This Week in JAMA FREE

Artificial nutrition is often provided to patients with acute lung injury (ALI); however, the optimal amount of enteral nutrition is not known. In a randomized trial that enrolled 1000 adults within 48 hours of ALI onset, investigators from the National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome Clinical Trials Network compared 2 initial enteral feeding strategies—lower-volume (trophic) vs full-energy replacement. The investigators found that trophic enteral feeding for up to 6 days did not improve ventilator-free days or reduce mortality but was associated with less gastrointestinal intolerance. In an editorial, Griffiths discusses nutrition for critically ill patients.

The 23-valent pneumococcal polysaccharide vaccine (PPSV23) is effective in preventing invasive pneumococcal disease in adults, but its effectiveness for preventing nonbacteremic pneumococcal pneumonia is poor. Among children, receipt of a pneumococcal conjugate vaccine is associated with decreased invasive and noninvasive disease. Smith and colleagues used decision-modeling techniques to examine the cost-effectiveness of 6 adult vaccination strategies involving either a 13-valent pneumococcal conjugate vaccine (PCV13) or PPSV23. The authors found that PCV13 may be more cost-effective than PPSV23; however, they acknowledge their findings are sensitive to a number of assumptions. In an editorial, Shapiro discusses the evolution of vaccine prevention of pneumococcal disease.

In an analysis of observational data from more than 1 million patients with myocardial infarction (MI) included in the National Registry of Myocardial Infarction, Canto and colleagues examined the association of patient age and sex with symptom presentation and in-hospital mortality. The authors report that women were more likely to present without chest pain and had higher mortality than men within the same age group; however, these differences were markedly attenuated with increasing age.

Article AUTHOR VIDEO INTERVIEW

Vaccination with whole-cell pertussis vaccine is associated with an increased risk of febrile seizures. Sun and colleagues assessed whether the acellular pertussis vaccine is associated with a similar risk in a population-based cohort of 378 834 Danish children who received the combined diphtheria-tetanus toxoids-acellular pertussis–inactivated poliovirus– Haemophilus influenzae type b (DTap-IPV-Hib) vaccine at ages 3, 5, and 12 months. The authors found an increased risk of febrile seizures on the day of the first 2 vaccinations but no increased risk of epilepsy.

In an analysis of data from 86 studies, Udell and colleagues found a variety of physical examination and laboratory findings that alone or in combination increase (or decrease) the likelihood of cirrhosis in patients with liver disease.

A 49-year-old man with a history of weight loss, asymmetric sensory changes in his legs, and idiopathic splenic infarction presents with right iliac fossa pain. On examination he is found to have a rash across his torso and limbs. What would you do next?

Researchers warn that bush meat and other illegally imported wildlife products can harbor zoonotic viruses and spread infectious diseases globally.

Marketing pharmaceuticals

Health care for veterans

A “shopping cart” for health care services?

“Physicians are, by nature, competitive, and emergency physicians tend toward the extreme end of the curve.” From “Putting the ‘Art’ in ‘Crash Cart’”

Thank you— JAMA peer reviewers and authors

Join David S. Ludwig, MD, PhD, March 21, from 2 to 3 PM eastern time to discuss weight loss strategies for adolescents. 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.

Dr A, a 30-year veteran physician, moved to a large practice. How would you address his frustration about quality improvement that focuses on populations instead of individuals? Go to www.jama.com, read the case, and submit your response by March 4.

For your patients: Information about cirrhosis.