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Failure to Disclose in: Adherence to a Mediterranean Diet, Cognitive Decline, and Risk of Dementia [Correction]
Failure to Report Financial Disclosure Information [Letters]
Barberger-Gateau, P.
A 37-Year-Old Man Trying to Choose a High-Quality Hospital [Clinical Crossroads]
Reynolds, E.
Uniform Format for Disclosure of Competing Interests in ICMJE Journals [Editorial]
Drazen, J. M., Van Der Weyden, M. B., Sahni, P., Rosenberg, J., Marusic, A., Laine, C., Kotzin, S., Horton, R., Hebert, P. C., Haug, C., Godlee, F., Frizelle, F. A., de Leeuw, P. W., DeAngelis, C. D.
This Week in JAMA [This Week in JAMA]
Prone Positioning in Patients With Moderate and Severe Acute Respiratory Distress Syndrome: A Randomized Controlled Trial [Original Contribution]
Taccone, P., Pesenti, A., Latini, R., Polli, F., Vagginelli, F., Mietto, C., Caspani, L., Raimondi, F., Bordone, G., Iapichino, G., Mancebo, J., Guerin, C., Ayzac, L., Blanch, L., Fumagalli, R., Tognoni, G., Gattinoni, L., for the Prone-Supine II Study Group Context Post hoc analysis of a previous trial has suggested that prone positioning may improve survival in patients with severe hypoxemia and with acute respiratory distress syndrome (ARDS). Objective To assess possible outcome benefits of prone positioning in patients with moderate and severe hypoxemia who are affected by ARDS. Design, Setting, and Patients The Prone-Supine II Study, a multicenter, unblinded, randomized controlled trial conducted in 23 centers in Italy and 2 in Spain. Patients were 342 adults with ARDS receiving mechanical ventilation, enrolled from February 2004 through June 2008 and prospectively stratified into subgroups with moderate (n = 192) and severe (n = 150) hypoxemia. Interventions Patients were randomized to undergo supine (n = 174) or prone (20 hours per day; n = 168) positioning during ventilation. Main Outcome Measures The primary outcome was 28-day all-cause mortality. Secondary outcomes were 6-month mortality and mortality at intensive care unit discharge, organ dysfunctions, and the complication rate related to prone positioning. Results Prone and supine patients from the entire study population had similar 28-day (31.0% vs 32.8%; relative risk [RR], 0.97; 95% confidence interval [CI], 0.84-1.13; P = .72) and 6-month (47.0% vs 52.3%; RR, 0.90; 95% CI, 0.73-1.11; P = .33) mortality rates, despite significantly higher complication rates in the prone group. Outcomes were also similar for patients with moderate hypoxemia in the prone and supine groups at 28 days (25.5% vs 22.5%; RR, 1.04; 95% CI, 0.89-1.22; P = .62) and at 6 months (42.6% vs 43.9%; RR, 0.98; 95% CI, 0.76-1.25; P = .85). The 28-day mortality of patients with severe hypoxemia was 37.8% in the prone and 46.1% in the supine group (RR, 0.87; 95% CI, 0.66-1.14; P = .31), while their 6-month mortality was 52.7% and 63.2%, respectively (RR, 0.78; 95% CI, 0.53-1.14; P = .19). Conclusion Data from this study indicate that prone positioning does not provide significant survival benefit in patients with ARDS or in subgroups of patients with moderate and severe hypoxemia. Trial Registration clinicaltrials.gov Identifier: NCT00159939
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Failure to Disclose in: Adherence to a Mediterranean Diet, Cognitive Decline, and Risk of Dementia [Correction]
Failure to Report Financial Disclosure Information [Letters]
Barberger-Gateau, P.
A 37-Year-Old Man Trying to Choose a High-Quality Hospital [Clinical Crossroads]
Reynolds, E.
Uniform Format for Disclosure of Competing Interests in ICMJE Journals [Editorial]
Drazen, J. M., Van Der Weyden, M. B., Sahni, P., Rosenberg, J., Marusic, A., Laine, C., Kotzin, S., Horton, R., Hebert, P. C., Haug, C., Godlee, F., Frizelle, F. A., de Leeuw, P. W., DeAngelis, C. D.
