This Week in JAMA FREE

Telemedicine applications such as audio, video, and electronic links in intensive care units (tele-ICU) allow health care professionals located remotely to oversee, create, and execute patient care plans. Lilly and colleagues Article assessed hospital mortality, length of stay, best practice adherence, and preventable complications before and after implementation of a collaborative tele-ICU intervention in ICUs at 1 academic medical center. The authors report that the tele-ICU intervention was associated with reductions in mortality and length of stay, higher rates of best practice adherence, and lower rates of complications. In an editorial, Kahn Article discusses the use and misuse of telemedicine in the ICU.

Type 2 diabetes is associated with an increased risk of fracture and, paradoxically, higher bone mineral density (BMD). Schwartz and colleagues analyzed data from 3 observational cohorts to assess whether established fracture prediction methods—BMD T score alone or as part of the World Health Organization Fracture Risk Algorithm (FRAX)—are applicable to older adults with diabetes. The authors found that for a given femoral neck BMD T score or FRAX score, persons with diabetes had a higher fracture risk than those without diabetes.

Some data suggest that medical staff fatigue during overnight hours contributes to worse patient outcomes. In a retrospective review of United Network for Organ Sharing data from adult patients who underwent orthotopic heart or lung transplants between January 2000 and June 2010, George and colleagues assessed whether nighttime transplant surgery had an adverse effect on recipient outcomes. The authors found no association between operative time of day and survival up to 1 year after transplant.

Many biomarkers have been proposed as potential determinants of disease risk, prognosis, or treatment response, but few biomarkers are routinely used in clinical practice. In a review of the literature, Ioannidis and Panagiotou Article examined the magnitude of the effect size for biomarkers evaluated in at least 1 highly cited study and included in at least 1 meta-analysis of the biomarker-disease determinant association. The authors found that highly cited biomarker studies often report more favorable effect sizes than subsequent larger studies or meta-analyses assessing the postulated association. In an editorial, Bossuyt Article highlights the necessity to critically evaluate the evidence on biomarkers.

Ms E was diagnosed with breast cancer at age 37 years and was subsequently found to have a BRCA1 mutation. She chose breast-conserving therapy and received adjuvant chemotherapy and radiation therapy. Tung discusses concerns of women (and families) with BRCA mutations, including treatment recommendations, risks of contralateral breast or other cancers, the effectiveness of Poly (ADP-ribose) polymerase 1 (PARP-1) inhibitors, and genetic testing in relatives of mutation carriers.

“The last time I ever saw Joe, he said, ‘It's been really nice talking to someone who wasn't in my head.’” From “A House Built Out of Madness.”

During the National Library of Medicine's 175 years of service, innovation has been key to the institution's mission of acquiring, organizing, disseminating, and preserving the world's medical knowledge.

Partnership for Patients

Physics of improvement

Realigning the comparative effectiveness agenda

Join Eric Widera, MD, Wednesday, June 15, from 2 to 3 PM eastern time to discuss assessing the ability to handle finances in older patients with cognitive impairment. To register, go to http://www.ihi.org/AuthorintheRoom.

How would you manage a 15-year-old athlete who experienced a sports-related concussion with loss of consciousness? Go to www.jama.com to read the case. Submit your response by July 3 for possible online posting.

Theme Issue on Cancer

For your patients: Information about breast cancer.