JAMA : the journal of the American Medical Association
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Randomized Controlled Trial Multicenter Study
Early, Individualized Recommendations for Hospitalized Patients With Acute Kidney Injury: A Randomized Clinical Trial.
Acute kidney injury (AKI) is a common complication during hospitalization and is associated with adverse outcomes. ⋯ Among patients hospitalized with AKI, recommendations from a kidney action team did not significantly reduce the composite outcome of worsening AKI stage, dialysis, or mortality, despite a higher rate of recommendation implementation in the intervention group than in the usual care group.
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Comment Randomized Controlled Trial Multicenter Study
Symptom Screening Linked to Care Pathways for Pediatric Patients With Cancer: A Randomized Clinical Trial.
Pediatric patients with cancer commonly experience severely bothersome symptoms. The effectiveness of routine symptom screening with symptom feedback and symptom management care pathways is unknown. ⋯ Symptom screening with symptom feedback and symptom management care pathways was associated with improved symptom scores and increased symptom-specific interventions. Future work should integrate symptom screening into routine clinical care.
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Randomized Controlled Trial Multicenter Study
Zerlasiran-A Small-Interfering RNA Targeting Lipoprotein(a): A Phase 2 Randomized Clinical Trial.
Elevated lipoprotein(a) increases the risk of atherosclerotic cardiovascular disease (ASCVD) and aortic stenosis. ⋯ Zerlasiran was well-tolerated and reduced time-averaged lipoprotein(a) concentration by more than 80% during 36 weeks of treatment in patients with ASCVD.
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Comment Randomized Controlled Trial Multicenter Study
Intratracheal Budesonide Mixed With Surfactant for Extremely Preterm Infants: The PLUSS Randomized Clinical Trial.
Bronchopulmonary dysplasia (BPD) is a common adverse outcome in extremely preterm infants born at less than 28 weeks' gestation. Systemic corticosteroids are effective against BPD but may be associated with adverse outcomes. Corticosteroids given directly into the lungs may be effective and safer. ⋯ In extremely preterm infants receiving surfactant for respiratory distress syndrome, early intratracheal budesonide may have little to no effect on survival free of BPD.
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Comment Randomized Controlled Trial Multicenter Study Comparative Study
Frequency of Screening and Spontaneous Breathing Trial Techniques: A Randomized Clinical Trial.
The optimal screening frequency and spontaneous breathing trial (SBT) technique to liberate adults from ventilators are unknown. ⋯ Among critically ill adults who received invasive mechanical ventilation for more than 24 hours, screening frequency (once-daily vs more frequent screening) and SBT technique (pressure-supported vs T-piece SBT) did not change the time to successful extubation. However, an unexpected and statistically significant interaction was identified; protocolized more frequent screening combined with pressure-supported SBTs increased the time to first successful extubation.