This Week in JAMA FREE

Among patients with cystic fibrosis (CF) aged 6 years or older, inhaled hypertonic saline is a recommended therapy. To assess whether hypertonic saline reduces the rate of pulmonary exacerbations in younger patients, Rosenfeld and colleagues randomly assigned 321 children with CF who were aged 4 to 60 months to receive either nebulized hypertonic saline or isotonic saline twice daily for 48 weeks. The authors found that hypertonic saline was not associated with fewer pulmonary exacerbations during the treatment period. In an editorial, Dasenbrook and Konstan discuss the challenge of identifying sensitive markers of early lung disease to use in the evaluation of therapeutic interventions for young patients with CF.

Low rates of adherence to psychotherapy for depression may be due to barriers encountered in accessing treatment. Mohr and colleagues randomly assigned 325 primary care patients with major depression to receive 18 sessions of cognitive behavioral therapy (CBT) administered over the telephone (T-CBT) or face-to-face. The authors report that at the end of treatment, patients who received T-CBT had lower attrition and similar improvement in depression symptoms as those receiving face-to-face CBT.

Article AND AUTHOR AUDIO INTERVIEW

Low-dose aspirin has been recommended for individuals at moderate to high risk of cardiovascular events, including patients with diabetes. However, any benefit of aspirin might be offset by the risk of major bleeding. In an analysis of administrative data from a population-based cohort of 4.1 million adults, De Berardis and colleagues found that compared with no aspirin use, low-dose (≤300 mg/d) aspirin was associated with an increased risk of major gastrointestinal or cerebral bleeding episodes during a median follow-up of 5.7 years. Patients with diabetes had an increased risk of major bleeding irrespective of aspirin use. In an editorial, Siller-Matula discusses the importance of assessing the net clinical benefit of aspirin therapy in individual patients.

Annually, an estimated 1 million adults (0.5%) worldwide who undergo noncardiac surgery die within 30 days. In an analysis of data from 15 133 patients enrolled in an international prospective cohort study evaluating major complications after surgery, Devereaux and colleagues found that the peak fourth-generation troponin T levels measured during the first 3 days after noncardiac surgery were associated with 30-day mortality.

Mr L is a 64-year-old man with an 11-year history of Parkinson disease. Advanced motor symptoms including dyskinesias and gait freezing have emerged, and Mr L is considering surgical intervention (deep brain stimulation) to manage these disease complications. Tarsy discusses the medical and surgical management of advanced symptoms of Parkinson disease.

New guidelines recommend a range of target levels for glycemic control for patients with type 2 diabetes, based on factors such as age and cardiovascular risk.

ACOs: who should create them?

Article AND AUTHOR VIDEO INTERVIEW

ACOs: not managed care redux

Kidney attack: improving outcomes of acute kidney injury

“I’d never met a patient outside the hospital or office, and I’d certainly never been to one of my patients' homes.” From “Goddess Night.”

The JAMA Network website

Dr Bauchner summarizes and comments on this week's issue. Go to http://jama.jamanetwork.com/multimedia.aspx#Weekly.

Join Mary Whooley, MD, on Wednesday, June 20, from 2 to 3 PM eastern time to discuss treating depression in adults with comorbid conditions. To register, go to http://www.ihi.org/AuthorintheRoom.

For your patients: Information about rosacea.