This Week in JAMA FREE

Dexmedetomidine, an α₂ agonist, provides analgesia and sedation without significant respiratory depression. In the Safety and Efficacy of Dexmedetomidine Compared With Midazolam (SEDCOM) Study, Riker and colleagues Article tested the hypothesis that a sedation strategy using dexmedetomidine would result in improved outcomes in mechanically ventilated, critically ill intensive care unit (ICU) patients. The investigators found that there was no difference between dexmedetomidine- and midazolam-treated patients in time spent at the target sedation level (Richmond Agitation-Sedation Scale range of −2 to +1). In an editorial, Wunsch and Kress Article discuss sedative agents and their effects on clinical outcomes in ICU patients.

Cardiac computed tomography angiography (CCTA) is a useful diagnostic imaging mode for assessment of coronary artery disease. However, potential risks from radiation exposure associated with CCTA are a concern. In an analysis of data from a prospective observational study of patients who underwent CCTA at 50 sites worldwide, Hausleiter and colleagues Article estimated the median effective dose of radiation associated with CCTA. The authors report the median radiation dose was 12 mSv, which is the equivalent of 1.2 times the dose of an abdominal computed tomography study or 600 chest x-rays. The authors found high variability in radiation dose between study sites and computed tomography systems. In an editorial, Einstein Article discusses the study findings and implications for patient care.

Patients with end-stage renal disease who live at higher altitudes achieve higher hemoglobin concentrations while receiving lower doses of erythropoietin. Winkelmayer and colleagues hypothesized that increased altitude may be associated with reduced mortality risk among patients receiving dialysis and tested their hypothesis in an analysis of data from a retrospective cohort of US patients. In analyses that adjusted for a number of potential demographic and clinical factors, the authors found that residential altitude was inversely associated with all-cause mortality.

In an analysis of data from a prospective cohort study of community-dwelling individuals aged 60 years or older in Dubbo, Australia, Bliuc and colleagues assessed the long-term mortality risks associated with a low-trauma osteoporotic fracture and subsequent fracture. The authors report that compared with the general population, men and women who experienced a low-trauma fracture had an increased risk of mortality that remained elevated for up to 10 years. A subsequent fracture was associated with a 3- to 4-fold increased mortality risk for an additional 5 years.

Ms G, a 51-year-old woman with a history of bipolar disorder, has used tobacco for more than 35 years. She has been trying to quit smoking for 8 years without long-term success. Schroeder discusses the epidemiology and pathophysiology of smoking in patients with mental illness and reviews evidence-based smoking cessation treatment strategies.

“How much do snapshots of human interaction in the clinic let us know who we are really treating?” From “The First Wake.”

Growing concerns surrounding melamine contamination in the global food supply have led to a heightened awareness of weaknesses in the US Food and Drug Administration's oversight of imports.

Obesity and the economy: from crisis to opportunity

The economic argument for disease prevention

Smoking and lung cancer

How would you manage a 76-year-old patient with multiple medical problems and recurrent Clostridium difficile colitis? Go to www.jama.com to read the case and submit your response, which may be selected for online publication. Submission deadline is February 25.

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

For your patients: Information about bipolar disorder.