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This Week in JAMA | May 9, 2012|

This Week in JAMA FREE

JAMA. 2012;307(18):1889. doi:10.1001/jama.2012.2973.
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GLUCOSE-INSULIN-POTASSIUM IN OUT-OF-HOSPITAL ACS

Experimental data suggest that immediate intravenous glucose-insulin-potassium (GIK) reduces ischemia-related arrhythmias and myocardial injury. Selker and colleagues randomly assigned 871 patients with suspected acute coronary syndromes (ACS) to receive either intravenous GIK or a 5% glucose placebo in the out-of-hospital setting and continued for 12 hours. The authors report that compared with placebo, GIK did not reduce progression to myocardial infarction. In an editorial, Califf discusses the study findings and opportunities for future investigation.

TRENDS IN NEONATAL ABSTINENCE SYNDROME

In an analysis of 2000-2009 data from nationally representative and serial cohorts of US newborns and mothers, Patrick and colleagues found a 3-fold increase in the incidence of neonatal abstinence syndrome and a nearly 5-fold increase in maternal opiate use, as well as increased hospital charges for newborns with a discharge diagnosis of drug withdrawal syndrome. In an editorial, Hayes and Brown discuss maternal opiate abuse and neonatal abstinence syndrome.

CHRONIC KIDNEY DISEASE RISK PREDICTION

Data from studies of predominantly white individuals with higher levels of kidney function suggest that the Chronic Kidney Disease Epidemiology (CKD-EPI) Collaboration equation provides a more accurate estimate of glomerular filtration rate (eGFR) and better prediction of CKD and associated risks than the conventional Modification of Diet in Renal Disease (MDRD) Study equation. In a meta-analysis of data from 1.1 million adults (45 cohort studies) representative of general and at-risk populations, Matsushita and colleagues found that the CKD-EPI Collaboration equation classified fewer individuals as having CKD and more accurately categorized the risk for mortality and end-stage renal disease than the MDRD Study equation. In an editorial, Kalantar-Zadeh and Amin discuss implications of these findings for patient care.

SEX DIFFERENCES IN STROKE RISK IN PATIENTS WITH AF

Among patients with atrial fibrillation (AF), women are at higher risk of stroke than men, and some studies suggest warfarin undertreatment may be a factor. In an analysis of data from a population-based cohort study of 83 513 older patients with incident AF and comparable warfarin treatment in men and women, Tsadok and colleagues found that stroke risk after a diagnosis of AF was greater in women than in men—particularly among women aged 75 years and older.

CLINICIAN'S CORNER
PROBIOTICS FOR ANTIBIOTIC-ASSOCIATED DIARRHEA

Hempel and colleagues report results of a systematic review and meta-analysis of data from studies assessing probiotic use in the prevention or treatment of antibiotic-associated diarrhea. In a pooled analysis of data from 63 placebo-controlled randomized trials (11 811 participants), probiotic consumption was associated with reduced risk of antibiotic-associated diarrhea; however, the influence of patient population, antibiotic characteristics, or probiotic preparation could not be determined.

JAMA CLINICAL CHALLENGE

A child has worsening photophobia, eye irritation, and redness after having been poked in the eye. Three days prior to presentation, topical erythromycin ointment was prescribed. What would you do next?

MEDICAL NEWS & PERSPECTIVES

More women are choosing surgery as a career, but they continue to report such barriers as negative attitudes toward pregnancy during training.

VIEWPOINTS

Improving outcomes after in-hospital cardiac arrest

Dialysis initiation in elderly patients

Chronic hepatitis C pharmacogenetics

A PIECE OF MY MIND

“In her agitated state, she had withdrawn from friends and family to avoid lashing out at some unsuspecting person. How could she tolerate a baby's crying?” From “Drowning in Plain Sight.”

NEXT WEEK

Theme Issue on Global Health

EDITOR'S AUDIO SUMMARY

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

AUTHORS IN THE ROOM TELECONFERENCE

Join Michael J. Blaha, MD, MPH, and Rita F. Redberg, MD, MSc, Wednesday May 16, from 2 to 3 PM eastern time to debate whether a healthy 55-year-old man should receive statin therapy. To register, go to http://www.ihi.org/AuthorintheRoom.

READERS RESPOND

How would you manage worsening motor complications in a man with an 11-year history of Parkinson disease? Read the case at www.jama.com. Submit your response by May 27 for possible online posting.

JAMA PATIENT PAGE

For your patients: Information about Kawasaki disease.

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