This Week in JAMA FREE

Police officers—who often work extended shifts—may experience chronic sleep deficiency or have untreated sleep disorders, which may adversely affect their health and safety. In a cross-sectional survey of 4957 North American police officers and prospective follow-up surveys completed by 3545 officers, Rajaratnam and colleagues found that 40% of the respondents screened positive for a sleep disorder, which was associated with increased risk of self-reported adverse health and job-related administrative errors and safety violations. In an editorial, Grandner and Pack discuss health and safety implications of sleep deprivation and untreated sleep disorders for individuals and society.

Article (AUTHOR VIDEO INTERVIEW)

High resting heart rate is a recognized predictor of cardiovascular morbidity and mortality, but whether temporal changes in resting heart rate influence the risk of death from ischemic heart disease is not known. Nauman and colleagues analyzed data from a prospective cohort study of 29 325 apparently healthy individuals who had resting heart rate measured on 2 occasions approximately 10 years apart. The authors report that an increase in resting heart rate over the 10-year period was associated with an increased risk of ischemic heart disease–related death.

In the Systolic Hypertension in the Elderly Program trial, in which 4736 older patients with isolated systolic hypertension were randomly assigned to chlorthalidone-based stepped-care therapy or placebo for 4.5 years, antihypertensive therapy resulted in a lower rate of cardiovascular events but effects on mortality were not significant. At a 22-year follow-up of the study participants, Kostis and colleagues found that 4.5 years' treatment with chlorthalidone-based therapy was associated with a gain in life expectancy free from cardiovascular death—corresponding to approximately 1 day gained for each month of treatment received.

Some evidence suggests that in severe sepsis, an early hyperinflammatory response is followed by immunosuppression. In a study that involved postmortem spleen and lung tissue harvested from 40 patients who died with sepsis, 29 control spleens from critically ill patients without sepsis, and 20 control lungs from transplant donors or lung cancer resections, Boomer and colleagues assessed the association of sepsis with changes in host immunity. The authors report biochemical, flow cytometric, and immunohistochemical findings consistent with immunosuppression in tissue obtained from the patients who died with sepsis that were not observed in the control tissues. In an editorial, Ward discusses evidence for the development of immunosuppression in patients with sepsis. In a commentary Angus calls for a reevaluation of current modes of treating sepsis.

A patient who experienced the sensation of an object striking his right eye, without acute pain or change in vision, presented to the emergency department 9 days later for evaluation of increasingly blurred vision. What would you do next?

“The central determinants of health care costs are physician habits, attitudes, and behaviors. In every clinical encounter, multiple decisions are made with significant financial consequences.” From “Fix It!”

The recent recommendation by the US Preventive Services Task Force advising against prostate-specific antigen–based screening for prostate cancer has provoked considerable debate in the medical community.

Accelerating identification and approval of cancer drugs

Homocysteine lowering: the role of subgroup analyses

Placebo effect in clinical practice

Join Harold C. Sox, MD, on Wednesday, January 18, at 2 PM eastern time to discuss the new American Cancer Society process for creating trust-worthy cancer screening guidelines. 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.

How would you manage care for a house officer with a needlestick injury? Go to www.jama.com to read the case. Submit your response by January 1.

For your patients: Information about frostbite.