The optimal approach to assess whether non–small cell lung cancer (NSCLC) has metastasized to the mediastinal lymph nodes is not clear. Annema and colleagues Article randomly assigned patients with (suspected) resectable NSCLC to undergo either surgical staging by video mediastinoscopy or staging by endosonography (combined transesophageal and endobronchial ultrasound) followed by surgical staging if no nodal metastases were found. The authors report that the combined strategy of endosonography and surgical staging had greater sensitivity than surgical staging alone in identifying patients with mediastinal nodal metastases. In an editorial, Iannettoni Article discusses the challenge of providing highly skill-dependent lung cancer staging modalities to all patients who might benefit.
Patients with type 2 diabetes should be encouraged to exercise, but whether to emphasize aerobic, resistance, or both types of exercise is unclear. To address this question, Church and colleagues Article randomly assigned individuals with type 2 diabetes to a 9-month supervised exercise intervention consisting of aerobic training only, resistance training only, or both aerobic and resistance training or to a nonexercise control group. The authors found that only the combination of resistance and aerobic training was associated with improved hemoglobin A1c (HbA1c) levels. In an editorial, Sigal and Kenny Article discuss what is known about the contribution of exercise to improved glycemic control.
In an analysis of data from the Framingham Heart Study, Lubitz and colleagues examined the contribution of familial atrial fibrillation (AF) to the risk of new-onset AF. The authors report that familial AF was associated with an increased risk of new-onset AF that was not attenuated by adjustment for established AF risk factors—including the presence of AF-related genetic variants. When familial AF occurred prematurely (onset ≤65 years old), a slight increase in predictive accuracy was observed compared with prediction based on traditional risk factors.
Intake of fructose increases serum uric acid levels, and an increasing incidence of gout in the United States has coincided with an increase in soft drink consumption. A prior study found that consumption of sugar-sweetened sodas, fruit juices, and fructose were associated with an increased risk of gout among men. To examine this relationship in women, Choi and colleagues analyzed data from the Nurses' Health Study and found that consumption of fructose-rich beverages (particularly sugar-sweetened soda and orange juice) was associated with an increased risk of incident gout among women.
Studies evaluating the effectiveness of quality improvement (QI) interventions are often of poor methodological quality. Fan and colleagues discuss issues to consider when evaluating articles about QI interventions, including the risk of bias, assessing whether appropriate outcomes were measured, and considering the applicability of the study results outside the original research setting.
“Joe and Elsie . . . were two strangers brought together by difficult circumstances.” From “A Modern Family.”
In an interview with JAMA, Donald M. Berwick, MD, MPP, head of the Centers for Medicare & Medicaid Services, describes his vision for the role that his agency will play in health system reform.
Population science: evolution and feasibility
Rationing: the real meaning
Academic medical centers' conflict of interest policies
Join Julia Neily, RN, MS, MPH, and James P. Bagian, MD, Wednesday, December 15, from 2 to 3 PM eastern time to discuss implementation of a medical team training program and surgical mortality. To register, go to http://www.ihi.org/AuthorintheRoom.
Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.
For your patients: Information about gout.
This Week in JAMA . JAMA. 2010;304(20):2205. doi:10.1001/jama.2010.1711