EDITORIAL Constancy of Purpose for Improving Patient Safety — Missing in Action Donald M. Berwick N Engl J Med 2023; 388:181-182DOI: 10.1056/NEJMe2213567 The 20th-century statistician and quality scholar W. Edwards Deming proposed the “14 Points for Top Leaders” — a checklist of management principles for executives who wish to nurture improvement in complex systems. First on his list was “constancy of purpose for improvement.”1 In Deming’s view, when leaders s...

Obesity and Critical Care Nutrition A panel discussion with an international group of experts in the care of obese patients in the critical care setting evaluated best practices in malnutrition screening and assessment, estimation of energy needs for obese patients, the risks and management of sarcopenic obesity, the importance of tailored nutrition, and the role of immunonutrition.  Patients in the ICU are often overweight and/or obese, with obesity r...

SPECIAL ARTICLE The Safety of Inpatient Health Care David W. Bates, David M. Levine, Hojjat Salmasian, et al N Engl J Med 2023; 388:142-153DOI: 10.1056/NEJMsa2206117 Abstract BACKGROUND Adverse events during hospitalization are a major cause of patient harm, as documented in the 1991 Harvard Medical Practice Study. Patient safety has changed substantially in the decades since that study was conducted, and a more current assessment of harm during hospital...

ORIGINAL ARTICLE Hypothermia or Machine Perfusion in Kidney Donors Darren Malinoski, Christina Saunders, Sharon Swain, et al N Engl J Med 2023; 388:418-426DOI: 10.1056/NEJMoa2118265 Abstract BACKGROUND Therapeutic hypothermia in brain-dead organ donors has been shown to reduce delayed graft function in kidney recipients after transplantation. Data are needed on the effect of hypothermia as compared with machine perfusion on outcomes after kidney transpla...

Effect of Daily Written Updates for Families of ICU Patients ICU patients are often too ill to make decisions for themselves and need family members or surrogates to make medical decisions on their behalf. Surrogates may have to use substituted judgment when the critically ill patient has left no advanced directives. In such a situation, the surrogate may have to make decisions by considering what the patient would have done in a similar situation. This can cause u...

Original Investigation  January 3, 2023 Effect of Remifentanil vs Neuromuscular Blockers During Rapid Sequence Intubation on Successful Intubation Without Major Complications Among Patients at Risk of Aspiration: A Randomized Clinical Trial Nicolas Grillot, Gilles Lebuffe, Olivier Huet, et al JAMA. 2023;329(1):28-38. doi:10.1001/jama.2022.23550 Key Points Question  Are rapid-onset opioids noninferior to rapid-onset neuromuscular ...

Editorial  December 16, 2022 Long-term Follow-up After Critical COVID-19: REMAP-CAP Revisited Michael L. Barnett, Paul E. Sax JAMA. Published online December 16, 2022. doi:10.1001/jama.2022.23700 The year 2020 was a grim and uncertain time for any clinician caring for inpatients with COVID-19, especially those with critical illness. In an era of modern medicine in which the range of options for many conditions can seem limitless, this novel v...

Research Letter  November 18, 2022 COVID-19 and Excess All-Cause Mortality in the US and 20 Comparison Countries, June 2021-March 2022 Alyssa Bilinski, Kathryn Thompson, Ezekiel Emanuel JAMA. 2023;329(1):92-94. doi:10.1001/jama.2022.21795 The US experienced high COVID-19 death rates and higher excess all-cause mortality compared with peer countries during 2020.1 However, an important question is how cross-national differences in mortality shifted ...

Editorial  December 27, 2022 The Relationship Between Income and Child Health: New Data for an Old Question Janet Currie, Hannes Schwandt JAMA. 2022;328(24):2402-2403. doi:10.1001/jama.2022.22245 Researchers have been using statistical methods to investigate the link between health and income in both adults and children since individual-level data allowing them to do so first became available.1-3 However, previous investigators were forc...

COMMENT|ONLINE FIRST Nutrition in critical illness—research is worth the EFFORT Emma J Ridley, Lee-anne S Chapple Lancet Published:January 25, 2023 DOI:https://doi.org/10.1016/S0140-6736(23)00091-0 Multiple high-quality randomised controlled trials conducted over the past decade in critical care nutrition have shown no difference between interventions and routine care.1, 2, 3, 4 These findings have led to the assumption that nutrition in...