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In This Issue of JAMA |

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JAMA. 2015;313(21):2099-2101. doi:10.1001/jama.2014.11777.
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RESEARCH

Acute kidney injury is a recognized complication after cardiac surgery. In a randomized trial involving 240 patients who were at high risk of acute kidney injury and undergoing cardiac surgery, Zarbock and colleagues found that remote ischemic preconditioning—3 cycles of 5-minute ischemia and 5-minute reperfusion in 1 upper arm performed by blood pressure cuff inflation after induction of anesthesia—compared with no ischemic preconditioning significantly reduced the rate of acute kidney injury. In an Editorial, Pan and Sheikh-Hamad discuss ischemic preconditioning–mediated organ protection.

Evidence for an association between exposure to selective serotonin reuptake inhibitors (SSRIs) in late pregnancy and risk of persistent pulmonary hypertension of the newborn (PPHN) is controversial. In an analysis of Medicaid data from more than 3.7 million pregnant women—128 950 of whom filled a prescription for an SSRI or non-SSRI antidepressant in the 90 days before delivery—Huybrechts and colleagues found that maternal use of SSRIs in late pregnancy may be associated with a small increased risk of PPHN.

The Pioneer Accountable Care Organization (ACO), launched in 2012 by the Centers for Medicare & Medicaid Services, aims to reduce expenditures while improving quality for fee-for-service (FFS) Medicare beneficiaries. In an analysis of 2012-2013 data from nearly 1.5 million beneficiaries aligned with 32 ACOs and a comparison group of more than 25 million general Medicare FFS beneficiaries, Nyweide and colleagues found that beneficiaries aligned with Pioneer ACOs exhibited smaller increases in total Medicare expenditures and reduction in use of different health services, with little difference in patient experience. Editorials—one by Casalino and a second by McClellan—discuss implications of the study findings for controlling health care expenditures and for evidence-based payment reform.

Editorial 1 and 2

In a multicenter study involving 20 hospitals in 9 US states, Schweizer and colleagues found that compared with standard practice, implementation of an evidence-based bundled intervention—screening for Staphylococcus aureus nasal carriage, decolonizing carriers, and prescribing optimal perioperative antibiotics—was associated with a modest decrease in complex S aureus surgical site infections among patients having cardiac surgery or hip or knee arthroplasties. In an Editorial, Malani discusses prevention of surgical site infections.

CLINICAL REVIEW & EDUCATION

An article in JAMA Psychiatry reported results of a randomized trial that compared 2 approaches for treating complicated grief in elderly persons—targeted complicated grief treatment or interpersonal psychotherapy. In this From The JAMA Network article, Simon discusses the treatment of complicated grief—particularly treatment models that incorporate strategies derived from cognitive behavioral therapy techniques.

A 36-year-old woman presented with a recent history of shortness of breath, weight loss, tremor, diaphoresis, and palpitations. Examination findings included tachycardia, a diffusely enlarged thyroid gland, brisk reflexes, and no exophthalmos. Laboratory results included a below-normal thyroid-stimulating hormone level and elevated levels of free thyroxine and free triodothyronine. The patient underwent imaging to evaluate her dyspnea. What would you do next?

The US Food and Drug Administration has approved an inhaled, rapid-acting, dry-powder formulation of recombinant insulin for treatment of adults with type 1 or type 2 diabetes. This Medical Letter on Drugs and Therapeutics article summarizes the clinical data on which approval was based and adverse effects reported in patients receiving inhaled insulin.

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