We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
In This Issue of JAMA |

Highlights FREE

JAMA. 2014;311(21):2147-2148. doi:10.1001/jama.2013.279528.
Text Size: A A A
Published online


Cardiac Output-Guided Hemodynamic Therapy, Surgical Outcomes

In a multicenter randomized trial that enrolled 734 high-risk patients undergoing major gastrointestinal surgery, Pearse and colleagues compared a cardiac output–guided hemodynamic therapy algorithm to direct perioperative intravenous fluid and inotrope infusion with usual care. The authors found no difference in a composite outcome of 30-day moderate or major complications and mortality between the 2 treatment groups. In an Editorial, Bennett-Guerrero discusses hemodynamic goal-directed therapy in high-risk surgical patients.

Kidney Function After Coronary Artery Bypass Graft Surgery

In an analysis of data from 2932 patients who had been randomly assigned to undergo coronary artery bypass graft surgery with cardiopulmonary bypass (on-pump) or using a beating-heart technique (off-pump), Garg and colleagues assessed the risk of acute kidney injury within 30 days of the surgery. The authors report that compared with the on-pump procedure, off-pump coronary artery bypass graft surgery was associated with a reduced risk of postoperative acute kidney injury but no difference in loss of kidney function at 1 year.

Azithromycin, Adverse Events in Older Patients With Pneumonia

Practice guidelines recommend combination therapy including macrolide drugs such as azithromycin as first-line therapy for patients hospitalized with community-acquired pneumonia. However, recent data suggest that azithromycin may be associated with increased risk of cardiovascular events. In a retrospective cohort study that included 73 690 patients aged 65 years or older hospitalized with pneumonia, Mortensen and colleagues found that a treatment regimen that included azithromycin was associated with a lower risk of 90-day mortality and a small increased risk of myocardial infarction.

Prophylactic ICDs, Survival in Patients With LVEF of 30%-35%

To assess survival associated with prophylactic placement of implantable cardioverter-defibrillators (ICDs) in patients with heart failure and a left ventricular ejection fraction between 30% and 35%, Al-Khatib and colleagues analyzed data from 408 patients in the National Cardiovascular Data Registry ICD registry and 408 patients (ICD-eligible but not treated) in the Get With the Guidelines–Heart Failure database. The authors report better survival at 3 years among patients who received a prophylactic ICD than among comparable patients not treated with an ICD.


Resistant Hypertension

Resistant hypertension—uncontrolled hypertension despite optimal doses of 3 or more antihypertensive agents—is increasingly common. Based on a review of 36 relevant studies, Vongpatanasin discusses the diagnosis of resistant hypertension, lifestyle modifications to lower blood pressure, secondary causes of treatment-resistant hypertension, and the efficacy of pharmacological and nonpharmacaological treatments.

Prophylactic Antibiotic Therapy in COPD

It is unclear whether prophylactic antibiotics are associated with lower rates of exacerbation of chronic obstructive pulmonary disease (COPD). In this JAMA Clinical Evidence Synopsis article, Herath and colleagues summarize a Cochrane review of 7 randomized trials (3170 patients) addressing this question. Among the findings was a clinically significant reduction in exacerbations associated with continuous macrolide antibiotic prophylaxis.

Abdominal Pain and Anemia in a Patient With Polycythemia Vera

A patient with a 23-year history of polycythemia vera reported left upper quadrant pain of 2 weeks’ duration. Three years earlier he was diagnosed with a splenic hemangioma. Examination revealed splenomegaly. A hemoglobin level was 6.8 g/dL. An abdominal computed tomographic scan was performed. What would you do next?



Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
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.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Related Content

Customize your page view by dragging & repositioning the boxes below.