This Week in JAMA FREE

Systemic corticosteroids are recommended for patients with acute exacerbations of chronic obstructive pulmonary disease (COPD), but the optimal dose and route of administration are uncertain. In a retrospective analysis of registry data from 79 985 patients with acute exacerbations of COPD who were admitted to non–intensive care settings and received systemic corticosteroids during the first 2 hospital days, Lindenauer and colleagues Article found comparable outcomes among patients who received either low-dose oral steroids or high doses of steroids administered intravenously. In an editorial, Krishnan and Mularski Article discuss the utility of comparative effectiveness research to monitor care quality, patient outcomes, and health care costs.

In an analysis of data from the European Prospective Investigation into Cancer and Nutrition, Johansson and colleagues examined the association of serum levels of vitamins B₂, B₆, and B₁₂; folate (B₉); methionine; and homocysteine—components of the 1-carbon pathway essential for DNA integrity and gene expression—with incident lung cancer. In analyses that accounted for smoking status, the authors found that serum levels of vitamin B₆ and methionine obtained at study enrollment were inversely associated with the risk of lung cancer.

Methicillin-resistant Staphylococcus aureus (MRSA) is an important emerging respiratory tract pathogen among patients with cystic fibrosis. To assess the association of MRSA on outcomes among patients with cystic fibrosis, Dasenbrook and colleagues compared survival patterns between patients with and without respiratory tract MRSA in a cohort study of 19 833 patients aged 6 to 45 years. The authors found that detection of MRSA in the respiratory tract of patients with cystic fibrosis was associated with worse survival.

Pyloric stenosis appears to aggregate in families; however, whether this is related to inheritance or common environment is not clear. In a population-based cohort study of nearly 2 million Danish children, Krogh and colleagues found that the incidence rate (per 1000 person-years) of pyloric stenosis was 1.8 for singletons and 3.1 for twins. Rates of pyloric stenosis were higher among monozygotic than dizygotic twins and higher among siblings than half-siblings and cousins. The authors estimated the heritability of pyloric stenosis to be 87%.

In a prospective cohort study that involved 437 patients with newly diagnosed early-stage lung cancer, Cykert and colleagues Article explored modifiable factors associated with the decision to undergo surgical resection. The authors report that a decision to not undergo surgery was independently associated with negative perceptions of patient-physician communication, misunderstandings of prognosis, older age, the presence of multiple comorbidities, and black race. In an editorial, Colice Article discusses racial disparities in lung cancer resection and implications for patient care.

“Should we as a society act proactively and encroach on a person's autonomy when she is putting only herself at risk of harm?” From “The ‘Right’ to Fall.”

The US Food and Drug Administration is poised to consider evidence about the safety of rosiglitazone, a drug used to lower blood glucose levels that has been linked to sometimes fatal cardiac problems.

Managing financial conflicts of interest in NIH-funded research

Quality of care: how good is good enough?

Payment policy, health care spending, and outcomes

Family-centered medical homes

Join Kenneth J. Mukamal, MD, MPH, MA, Wednesday, July 21, from 2 to 3 PM eastern time to discuss advising a 42-year-old patient about whether he should drink alcohol for his health. To register, go to http://www.ihi.org/AuthorintheRoom.

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

For your patients: Information about chronic obstructive pulmonary disease.