This Week in JAMA FREE

Among critically ill patients, tight glucose control is associated with less morbidity and mortality; however, transient hypoglycemic episodes could have adverse effects, particularly on the developing brain. Mesotten and colleagues assessed neurocognitive function in 569 children who, approximately 4 years prior, participated in a randomized clinical trial comparing tight glucose control with usual care in critically ill children. The authors report that children treated with tight glucose control did not have worse measures of intelligence or cognitive function than those who received usual care. In an editorial, Tasker discusses glycemic control in critical care.

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Lung-protective mechanical ventilation using lower tidal volumes is associated with improved outcomes in acute lung injury. In a meta-analysis of data from 20 studies (2822 patients) that evaluated the use of lower vs higher tidal volumes in patients without acute lung injury at the onset of mechanical ventilation, Neto and colleagues found that protective ventilation was associated with better clinical outcomes including less lung injury, pulmonary infection, atelectasis, and biochemical alterations. In an editorial, Fergusson discusses whether current evidence supports low tidal volumes for all mechanically ventilated patients.

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In an analysis of data from a prospective cohort of 44 985 men without cardiovascular disease at baseline, Joosten and colleagues found that conventional cardiovascular risk factors—smoking, hypertension, hypercholesterolemia, and type 2 diabetes—accounted for most of the risk associated with development of clinically significant peripheral artery disease during 25 years of follow-up.

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Trivedi and colleagues analyzed data from 308 Medicare-certified nursing homes that reported at least 1 norovirus outbreak in 2009 to 2011, and they found that all-cause hospitalization and mortality were increased during periods of reported norovirus outbreaks compared with nonoutbreak periods.

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Most medical interventions have modest effects, but occasionally some trials find very large effects. Pereira and colleagues assessed the frequency and features of very large treatment effects in an evaluation of 85 002 forest plots—displaying quantitative data on treatment comparisons and outcomes in 3082 systematic reviews of medical interventions. Among their findings was that most large treatment effects emerge from small studies, and, when additional trials are performed, the effect sizes typically become much smaller. In an editorial, Oxman discusses implications for clinical research and patient health.

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A 77-year-old man develops an acute inability to walk, without trauma or back pain, or bowel, bladder, or radicular symptoms. Examination reveals reduced left leg strength and reflexes, and multiple upper body blue-black cutaneous swellings. Bilateral leg weakness develops. What would you do next?

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A nationwide quality improvement effort that empowers nurses is helping hospitals reduce rates of central line infections.

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The health policy election

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Choosing wisely, improving quality

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Needed: a health care system that learns

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“Cardiovascular disease is the leading cause of death or disability in the United States, but cancer in our culture has been deemed different from other serious illnesses, often used metaphorically to suggest something shameful, wild, terrifying, and destructive.” From “Cancer Survivorship and Beyond.”

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Join Nancy A. Rigotti, MD, Wednesday, November 14, from 2 to 3 PM eastern time to discuss strategies to help patients quit smoking. To register, go to http://www.ihi.org/AuthorintheRoom.

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

For your patients: Information about age-related macular degeneration.

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Theme Issue on Cardiovascular Disease