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This Week in JAMA
May 26, 2010

This Week in JAMA

JAMA. 2010;303(20):2005. doi:10.1001/jama.2010.677

Antibiotic therapy is recommended for patients with acute exacerbations of chronic obstructive pulmonary disease (COPD); however, the evidence supporting this recommendation is limited. In a retrospective cohort study of 84 621 patients hospitalized for acute exacerbations of COPD, Rothberg and colleagues compared outcomes among patients who received antibiotics in the first 2 hospital days with patients who received antibiotics later or not at all. The authors report that early antibiotic treatment was associated with improved outcomes, including a lower likelihood of mechanical ventilation after the second hospital day, lower inpatient mortality, and fewer readmissions for acute exacerbations of COPD within 30 days of discharge.

In an analysis of National Health and Nutrition Examination Survey data from 1988-1994 and 1999-2008, Egan and colleagues Article assessed progress in treating and controlling hypertension in the United States. Among their findings was that blood pressure was controlled to less than 140/90 mm Hg in an estimated 50.1% of patients with hypertension in 2007-2008. Rates of hypertension control were lower among persons aged 18 to 39 years than among older individuals and among Hispanic compared with white individuals. In an editorial, Chobanian Article discusses factors that may contribute to improved treatment and control of hypertension.

Pneumonia is the leading cause of childhood death in sub-Saharan Africa and determining the causative pathogens could enhance vaccine development. In a prospective observational and case-control study conducted at a rural Kenyan hospital, Berkley and colleagues assessed the presence of respiratory viruses in nasal wash specimens obtained from children with severe pneumonia or mild upper respiratory tract infection or those seen for well-child immunizations. The authors report that among infants and children with severe pneumonia, respiratory syncytial virus was the predominant viral pathogen.

Clinical trial investigators may consciously or subconsciously shape the reporting of trial results, including distorted interpretation of results that may mislead readers (eg, reporting with a positive “spin”). In a representative sample of 72 randomized clinical trials that were published in December 2006 and reported statistically nonsignificant results for the primary outcome(s), Boutron and colleagues found that reporting and interpretation of the primary outcome(s) often had a positive spin, inconsistent with the actual study results.

Mr Q is a 42-year-old man with hypercholesterolemia who, for the past decade, has consumed 3 or 4 ounces of red wine nightly as a cardioprotective strategy. At a recent specialty clinic visit, the physician cautioned that regular moderate alcohol intake may accelerate age-related brain atrophy. Mukamal discusses the epidemiology of alcohol use in the United States, the benefits and harms of moderate alcohol intake, and the strengths and limitations of the observational evidence linking alcohol intake to disease risk.

“It occurred to me that when a child doesn't reach a milestone, that rewarding moment of parental pride and amazement doesn't ever come.” From “The Denver II.”

Severity of disease should guide treatment choices for patients with Clostridium difficile infection, say new clinical guidelines.

Balancing hypoglycemia and glycemic control

Washington, Ottawa, and health care reform

Retooling the uniformed Public Health Service

An article in the April issue of the Archives of Dermatology reported that an appearance-focused skin cancer prevention intervention reduced indoor tanning among women with seasonal affective disorder symptoms or pathological tanning motives. Robinson discusses counseling strategies that address individuals' motivations to tan.

Join David B. Carr, MD, Wednesday, June 16, from 2 to 3 PM eastern time to discuss dealing with older adult drivers with cognitive impairment. To register, go to http://www.ihi.org/AuthorintheRoom.

For your patients: Information about hypertension.

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