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JAMA. 2001;286(3):269. doi:10.1001/jama.286.3.269.
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RHC AND COMPLICATIONS AFTER NONCARDIAC SURGERY

Cardiac complications are the most common cause of mortality among patients undergoing elective noncardiac surgery. In this prospective observational study, Polanczyk and colleaguesArticle evaluated the relationship between use of perioperative right heart catheterization (RHC) for hemodynamic monitoring and rates of postoperative cardiac complications among patients aged 50 years or older undergoing major elective noncardiac procedures. No association was found between perioperative RHC use and reduction in postoperative cardiac or noncardiac complications. In multivariate analyses and in an analysis of a subset of matched patients who did and did not undergo RHC, RHC was associated with an increased risk of major postoperative cardiac events. In an editorial, DalenArticle notes that most research has not shown any clinical benefit of pulmonary artery catheter use in critically ill or perioperative patients and concludes that RHC is not indicated for routine monitoring of patients undergoing major surgery.

ANALGESIC USE AND RISK OF RENAL DYSFUNCTION IN MEN

Evidence supporting an association between regular analgesic use and increased risk of chronic renal disease has been inconsistent. Using data from 11 032 healthy men followed up for an average of 14 years in the Physicians' Health Study, Rexrode and colleagues found no significant associations between self-reported use of aspirin, acetaminophen, or other nonsteroidal anti-inflammatory drugs and either elevated creatinine levels or reduced creatinine clearance.

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PACIFIER USE AND RISK OF EARLY WEANING

Observational studies have suggested that pacifier use is associated with early weaning. To test whether this association is causal, Kramer and colleagues randomly assigned breastfeeding women to 1 of 2 breastfeeding promotion interventions—an experimental counseling intervention that recommended avoidance of pacifier use and offered alternative ways to comfort a crying or fussing infant or a control intervention that included pacifier use as an option for comforting an infant. Pacifier use was significantly lower in the experimental group compared with the control group, but there was no significant difference in risk of weaning before age 3 months. Reanalysis of the data according to exposure to pacifier use regardless of randomized allocation showed a strong observational association between daily pacifier use and weaning by 3 months, suggesting that pacifier use is a marker of breastfeeding difficulties or reduced motivation to breastfeed.

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INFLAMMATORY BIOMARKERS AND RISK OF TYPE 2 DM

Systemic inflammation may play an intermediary role in the pathogenesis of type 2 diabetes mellitus (DM). In this case-control study using data from the prospective Women's Health Study, Pradhan and colleagues found that median baseline levels of 2 inflammatory biomarkers—C-reactive protein and interleukin 6—were significantly higher among women who developed type 2 DM over 4 years of follow-up compared with women who did not develop DM.

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DIGESTIVE TRACT DECONTAMINATION IN CRITICALLY ILL PATIENTS

Meta-analyses of randomized trials of selective decontamination of the digestive tract (SDD) have shown significant reductions in the incidence of nosocomial pneumonia among mechanically ventilated patients receiving SDD. van Nieuwenhoven and colleagues analyzed the relationship between methodological quality of 32 studies of SDD and the reported effects on pneumonia and mortality. Significant reductions in the incidence of pneumonia were reported in 21 studies, but a significant decrease in mortality was not found in any individual trial. Methodological quality was inversely related to the benefit of SDD on the incidence of nosocomial pneumonia. No association between trial quality and impact of SDD on mortality was observed.

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MEDICAL NEWS & PERSPECTIVES

Physician-astronauts have played an important role during the 20 years of NASA space shuttle missions. Their efforts, and new technologies developed to support them, have advanced space medicine and are assisting down-to-earth physicians.

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THE RATIONAL CLINICAL EXAMINATION

How to determine if a patient has digital clubbing.

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CALL FOR PAPERS FOR ON CALL

Announcing a new monthly JAMA feature, On Call, a forum for discourse on educational, professional, and scientific topics of special relevance to residents and fellows.

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JAMA PATIENT PAGE

For your patients: Information about pacifier use.

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