JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENT
JAMA NEWS RELEASES
(Embargoed for Release: 3:00 p.m. CT, Tuesday, February 19, 2008)
JAMA NEWS RELEASES
PATIENTS APPEAR TO HAVE LOWER RATE OF SURVIVAL IF IN-HOSPITAL CARDIAC ARREST OCCURS DURING NIGHT, WEEKENDS
DIFFERENT TREATMENTS FOR ACUTE KIDNEY FAILURE APPEAR TO OFTEN HAVE SIMILAR OUTCOMES
BIANNUAL MASS ANTIBIOTIC TREATMENT MAY HELP REDUCE MAJOR INFECTIOUS CAUSE OF BLINDNESS IN AFRICA
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
HOSPITALIZED PATIENTS ARE LESS LIKELY TO SURVIVE CARDIAC ARREST DURING NIGHTS AND WEEKENDS
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Embargoed for Release: 3:00 p.m. CT, Tuesday, February 19, 2008
Media Advisory: To contact Mary Ann Peberdy, M.D., call Joe Kuttenkuler at 804-828-6607.
PATIENTS APPEAR TO HAVE LOWER RATE OF SURVIVAL IF IN-HOSPITAL CARDIAC ARREST OCCURS DURING NIGHT, WEEKENDS
CHICAGO—Patients who have an in-hospital cardiac arrest at night or on the weekend have a substantially lower rate of survival to discharge than hospitalized patients who experience a cardiac arrest during day/evening times on weekdays, according to a study in the February 20 issue of JAMA.
The detection and treatment of cardiac arrests may be less effective at night because of patient, hospital, staffing and response factors. If in-hospital cardiac arrests are more common or survival is worse on nights and weekends, this information could have important implications for hospital staffing, training, care delivery processes and equipment decisions, according to background information in the article.
Mary Ann Peberdy, M.D., of Virginia Commonwealth University, Richmond, Va., and colleagues evaluated survival rates for adults with in-hospital cardiac arrest by time of day and day of week. The study included data on 86,748 adult, in-hospital cardiac arrest events occurring at 507 medical/surgical hospitals participating in the American Heart Association’s National Registry of Cardiopulmonary Resuscitation from January 2000 through February 2007. The researchers examined survival from cardiac arrest in hourly time segments, defining day/evening as 7:00 a.m. to 10:59 p.m., night as 11:00 p.m. to 6:59 a.m., and weekend as 11:00 p.m. on Friday to 6:59 a.m. on Monday.
A total of 58,593 cases of in-hospital cardiac arrest occurred during day/evening hours (including 15,110 on weekends), and 28,155 cases occurred during night hours (including 7,790 on weekends).
The researchers found that rates of survival to discharge (14.7 percent vs. 19.8 percent), return of spontaneous circulation for longer than 20 minutes (44.7 percent vs. 51.1 percent), survival at 24 hours (28.9 percent vs. 35.4 percent), and favorable neurological outcomes (11.0 percent vs. 15.2 percent) were substantially lower during the night compared with day/evening.
Survival to discharge at night was similar during the week (14.6 percent) and weekends (14.8 percent). Survival during day/evening weekdays (20.6 percent) was higher than on weekends (17.4 percent).
"The principal finding of this study was that survival to discharge following in-hospital cardiac arrest was lower [when the arrest occurred] during nights and weekends compared with day/evening times on weekdays, even after accounting for many potentially confounding patient, arrest event, and hospital factors," the authors write.
"The mechanism for the decreased survival during the night is likely multifactorial, potentially including biological differences in patients as well as health care staff and hospital staffing and operational factors. These data suggest the need to focus on night and weekend hospitalwide resuscitation system processes of care that can potentially improve patient safety and survival following cardiac arrest," the researchers conclude.
(JAMA. 2008;299[7]:785-792. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, February 19, 2008
Media Advisory: To contact corresponding author Marcello Tonelli, M.D., S.M., call Lindsay Elleker at 780-492-0647.
