There is evidence that titrating positive end-expiratory pressure (PEEP) to offset esophageal pressure (an estimate of pleural pressure) can attenuate lung injury and improve patient outcomes in acute respiratory distress syndrome. Beitler and colleagues for the EPVent-2 Study Group randomized 200 patients with acute respiratory distress syndrome and found that PEEP titration guided by esophageal pressure, compared with a conventional ventilatory strategy, did not improve a composite outcome of mortality and days free from mechanical ventilation. In an Editorial, Cavalcanti and colleagues conclude that the tool in common use for adjusting PEEP and the more invasive, costly, and cumbersome technique tested in this study have similar clinical outcomes.聽
Visual Abstract
Adherence to a high-quality diet is associated with a lower risk of new depressive symptoms. Bot and colleagues for the MooDFOOD Prevention Trial Investigators randomized 1025 overweight or obese adults with depressive symptoms and found that neither multinutrient supplementation nor food-related behavioral activation therapy reduced episodes of major depressive disorder. In an Editorial, Berk and Jacka suggest that dietary changes should be integrated with psychological and pharmacological therapies as well as evidence-based lifestyle interventions.
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CME
Many patients with obesity and depression have poor treatment adherence and therapeutic response. In a randomized trial by Ma and colleagues that enrolled 409 adults with obesity and depression, a collaborative care intervention integrating behavioral weight loss treatment, problem-solving therapy, and antidepressant medications improved weight loss and depressive symptoms at 12 months.
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CME
Individuals with type 2 diabetes seldom achieve recommended levels of physical activity. Balducci and colleagues for the Italian Diabetes and Exercise Study 2 Investigators randomized 300 physically inactive and sedentary patients with type 2 diabetes and found that a behavioral intervention resulted in a sustained increase in physical activity and a decrease in sedentary time.
Clinical Review & Education
In this JAMA Clinical Guidelines Synopsis of a 2017 guideline developed by the Infectious Diseases Society of America, Hamilton and Cifu discuss the clinical management of children and adults with suspected or confirmed infectious diarrhea.
This JAMA Insights article by Gwinn and colleagues explains how genetic sequencing of infectious pathogens can be used to identify etiologies of disease outbreaks and suggest treatment strategies.
This JAMA Clinical Challenge by Saxena and colleagues presents a 54-year-old man with pancytopenia and a history of Roux-en-Y gastric bypass. What would you do next?