This Week in JAMA [This Week in JAMA]
Prone Positioning in Patients With Moderate and Severe Acute Respiratory Distress Syndrome: A Randomized Controlled Trial [Original Contribution]
Taccone, P., Pesenti, A., Latini, R., Polli, F., Vagginelli, F., Mietto, C., Caspani, L., Raimondi, F., Bordone, G., Iapichino, G., Mancebo, J., Guerin, C., Ayzac, L., Blanch, L., Fumagalli, R., Tognoni, G., Gattinoni, L., for the Prone-Supine II Study Group Context Post hoc analysis of a previous trial has suggested that prone positioning may improve survival in patients with severe hypoxemia and with acute respiratory distress syndrome (ARDS). Objective To assess possible outcome benefits of prone positioning in patients with moderate and severe hypoxemia who are affected by ARDS. Design, Setting, and Patients The Prone-Supine II Study, a multicenter, unblinded, randomized controlled trial conducted in 23 centers in Italy and 2 in Spain. Patients were 342 adults with ARDS receiving mechanical ventilation, enrolled from February 2004 through June 2008 and prospectively stratified into subgroups with moderate (n = 192) and severe (n = 150) hypoxemia. Interventions Patients were randomized to undergo supine (n = 174) or prone (20 hours per day; n = 168) positioning during ventilation. Main Outcome Measures The primary outcome was 28-day all-cause mortality. Secondary outcomes were 6-month mortality and mortality at intensive care unit discharge, organ dysfunctions, and the complication rate related to prone positioning. Results Prone and supine patients from the entire study population had similar 28-day (31.0% vs 32.8%; relative risk [RR], 0.97; 95% confidence interval [CI], 0.84-1.13; P = .72) and 6-month (47.0% vs 52.3%; RR, 0.90; 95% CI, 0.73-1.11; P = .33) mortality rates, despite significantly higher complication rates in the prone group. Outcomes were also similar for patients with moderate hypoxemia in the prone and supine groups at 28 days (25.5% vs 22.5%; RR, 1.04; 95% CI, 0.89-1.22; P = .62) and at 6 months (42.6% vs 43.9%; RR, 0.98; 95% CI, 0.76-1.25; P = .85). The 28-day mortality of patients with severe hypoxemia was 37.8% in the prone and 46.1% in the supine group (RR, 0.87; 95% CI, 0.66-1.14; P = .31), while their 6-month mortality was 52.7% and 63.2%, respectively (RR, 0.78; 95% CI, 0.53-1.14; P = .19). Conclusion Data from this study indicate that prone positioning does not provide significant survival benefit in patients with ARDS or in subgroups of patients with moderate and severe hypoxemia. Trial Registration clinicaltrials.gov Identifier: NCT00159939
Sites:
National Association of Retired Physicians: An association established to promote the use of retired physicians more easily in volunteer medicine.American Board of Internal Medicine: American Board of Internal Medicine, Philadelphia PA 19106. A resource for residents and fellows in training, diplomates, and training program directors for Board Certification and Maintenance of Cetification in Internal Medicine and its subspecialties. Including information for health organizat...
American Board of Medical Specialties: Umbrella organization for the 24 approved medical specialty boards in the United States.
American Society of Internal Medicine: Web site of the American College of Physicians, the leading professional organization for internal medicine. Publisher of Annals of Internal Medicine and MKSAP (Medical Knowledge Self-Assessment Program).
Doctors For Adults: Information about internists / doctors of internal medicine and common illnesses they diagnose and treat. Internists are primary care physicians and specialists that focus on adult health care.
Internal Medicine on the Web: Various online associations devoted to the improvement of medical education in the US, Canada, and Puerto Rico.
Society of General Internal Medicine: Seeking to improve patient care, education, and research in primary care and general internal medicine.
Southern Medical Association: The Southern Medical Association enables physicians to practice the highest standards of medicine by fostering professional development and economic stability through education, services, collegiality, and leadership across multiple specialties.
This directory is based on the Open Directory and may have been modified
