JAMA : the journal of the American Medical Association
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Randomized Controlled Trial Multicenter Study
Femoral vs jugular venous catheterization and risk of nosocomial events in adults requiring acute renal replacement therapy: a randomized controlled trial.
Based on concerns about the risk of infection, the jugular site is often preferred over the femoral site for short-term dialysis vascular access. ⋯ Jugular venous catheterization access does not appear to reduce the risk of infection compared with femoral access, except among adults with a high BMI, and may have a higher risk of hematoma.
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Randomized Controlled Trial Multicenter Study
Escitalopram and problem-solving therapy for prevention of poststroke depression: a randomized controlled trial.
Depression occurs in more than half of patients who have experienced a stroke. Poststroke depression has been shown in numerous studies to be associated with both impaired recovery in activities of daily living and increased mortality. Prevention of depression thus represents a potentially important goal. ⋯ In this study of nondepressed patients with recent stroke, the use of escitalopram or problem-solving therapy resulted in a significantly lower incidence of depression over 12 months of treatment compared with placebo, but problem-solving therapy did not achieve significant results over placebo using the intention-to-treat conservative method of analysis.
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Multicenter Study
Improvement in process of care and outcome after a multicenter severe sepsis educational program in Spain.
Concern exists that current guidelines for care of patients with severe sepsis and septic shock are followed variably, possibly due to a lack of adequate education. ⋯ A national educational effort to promote bundles of care for severe sepsis and septic shock was associated with improved guideline compliance and lower hospital mortality. However, compliance rates were still low, and the improvement in the resuscitation bundle lapsed by 1 year.
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Multicenter Study
Corticosteroids and mortality in children with bacterial meningitis.
In adults, adjuvant corticosteroids significantly reduce mortality associated with bacterial meningitis; however, in children, studies reveal conflicting results. ⋯ In this multicenter observational study of children with bacterial meningitis, adjuvant corticosteroid therapy was not associated with time to death or time to hospital discharge.