DIFFERENT TREATMENTS FOR ACUTE KIDNEY FAILURE APPEAR TO OFTEN HAVE SIMILAR OUTCOMES
CHICAGO—An analysis of studies examining treatments for acute kidney failure indicates that intermittent hemodialysis and continuous kidney replacement therapy appear to lead to similar clinical outcomes, including a similar risk of death, according to an article in the February 20 issue of JAMA.
Acute renal (kidney) failure (ARF) is increasingly common and is associated with high costs and adverse outcomes, including a higher risk of death, increased length of hospital stay and the requirement for chronic dialysis. A variety of options are currently available for prescribing acute renal replacement (procedures which temporarily or permanently remedy insufficient cleansing of body fluids by the kidneys), including intermittent, continuous, and extended-duration hemodialysis and hemofiltration (similar to hemodialysis, a slow, continuous therapy in which sessions, usually daily, last between 12 to 24 hours), and a combinations of these. "Despite advances in dialysis technology, many questions remain about how best to provide renal replacement to patients with ARF," the authors write.
Neesh Pannu, M.D., S.M., of the University of Alberta, Edmonton, Canada, and colleagues conducted a review and evaluation of current evidence for the optimal dialytic management of ARF. They searched databases for studies examining dialytic support in adults with acute renal failure that reported the incidence of clinical outcomes such as mortality, length of hospital stay, need for chronic dialysis, or development of hypotension (abnormally low blood pressure). From 173 retrieved articles, 30 randomized controlled trials (RCTs) and eight prospective cohort studies were eligible for inclusion.
An analysis of the data from the studies indicated that no conclusions could be drawn about optimal indications for or timing of renal replacement. Data comparing continuous renal replacement therapy (CRRT) with intermittent hemodialysis demonstrated no clinically relevant difference in outcomes between methods, including the risk of death, or for the requirement for chronic dialysis treatment in survivors. There was also no evidence that either CRRT or intermittent hemodialysis was superior for reducing resource use or the risk of chronic dialysis dependence in patients with ARF.
Regarding the recommended management strategy for patients with severe ARF, the authors write: "The decision to initiate renal replacement therapy (RRT) in patients with severe ARF requires consideration of multiple factors, including assessment of intravascular volume, electrolyte and acid-base status, uremia [retention in the bloodstream of waste products normally excreted in the urine], nutritional requirements, urine output, hemodynamic status, and the evolving clinical course of each patient. Potential advantages of earlier RRT initiation must be set against the hypothetical risks of treatment-induced renal injury, bleeding due to anticoagulation, and mechanical and infectious complications associated with central venous access."
"Given the significantly higher cost of CRRT, intermittent hemodialysis may be preferable for patients with ARF who require RRT. In otherwise stable patients, alternate-day dialysis treatments of 4 or more hours using blood flows of 250 mL/min or greater are usually sufficient in patients with or without concomitant critical illness. More frequent hemodialysis may be required in highly catabolic [a destructive metabolic process] patients or to achieve treatment targets for fluid, electrolyte, or acid-base management, although data identifying how such targets should be set are limited. Despite the lack of data supporting its superiority and its higher cost, some clinicians may prefer to use CRRT in critically ill patients with ARF and severe hemodynamic instability. If CRRT is used, the target dose should be 35 mL/kg per hour [3 L/h in a 154 lb. person]," the researchers write.
(JAMA. 2008;299[7]:793-805. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, February 19, 2008
Media Advisory: To contact corresponding author Thomas M. Lietman, M.D., call Wallace Ravven at 415-502-1332. To contact editorial co-author David Mabey, D.M., F.R.C.P., email: david.mabey{at}lshtm.ac.uk.
BIANNUAL MASS ANTIBIOTIC TREATMENT MAY HELP REDUCE MAJOR INFECTIOUS CAUSE OF BLINDNESS IN AFRICA
CHICAGO—Changing the administration of the antibiotic azithromycin from once to twice a year in villages in Ethiopia substantially reduced eye infections in preschool children caused by chlamydia, which causes the serious, contagious eye disease trachoma, according to a study in the February 20 issue of JAMA.
