Seven to 14 days' treatment with systemic glucocorticoids is recommended for patients with acute exacerbations of chronic obstructive pulmonary disease (COPD); however, the optimal dose and duration of therapy are not known. In a randomized trial that enrolled 314 patients with an acute exacerbation of COPD, Leuppi and colleagues found that with regard to the time to reexacerbation, oral prednisone (40 mg daily) for 5 days was noninferior to treatment for 14 days. In an editorial, Sin and Park discuss implications of the study findings for patients with COPD.
See Article, Editorial, and Author Audio Interview
A common polymorphism in the promoter of a mucin gene (MUC5B) has been associated with an increased risk of idiopathic pulmonary fibrosis (IPF). In a retrospective study that involved 586 patients with idiopathic pulmonary fibrosis, Peljto and colleagues found that patients with 1 or more copies of the idiopathic pulmonary fibrosis risk allele (T) had improved all-cause survival.
Among persons who are mild to moderately obese and have type 2 diabetes, it is not clear whether bariatric surgery is associated with greater weight loss and better metabolic risk factor control than nonsurgical treatment. Two articles in this issue address this question. In a randomized trial of 120 patients, Ikramuddin and colleagues found that adding Roux-en-Y gastric bypass to lifestyle modification and intensive medical management resulted in a greater likelihood of achieving hemoglobin A1c, lipid, and blood pressure treatment goals. In an analysis of data from 54 surgical and nonsurgical studies that involved patients with diabetes and body mass index of 30 to 35, Maggard-Gibbons and colleagues found that bariatric surgical procedures were associated with greater short-term weight loss and more favorable intermediate glucose outcomes than nonsurgical treatments. In an editorial, Wolfe and colleagues discuss implications of treating type 2 diabetes with surgery.
See Article, Review, Editorial, and
Highly Sensitive Assays for Cardiac Troponins
Cardiac troponins are the preferred biomarkers for diagnosis of myocardial infarction. However, acute and chronic conditions distinct from acute coronary syndromes (ACS) can lead to small elevations in troponin levels—detectable with new highly sensitive troponin assays—potentially exposing some patients to unnecessary testing and risk. de Lemos discusses the interpretation of elevated troponin levels in patients with and without suspected ACS.
See Grand Rounds
From the JAMA Network
An article in the February 2013 issue of JAMA Surgery reported that among adult patients with major trauma and significant blood loss, higher plasma-to-packed red blood cell (pRBC) and platelet-to-pRBC ratios early in resuscitation are associated with decreased mortality. Maier discusses strategies to prevent hemorrhage-related mortality in severely injured patients and unresolved challenges requiring further investigation.
In an attempt to find a middle ground between criminalization and legalization of illicit drugs, a new drug control policy from the White House emphasizes preventing, treating, and supporting recovery from substance abuse disorders.
Mortality as a financial incentive: consequences and implications
The future of quality measurement: improvement and accountability
Synthesizing evidence: shifting focus to the body of evidence
Opioid analgesics: risky drugs, not risky patients
“Patients are the best judges of whether health care organizations meet their needs, ie, are customer friendly, provide accessible and culturally sensitive care, and engage them in the decision-making process.” From “A View From the Safety Net.”
Dr McDermott summarizes and comments on this week's issue, including Viewpoints, Editorials, Original Contributions, and clinical content. Go to http://jama.jamanetwork.com/multimedia.aspx#Weekly
For your patients: Information about ear problems in children.
This Week in JAMA. JAMA. 2013;309(21):2183. doi:10.1001/jama.2013.5826