This Week in JAMA FREE

Corticosteroids are commonly given to children undergoing tonsillectomy to reduce postoperative nausea and vomiting; however, steroids might increase the risk of perioperative hemorrhage. In a randomized trial that enrolled 314 children, Gallagher and colleagues found that compared with saline placebo, a 1-time dose of dexamethasone did not result in more bleeding events requiring inpatient admission or reoperation. An increase in less severe bleeding events could not be excluded.

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Cram and colleagues assessed trends in total knee arthroplasty (TKA) in an analysis of 1991-2010 Medicare data from more than 3.2 million patients who underwent primary TKA and 318 563 patients who underwent revision TKA. Among the authors' findings were that increases in procedure volume were largely driven by increases in per-capita utilization and that hospital length of stay declined while readmission rates increased. In an editorial, Slover and Zuckerman discuss costs associated with evolving trends in knee arthroplasty.

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Fractional flow reserve (FFR)—typically evaluated during invasive coronary angiography—reflects coronary flow in the presence of stenosis. Min and colleagues assessed the diagnostic accuracy of noninvasive measurement of FFR calculated from coronary computed tomographic (CT) angiography (FFR_CT) in a multicenter study of 252 patients who underwent both invasive coronary angiography and CT angiography. The authors report that FFR_CT plus CT angiography was associated with improved diagnostic accuracy and discrimination compared with CT angiography alone for the diagnosis of hemodynamically significant coronary artery disease. In an editorial, Patel discusses implications for the evaluation of patients with chest pain.

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Multiple treatment comparison (MTC) meta-analysis uses both direct (head-to-head) evidence from randomized clinical trials as well as indirect evidence to compare the relative effectiveness of the examined interventions. In this Users' Guides to the Medical Literature, Mills and colleagues discuss important considerations when interpreting the results of an MTC meta-analysis. These include the homogeneity of the studies for each intervention; the similarity of the study populations, designs, and outcomes across interventions; and the consistency of the findings derived from direct and indirect evidence.

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In a discussion of the case of an 81-year-old man who was hospitalized with severe dyspnea and respiratory failure, Fried and colleagues highlight challenges in the management of chronic obstructive pulmonary disease (COPD) in elderly patients. Such factors include patient comorbidities, the increased risk of treatment-associated adverse events, age-related functional and cognitive decline, and end-of-life care planning.

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A 13-year-old boy has a 1-month history of asymptomatic penile papules, which are tiny, glistening, and flesh-colored. He denies sexual exposure. What would you do next?

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A new office within the National Institutes of Health has been formed to foster more attention to and funding for emergency care research.

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Bringing diagnosis into quality and safety equations

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Overcoming hospital pricing power

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Controlling health care costs in Massachusetts

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Consortium for comparative effectiveness in joint replacement

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“How many patients never come into the ED in the first place for fear of being wiped out financially? And how many patients who do come into the ED are in fact wiped out financially?” From “Worlds Apart.”

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

Join Robert W. Haley, MD, Wednesday October 10, from 2 to 3 PM eastern time to discuss controlling urban epidemics of West Nile virus infection. To register, go to http://www.ihi.org/AuthorintheRoom.

For your patients: Information about chronic obstructive pulmonary disease.

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