This Week in JAMA FREE

Asthma management requires periodic dose adjustment of controller medications; however, the best strategy for doing so is not clear. In a randomized trial that involved 342 adults with asthma controlled with low-dose corticosteroid therapy, Calhoun and colleagues found that time to treatment failure did not differ among patients who were randomly assigned to receive corticosteroid dose adjustment based on physician assessment, biomarker (exhaled nitric oxide) assessment, or asthma symptom occurrence. In an editorial, O’Connor and Reibman discuss the implications for patient care.

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In an analysis of registry data from 6707 patients with ST-segment elevation myocardial infarction (STEMI) between 1995 and 2010, Puymirat and colleagues sought to identify factors—other than reperfusion therapy—associated with improved survival. Among their findings was that a decline in 30-day mortality was accompanied by a decrease in the relative proportion of older patients and an increase in the proportion of younger women (<60 years) experiencing STEMI, an increase in early use of recommended medications, and a shorter time from symptom onset to hospital admission.

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Metastasis to regional lymph nodes is an important prognostic factor in melanoma. In an analysis of data from 403 patients with melanoma—who underwent either single-photon emission computed tomography/computed tomography (SPECT/CT)–aided sentinel lymph node excision (SLNE) or standard SLNE using preoperative lymphoscintigraphy—Stoffels and colleagues found that SPECT/CT-aided SLNE was associated with improved detection of lymph node metastasis and a higher rate of disease-free survival.

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In an analysis of Medicare data, Colla and colleagues compared annual spending in the Physician Group Practice Demonstration (PGPD)—a pilot program involving 10 practices (≈990 000 patients) and incentives resembling those proposed for accountable care organizations—with spending for Medicare beneficiaries (≈7.5 million patients) from the same regions who received care from non-PGPD physicians. The authors report that modest savings were achieved by some PGPD-participating institutions, with larger savings for beneficiaries who were dually eligible for Medicare and Medicaid. In an editorial, Berwick discusses how the findings may inform development of new models of care.

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Controversy exists about the effects of omega-3 polyunsaturated fatty acid supplementation on major cardiovascular disease (CVD). In a systematic review and analysis of data from 20 randomized trials (68 680 patients), Rizos and colleagues found no association between supplementation and the risks of all-cause mortality, cardiac death, sudden death, myocardial infarction, or stroke.

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A 9-year-old child has had uncontrolled seizures since age 7 months, brachydactyly, and x-ray evidence of fourth and fifth metacarpal shortening. Laboratory evaluation reveals hypocalcemia. What would you do next?

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Cost remains a barrier to accessing care in Massachusetts for patients with public insurance, which may have implications for health reform.

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Ward attendings: a new normal

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Engaging physicians for quality improvement

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Surgery vs lifestyle treatment of type 2 diabetes

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Changing medical professionals' eating habits

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“Although care provided in the 1960s might be considered more humanistic, we, as a society and part of the medical establishment, remained uncomfortable dealing with human emotions.” From “A Path to Wholeness.”

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Call for Papers

Authors are invited to submit manuscripts for an upcoming JAMA theme issue.

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Join Philip Greenland, MD, Wednesday, September 19, from 2 to 3 PM eastern time to discuss risk markers for assessing patients at intermediate risk of CVD. To register, go to http://www.ihi.org/AuthorintheRoom.

Dr Bauchner summarizes and comments on this week's issue. Go to http://jama.jamanetwork.com/multimedia.aspx#Weekly

For your patients: Information about West Nile virus.

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