Trachoma is the leading infectious cause of blindness worldwide. Although it has been eliminated from Western Europe and the United States, it is still common in poor, arid areas such as rural sub-Saharan Africa. "The World Health Organization has launched a program to control trachoma, relying in large part on annual repeated mass azithromycin administrations. Program administrators anticipate that the treatments will reduce the prevalence of the ocular strains of chlamydia that cause trachoma to a level low enough that resulting blindness will be no longer be a major public health concern. However, local elimination of ocular chlamydia may be obtainable," the authors write.
Elimination has become a particularly important goal because of a growing concern that infection may return into communities that have lost some of their immunity to chlamydia after antibiotics are discontinued. Mathematical models have suggested that elimination is possible, but may require relatively frequent treatments in regions with high incidence, according to background information in the article.
Muluken Melese, M.D., M.P.H., of Orbis International, Addis Ababa, Ethiopia, and colleagues compared the outcomes of azithromycin given annually and biannually to all residents (age 1 year or older) of 16 rural villages in the Gurage Zone, Ethiopia, an area with a high prevalence of trachoma, from March 2003 to April 2005. Overall, 14,897 of 16,403 eligible individuals (90.8 percent) received their scheduled treatment.
The researchers found that two annual treatments (at the beginning of the study and 12 months) reduced infection in preschool children in eight villages 6-fold, from 42.6 percent to 6.8 percent by 24 months. Four biannual treatments (baseline, 6, 12, and 18 months) reduced infection in preschool children in the other eight villages 35-fold, from 31.6 percent to 0.9 percent by 24 months. The prevalence of infection at 24 months was significantly lower in children in the biannually treated villages (0.9 percent) than in the annually treated villages (6.8 percent). At 24 months, no infection could be identified in preschool children in 6 of 8 of the residents receiving biannual treatment and 1 of 8 of the residents receiving annual treatments. Having no infection identified at 24 months was associated with being in the biannual treatment group.
"Biannual coverage of a large portion of the community may be necessary to eliminate infection from a severely affected community or at least to do so in a timely manner. Although programs may be reluctant to devote their scarce resources to more frequent treatment, this may be more cost-effective in the long term. Local elimination of the ocular strains of chlamydia from villages is a feasible goal but may require biannual distributions in hyperendemic areas. The results of this study confirm models that suggest treatments will need to be given for more than the 2 years to predictably achieve elimination in more than 95 percent of villages. Whether elimination from a larger area is possible will depend on the frequency of community-to-community transmission," the authors conclude.
(JAMA. 2008;299[7]:778-784. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: MASS ANTIBIOTIC ADMINISTRATION FOR ERADICATION OF OCULAR CHLAMYDIA TRACHOMATIS
In an accompanying editorial, David Mabey, D.M., F.R.C.P., and Anthony W. Solomon, M.R.C.P., Ph.D., of the London School of Hygiene & Tropical Medicine, London, write that the findings by Melese and colleagues add important information regarding treating trachoma.
"Treating entire regions twice yearly could help ensure that gains made from frequent antibiotic use are not eroded by reintroduction of infection from outside the treated area but will significantly increase the cost of antibiotics and of their distribution. Finally, studies to examine whether more frequent azithromycin use will result in the emergence of macrolide-resistant strains of C trachomatis or other important pathogens are urgently required, for such an outcome would more than offset any gain derived from biannual treatment. In the meantime, the findings of Melese et al represent an important contribution to understanding how blinding trachoma can be reduced and hopefully eliminated."
(JAMA. 2008;299[76]:819-820. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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JAMA REPORTS
VIDEO: Windows Media | Quicktime
HOSPITALIZED PATIENTS ARE LESS LIKELY TO SURVIVE CARDIAC ARREST DURING NIGHTS AND WEEKENDS
INTRO:
Cardiac arrest is considered a major public health issue. Now a new study finds patients who suffer from cardiac arrest while hospitalized, may be less likely to survive depending on the day and time they experience trouble. Jennifer Mitchell explains in this week’s JAMA Report.
VIDEO:
doctor listening to heart
talking to patient in bed
two shot doc and patient
AUDIO:
CRITICAL CARE SPECIALIST KYLE GUNNERSON HAS HELPED RESUSCITATE NUMEROUS PATIENTS IN CARDIAC ARREST. HE SAYS TWO FACTORS ARE ESSENTIAL FOR SURVIVAL.
