This Week in JAMA FREE

Although extracorporeal membrane oxygenation (ECMO) was used to treat patients with influenza A(H1N1)–associated severe acute respiratory distress syndrome (ARDS), its role in treating adults with severe ARDS remains controversial. Noah and colleagues compared hospital mortality among 80 patients with H1N1-related ARDS who were transferred to an ECMO center (of whom 69 received treatment, 22 died before hospital discharge) with mortality among 195 patients matched on demographic, physiological, and comorbid characteristics but not referred for ECMO. The authors found that transfer to an ECMO center was associated with a lower risk of hospital mortality. In an editorial, Checkley discusses ECMO and highly specialized care for patients with severe ARDS.

Whether recent declines in ischemic heart disease and its risk factors have been accompanied by declines in heart failure hospitalization and mortality is not known. In an analysis of data from more than 55 million Medicare beneficiaries hospitalized between 1998 and 2008, Chen and colleagues found that heart failure–related hospitalizations declined significantly over the decade—but at a lower rate for black men than for other race-sex categories—and that 1-year mortality rates declined minimally, from 31.7% in 1999 to 29.6% in 2008. In an editorial, Gheorghiade and Braunwald discuss strategies to improve outcomes for patients hospitalized for heart failure.

ArticleArticle (AUTHOR VIDEO INTERVIEW)

Hemodialysis membranes in use today are highly biocompatible, and thus, thrombocytopenia has been considered an uncommon dialysis-related complication. However, Kiaii and colleagues found that 20 patients who underwent hemodialysis at 1 dialysis unit developed profound thrombocytopenia, which after investigation appeared to be associated with use of electron beam (e-beam) sterilized dialyzer membranes. In a subsequent analysis of historical and prospective data from 2131 patients undergoing hemodialysis in 2 provinces in Canada, the authors found that the use of e-beam sterilized dialyzers was associated with significant thrombocytopenia following dialysis. In an editorial, Himmelfarb discusses the investigation and assurance of patient safety during hemodialysis.

ArticleArticle (AUTHOR AUDIO INTERVIEW)

There is growing interest in hospital readmission risk prediction tools to identify patients who might benefit from transitional care interventions or to standardize risk readmission rates in hospital quality comparisons. Kansagara and colleagues performed a systematic literature review to identify and characterize validated readmission risk prediction models, and to assess their performance. The authors identified 26 unique and validated hospital readmission risk prediction models. In their assessment of model performance, they found that most of the models, whether designed for hospital comparison or clinical purposes, had poor predictive ability.

A 24-year-old man has a 2-year history of progressive and painless right-sided lower abdominal swelling and scrotal enlargement. On examination, the swellings were smooth and transilluminant. What would you do next?

“You hold the hand of the tearful resident who has just lost a patient's airway, you pat the back of the fellow who works into the night to rescue the boy with heat stroke, you hug the attending physician who grieves for the young man with cancer.” From “Do You Still Feel It?”

Patient advocates and some physicians are urging the US Food and Drug Administration to take bolder steps to ensure that companies follow through on required postmarket studies.

Mandatory HPV vaccination and politics

Lessons from the US rotavirus vaccination program

Join Steven Zweig, MD, MSPH, Wednesday, November 16, from 2 to 3 PM eastern time to discuss the physician's role in patients' nursing home care. To register, go to http://www.ihi.org/AuthorintheRoom.

Dr Bauchner summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

Ms C, a 68-year-old woman, is contemplating autologous blood donation before elective surgery. How would you advise her? Go to www.jama.com to read the case. Submit your response by October 30 for possible online posting.

For your patients: Information about influenza.