirium is associated with prolonged duration of mechanical ventilation and increased mortality. A randomized trial by van den Boogaard and colleagues for the REDUCE Study Investigators enrolled 1789 critically ill adults in 21 intensive care units and found that haloperidol prescribed as prophylaxis for delirium did not improve survival. In an Editorial, Delaney and colleagues note that nonpharmacological interventions to prevent delirium, such as avoiding excessive sedation, benzodiazepines, and nocturnal noise; mobilizing patients; and maintaining a day-night schedule, remain the standard of care.
Administrative costs account for a large proportion of health care expenditures in the United States. Tseng and colleagues conducted interviews with 27 health system administrators and 34 physicians for a time-driven activity-based costing study and estimated the costs of billing and insurance-related activities to range from $20 for a primary care visit to $215 for an inpatient surgical procedure. In an Editorial, Lee and Blanchfield suggest that alternative payment models and standardized transmission of clinical and financial data could improve the efficiency of electronic billing and payment systems.
Clinical Review & Education
Acute respiratory distress syndrome is an inflammatory lung injury that accounts for 10% of intensive care unit admissions. Fan and colleagues review the diagnosis and treatment of patients with this life-threatening condition. In an Editorial, Gattinoni and colleagues recommend enhancements in the design of clinical trials of therapeutic interventions for acute respiratory distress syndrome.
, , and
CME and and
In this JAMA Clinical Guidelines Synopsis of a 2017 guideline developed by the American Thoracic Society, the European Society of Intensive Care Medicine, and the Society of Critical Care Medicine, Howell and Davis discuss the benefits and harms of mechanical ventilation in adult patients with acute respiratory distress syndrome.
and
This JAMA Clinical Challenge by Lipner presents a woman in her 60s with an ulcerated nodule on her finger and near-complete loss of the nail. What would you do next?