VIDEO:
SOT/FULL
@ :11
Super: Kyle Gunnerson M.D.
Critical Care Specialist
Runs :11
AUDIO:
“The two most important things about surviving a cardiac arrest is identifying an abnormal rhythm quickly and then delivering the appropriate therapy.”
VIDEO:
B-ROLL
GFX/JAMA COVER
hallway hospital shot
AUDIO:
ACCORDING TO A STUDY THIS WEEK IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, THERE IS CAUSE FOR CONCERN AT MANY U.S. HOSPITALS. PATIENTS WHO GO INTO CARDIAC ARREST WHILE HOSPITALIZED MAY BE LESS LIKELY TO SURVIVE.
VIDEO:
SOT/FULL
@ :35
Super: Mary Ann Peberdy, M.D.
Virginia Commonwealth University
Runs :11
AUDIO:
“We were able to determine that survival from cardiac arrest was significantly lower when the arrest occurred during the night or on the weekend compared to during weekdays.”
VIDEO:
B-ROLL
two doctors talk
tight of heart machine
FULL SCREEN GRAPHIC
Cardiac Arrest Survival Rates
Night: 15% Survival Rate
Day: 20% Survival Rate
(down arrow in-between)
Weekday 20% (arrow) Weekend 17%
AUDIO:
DR. MARY ANN PEBERDY AND HER COLLEAGUES AT VIRGINIA COMMONWEALTH UNIVERSITY ANALYZED DATA FROM ABOUT EIGHTY-SIX THOUSAND INCIDENTS OF CARDIAC ARREST AT ROUGHLY FIVE HUNDRED U.S. HOSPITALS AND MEDICAL CENTERS. THEY FOUND PATIENTS WHO WENT INTO CARDIAC ARREST DURING THE NIGHT HAD ONLY A FIFTEEN PERCENT SURVIVAL RATE COMPARED TO A TWENTY PERCENT SURVIVAL RATE DURING THE DAY. DURING WEEKENDS THE LIKELIHOOD OF SURVIVAL ALSO DECREASED.
VIDEO:
SOT/FULL
Mary Ann Peberdy, M.D.
Virginia Commonwealth University
Runs :07
AUDIO:
“It may be a physiological difference in patients that accounts for this study, it may be that hospital staffing patterns are different.”
VIDEO:
Staff walking in hall
staff run down hall
AUDIO:
LOWER PATIENT SURVIVAL RATES WERE FOUND IN ALL AREAS OF THE HOSPITALS EXCEPT THE EMERGENCY DEPARTMENT.
VIDEO:
SOT/FULL
Mary Ann Peberdy, M.D.
Virginia Commonwealth University
Runs: 09
AUDIO:
“The emergency department is one of the only areas in the hospital that has consistent staffing twenty-four hours a day and seven days a week.”
VIDEO:
B-ROLL
resuscitation drill video
AUDIO:
THE STUDY RECOMMENDS HOSPITALWIDE RESUSCITATION TRAINING LIKE THIS AT ALL U.S. HOSPITALS WITH AN EMPHASIS ON NIGHT AND WEEKENDS.
VIDEO:
SOT/FULL
Kyle Gunnerson, M.D.
Critical Care Specialist
Runs: 05
AUDIO:
“It’s imperative that we go to the measures it will take to address this issue.”
VIDEO:
B-ROLL
Staff in hallway
Nursing station
mock resuscitation drill
AUDIO:
MANY HOSPITAL STAFF RESPOND TO ONE CARDIAC ARREST OR LESS A YEAR. ADDITIONAL TRAINING COULD HELP THEM RETAIN NECESSARY SKILLS AND IMPROVE PATIENT SAFETY IN THE PROCESS. JENNIFER MITCHELL, THE JAMA REPORT.
TAG:
The study defined “night” hours beginning at 11PM through 7AM. Weekends were defined from 11PM Friday night through 7AM Monday morning. Researchers say staffing and the need for more training may just be part of the answer. Data for this study was compiled from the National Registry of Cardiopulmonary Resuscitation from 2000 through 2007. Hospital and medical center names were not made public. For more information, visit www.jama.com.
