This Week in JAMA

Current standard treatment for idiopathic sensorineural hearing loss is a tapering dose of oral corticosteroids. However, results from uncontrolled case series have suggested that intratympanic corticosteroid injection may achieve similar rates of hearing improvement. In a randomized, noninferiority trial that involved 250 patients with sensorineural hearing loss, Rauch and colleagues Article compared the effect of oral prednisone vs intratympanic methylprednisolone on hearing recovery assessed 2 months after treatment. The authors defined noninferiority as a less than 10-dB difference in hearing outcome between treatments and found that intratympanic treatment was not inferior to oral prednisone treatment. In an editorial, Piccirillo Article discusses sudden sensorineural hearing loss, its treatment, and questions for future investigation.

The risks associated with new-onset atrial fibrillation (AF) among seemingly healthy middle-aged women and others with a low overall cardiovascular risk factor burden are poorly defined. In an analysis of observational follow-up data from participants in the Women's Health Study who were considered healthy at baseline, Conen and colleagues Article found that incident AF was independently associated with an increased risk of cardiovascular, noncardiovascular, and all-cause mortality, with some of the risk potentially explained by nonfatal cardiovascular events. In an editorial, Miyasaka and Tsang Article discuss the evidence that links atrial fibrillation with premature death.

In a prospective cohort study of 470 elderly patients who had symptoms of heart failure, Alehagen and colleagues evaluated the association of baseline levels of plasma copeptin—the C-terminal fragment of provasopressin—and the N-terminal fragment of B-type natriuretic peptide (NT-proBNP) with all-cause and cardiovascular mortality during 13 years of follow-up. The authors report that elevated concentrations of copeptin were associated with an increased risk of all-cause and cardiovascular mortality.

In an analysis of data from a national cross-sectional sample of Medicare beneficiaries, Chang and colleagues examined the association between the primary care physician workforce and individual patient-level outcomes (specifically, mortality, ambulatory care sensitive condition hospitalizations, and Medicare program spending). The authors used 2 measures of the physician workforce—one based on physician self-designated specialty in the American Medical Association Masterfile and the other, an estimate of ambulatory full-time equivalents (FTE) of primary care physicians derived from Medicare claims. They found that a higher level of primary care physician workforce, particularly that estimated by the FTE measure, was associated with more favorable patient outcomes.

From the Archives Journals

An article in the current issue of Archives of Facial Plastic Surgery reports quantitative functional and quality-of-life outcomes among children with facial nerve paralysis who underwent free muscle transfer for smile reanimation. Alam discusses the importance of quantitative assessment of surgical outcomes to define best treatment.

“Our professional commitment is centered on our patients, just as teachers are committed to their students, attorneys are committed to their clients, and US senators are committed to their constituents.” From “Dear Provider.”

Some researchers warn that drug-eluting stents, which are now a feature of most angioplasty procedures, are being used inappropriately in certain patient populations.

Access to firearms for persons with mental illness

A framework for societal investment in health

Patients: knights, knaves, or pawns?

Join Eric Widera, MD, Wednesday, June 15, from 2 to 3 PM eastern time to discuss the handling of finances for older patients with cognitive impairment. To register, go to http://www.ihi.org/AuthorintheRoom.

Ms E is a 41-year-old woman with breast cancer and a BRCA1 mutation. How would you reduce her future risk of breast cancer? Go to www.jama.com to read the case. Submit your response by May 29 for possible online posting.

For your patients: Information about hernias.