This Week in JAMA FREE

Some patients with gout do not respond to conventional urate-lowering therapy, and they may progress to severe chronic gout. Sundy and colleagues randomly assigned 225 patients with severe gout and allopurinol intolerance or refractoriness to receive biweekly or monthly infusions of pegloticase (a recombinant uricase) or placebo for 6 months. The authors report that compared with placebo, 8 mg of pegloticase either every 2 weeks or every 4 weeks was associated with lower uric acid levels.

There is substantial uncertainty regarding use of adjuvant radioactive iodine for thyroid cancer. In a cohort of 189 219 patients with well-differentiated thyroid cancer treated at 981 hospitals, Haymart and colleagues Article examined radioactive iodine use after total thyroidectomy. The authors found that between 1990 and 2008, radioactive iodine use increased across tumors of all sizes and that wide between-hospital variation in use was associated with hospital characteristics. In an editorial, Livingston and McNutt Article discuss the hazards of using administrative data to draw conclusions about appropriateness of care.

There are limited data on long-term outcomes among individuals with persistent asymptomatic isolated microscopic hematuria. In an analysis of linked data from the Israeli end-stage renal disease (ESRD) registry and medical data from 1.2 million Israeli adolescents and young adults examined for military service, Vivante and colleagues Article found that diagnosis of persistent asymptomatic isolated microscopic hematuria was associated with an increased risk of ESRD during 21 years of follow-up. In an editorial, Brown Article discusses benefits of routine urine dipstick testing of asymptomatic adults.

Freedman and colleagues analyzed data from an 8-state prospective cohort study involving 467 528 individuals aged 51 to 71 years at baseline in 1995-1996 and the respective state cancer registries to assess the population attributable risk of tobacco smoking for bladder cancer. The cohort was followed up through 2006, and bladder cancer risk estimates calculated and compared with a pooled estimate from 7 US cohorts initiated between 1963 and 1987. The authors found that relative risks for bladder cancer among smokers in the recent cohort were higher than previously reported, and the population attributable risk of smoking for women was comparable with that for men.

Mr and Mrs M lived independently across the country from their daughter until 2006, when Mr M was diagnosed with mild cognitive impairment. Their daughter invited her parents to move into her home, ultimately hiring domestic and personal care assistants for her parents and renovating her home to accommodate them. Ritchie and colleagues Article discuss the physician's role in caring for and advising parents and adult children during multigenerational living. In a commentary, Swartz Article discusses the financial costs of caring for elderly parents and related health policies.

“As I continue to witness [John’s] journey from being a physician to a patient himself, I still worry about the best way to support him through it all.” From “Parallel Universe.”

Sound evidence to support routine screening for autism is lacking, according to a recent study.

Real-world imperative of outcomes research

US patient-centered outcomes research institute

Implementing accountable care organizations

Author interview

Skin fragility and blister formation

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

Join Laura Mosqueda, MD, Wednesday, September 21, from 2 to 3 PM eastern time to discuss identification of and intervention for elder mistreatment. To register, go to http://www.ihi.org/authorintheroom.

Mr J is 76 years old with multiple medical problems and limited health literacy. How would you reduce the complexity of his care and help him understand his self-care needs? Read the case at www.jama.com. Submit your response by September 14 for possible online posting.

For your patients: Information about regional anesthesia.