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This Week in JAMA |

This Week in JAMA FREE

JAMA. 2009;302(10):1033. doi:10.1001/jama.2009.1321.
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PROCALCITONIN-BASED GUIDELINES FOR TREATMENT OF LRTIS

Assessment of serum levels of procalcitonin (PCT), which is released in response to bacterial infections, could distinguish bacterial from viral lower respiratory tract infections (LRTIs) and inform decisions about antibiotic therapy. To evaluate this, Schuetz and colleagues Article from the ProHOSP Study randomly assigned patients with LRTIs to receive antibiotics according to an experimental PCT-based algorithm or according to standard evidence-based guidelines. The authors found that PCT guidance resulted in similar rates of adverse outcomes and lower rates of antibiotic exposure and antibiotic-associated adverse events compared with standard guidelines. In an editorial, Yealy and Fine Article discuss the utility of a PCT-guided decision rule for routine care of patients with respiratory infections.

DOPAMINE PRETREATMENT AND KIDNEY GRAFT FUNCTION

To assess whether medical management of brain-dead kidney donors is associated with improved transplant outcomes, Schnuelle and colleagues randomly assigned 264 deceased heart-beating donors to receive low-dose dopamine, or not, before surgical recovery of the kidneys. The authors report that the dialysis requirement in the first week after transplant was significantly lower in recipients of kidneys from dopamine-treated donors than in untreated donors.

GENETIC MODIFIERS OF LIVER DISEASE IN CYSTIC FIBROSIS

A small subset of patients with cystic fibrosis (CF) develops severe liver disease characterized by cirrhosis with portal hypertension. In an examination of 9 polymorphisms in 5 candidate genes that are associated with liver disease in cystic fibrosis, Bartlett and colleagues found that patients who carry the SERPINA11-antiprotease and α1-antitrypsin) Z allele have a significantly increased risk of developing severe liver disease.

DOPAMINE REWARD PATHWAYS IN ADHD

Dysfunction in dopamine neurotransmission in reward/motivation pathways may underlie symptoms of inattention and impulsivity observed in individuals with attention-deficit/hyperactivity disorder (ADHD). Using positron emission tomography, Volkow and colleagues measured specific binding of radioligands for dopamine transporters and receptors in the nucleus accumbens and midbrain—key regions for reward/motivation—in a study involving unmedicated adults with ADHD and healthy controls. The authors found a reduction in dopamine synaptic markers associated with symptoms of inattention in the dopamine reward pathway of individuals with ADHD.

ARTICLE CITATIONS IN CITATION DATABASES

Citation counts are a measure of the effect of scholarly publication and may be a factor for academic advancement. Kulkarni and colleagues searched 3 established citation databases (Web of Science, Scopus, and Google Scholar) for citation count profiles of 328 original research articles published in 3 general medical journals and found that each database produced quantitatively and qualitatively different citation counts.

CLINICIAN'S CORNER
A WOMAN WITH OBESITY
CLINICAL CROSSROADS

Ms S, a 52-year-old woman with severe obesity, depression, and anxiety, is considering weight loss surgery. Wee discusses the benefits and risks of the Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding procedures.

A PIECE OF MY MIND

“Although I generally enjoy the practice of medicine, this attitude isn't always reflected in my stories, many of which seem depressing or even horrifying.” From “Years of Stories.”

MEDICAL NEWS & PERSPECTIVES

The discovery of Chagas disease in Brazil in 1907 was a remarkable feat. But 100 years later a gold standard diagnostic test and effective, nontoxic treatment remain elusive.

COMMENTARIES

Journal impact factor

Electronic medical records

Regional variation and the affluence-poverty nexus

AUTHOR IN THE ROOM TELECONFERENCE

Join Thomas H. Gallager, MD, Wednesday, September 16, from 2 to 3 PM eastern time to discuss the medical error involving a woman who experienced wrong-site surgery for skin cancer. To register, go to http://www.ihi.org/AuthorintheRoom.

READERS RESPOND

How would you manage a 52-year-old woman with disabling diabetic neuropathy? Go to www.jama.com to read the case and submit a response by October 4 for possible online publication.

JAMA PATIENT PAGE

For your patients: Information about cystic fibrosis.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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