This Week in JAMA FREE

Bronchoalveolar lavage (BAL)–directed therapy is an alternative to standard management—consisting of oropharyngeal cultures and clinical features—to diagnose and treat pulmonary exacerbations in young children with cystic fibrosis. However, whether BAL-directed therapy offers clinical benefit is not known. Wainwright and colleagues compared BAL-directed therapy with standard management in a randomized trial that enrolled infants diagnosed with cystic fibrosis by newborn screening. The authors report that compared with standard management, BAL-directed therapy did not result in a lower prevalence of Pseudomonas aeruginosa infection or in less structural lung injury at age 5 years.

Knowledge of family cancer history is important for assessing an individual's cancer risk and guiding screening recommendations. In an examination of baseline and follow-up family history data from participants in a population-based registry of persons with a personal or family history of cancer, Ziogas and colleagues Article found substantial changes in family history of colorectal, breast, and prostate cancer—particularly during participants' early and middle adulthood—that would result in recommendations for earlier or more intense cancer screening. In an editorial, Acheson Article discusses the importance of changes in family history for cancer prevention.

Li and colleagues Article analyzed data from US nursing home Minimum Data Set files to assess trends in the prevalence of pressure ulcers among long-term residents at high risk and to examine disparities by race and site of care. The authors report that overall rates of pressure ulcers among high-risk patients decreased from 2003 through 2008, but rates were persistently higher among black residents than among white residents, a finding that was in part related to higher rates of pressure ulcers in nursing homes that disproportionately served black residents. In an editorial, Bergstrom and Horn Article discuss patient and system-related factors that may contribute to racial disparities in pressure ulcer prevalence.

Coverage of dental care is required for children covered by Medicaid, but states have wide latitude in setting Medicaid payment rates for dentists. In an analysis of Medicaid dental fees merged with data on children's use of dental care from the National Health Interview Survey, Decker found that children covered by Medicaid use dental care less frequently than children with private insurance, but that higher Medicaid dental fees were associated with a higher likelihood of seeing a dentist and receiving dental care.

Characteristics of patients with severe sepsis or septic shock vary widely, which complicates the development of new therapies. Suffredini and Munford summarize the results of sepsis clinical trials conducted during the past 4 decades and discuss possible directions for future investigation.

“I wish I could tell her how grateful I am for what she is showing me, but it would embarrass her.” From “The Gift of Perspective.”

A new study documents the lingering effects of stroke, such as cognitive impairment, anxiety, and depression.

The WHO pandemic influenza preparedness framework

Discussing fertility preservation with cancer patients

Realigning incentives for health care reform

State intervention for life-threatening childhood obesity

Join Gordon D. Schiff, MD, Wednesday, July 20, from 2 to 3 PM eastern time to discuss addressing diagnostic delays and communication across institutions. To register, go to http://www.ihi.org/AuthorintheRoom.

Dr Bauchner summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

Mr Y, a healthy 42-year-old divorced man, is at relatively low risk for HIV infection. Should he undergo screening for HIV infection? Go to www.jama.com to read the case. Submit your response by August 7 for possible online posting.

For your patients: Information about kidney cancer.