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JAMA Internal Medicine
Journal Prestige (SJR): 8.032
Citation Impact (citeScore): 4
Number of Followers: 284  
 
  Full-text available via subscription Subscription journal
ISSN (Print) 2168-6106 - ISSN (Online) 2168-6114
Published by American Medical Association Homepage  [14 journals]
  • October 2018 Issue Highlights
    • Pages: 1289 - 1291
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2017.5234
      Issue No: Vol. 178, No. 10 (2018)
       
  • JAMA Internal Medicine
    • Pages: 1292 - 1292
      Abstract: Mission Statement: To promote the art and science of medicine and the betterment of human health by publishing manuscripts of interest and relevance to internists practicing as generalists or as medical subspecialists.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2017.5235
      Issue No: Vol. 178, No. 10 (2018)
       
  • Cervical Cancer Screening—Moving From the Value of Evidence to the
           Evidence of Value
    • Authors: Sawaya GF.
      Pages: 1293 - 1295
      Abstract: Widespread implementation of cytology-based screening programs has resulted in marked declines in cervical cancer incidence and mortality in the United States. Nonetheless, an estimated 13 240 women will be diagnosed with cervical cancer in 2018, and 4170 will die from the disease. It is likely that a sizable proportion of these women will not have been appropriately screened.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.4282
      Issue No: Vol. 178, No. 10 (2018)
       
  • Failing Grade for Shared Decision Making for Lung Cancer Screening
    • Authors: Redberg RF.
      Pages: 1295 - 1296
      Abstract: As we accrue more data on the benefits and harms from cancer screening, it is clear that the benefits do not always exceed the harms. This imbalance is particularly at issue in lung cancer screening by low-dose computed tomography (LDCT), for which 1 randomized clinical trial found a mortality benefit in high-risk smokers and ex-smokers, but 3 other randomized clinical trials found no benefit. In addition, data from the National Health Interview Survey show that most people undergoing screening for lung cancer do not fall in the recommended groups, and thus their harms of LDCT, including radiation exposure, will likely exceed the benefits.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3527
      Issue No: Vol. 178, No. 10 (2018)
       
  • Screening for Atrial Fibrillation Comes With Many Snags
    • Authors: Mandrola J; Foy A, Naccarelli G.
      Pages: 1296 - 1298
      Abstract: The association of atrial fibrillation (AF) with an increased risk of stroke and heart failure makes it a serious health condition. Many people have AF and do not know it, and its prevalence continues to rise in parallel with the growing numbers of people living with obesity and cardiac risk factors.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.4038
      Issue No: Vol. 178, No. 10 (2018)
       
  • Clinician-Patient Discussions of Successful CPR
    • Authors: Breu AC.
      Pages: 1299 - 1300
      Abstract: This article explores the importance of goals of care discussions between clinicians and patients before setting a do-not-resuscitate order or administering CPR.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.4066
      Issue No: Vol. 178, No. 10 (2018)
       
  • Tai Ji Quan vs a Multimodal Exercise Intervention for Preventing Falls in
           High-Risk Older Adults
    • Authors: Li F; Harmer P, Fitzgerald K, et al.
      Pages: 1301 - 1310
      Abstract: This randomized clinical trial compares the effectiveness of a tai ji quan intervention with multimodal exercise and stretching exercise in reducing falls in older adults who had fallen in the past year.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3915
      Issue No: Vol. 178, No. 10 (2018)
       
  • Evaluating Shared Decision Making for Lung Cancer Screening
    • Authors: Brenner AT; Malo TL, Margolis M, et al.
      Pages: 1311 - 1316
      Abstract: This analysis assesses the quality of shared decision making between clinicians and patients eligible for lung cancer screening regarding the initiation of lung cancer screening in clinical practice.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3054
      Issue No: Vol. 178, No. 10 (2018)
       
  • Association Between Physician Burnout and Patient Safety, Professionalism,
           and Patient Satisfaction
    • Authors: Panagioti M; Geraghty K, Johnson J, et al.
      Pages: 1317 - 1330
      Abstract: This meta-analysis examines whether physician burnout is associated with low-quality, unsafe patient care.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3713
      Issue No: Vol. 178, No. 10 (2018)
       
  • Clinician Burnout and the Quality of Care
    • Authors: Linzer M.
      Pages: 1331 - 1332
      Abstract: Burnout, a syndrome of emotional exhaustion, depersonalization, and a lack of sense of accomplishment, is a negative reaction to adverse work conditions. Prior to 2001, there were concerns about waning preferences for career choices in primary care and a developing notion that clinician satisfaction was related to favorable outcomes, again in terms of career choice by learners. In 2001, John Eisenberg, a leading health services researcher and 1 of the early directors of the Agency for Healthcare Research and Quality, defined the healthy workplace for clinicians and patients; the field of clinician well-being was then launched.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3708
      Issue No: Vol. 178, No. 10 (2018)
       
  • Effect of Group-Administered Behavioral Treatment on Urinary Incontinence
           in Older Women
    • Authors: Diokno AC; Newman DK, Low LK, et al.
      Pages: 1333 - 1341
      Abstract: This multisite randomized clinical trial compares the effectiveness, cost, and cost-effectiveness of group-administered behavioral treatment vs no treatment for urinary incontinence in older women.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3766
      Issue No: Vol. 178, No. 10 (2018)
       
  • Trends in Visits to Acute Care Venues for Treatment of Low-Acuity
           Conditions in the United States
    • Authors: Poon SJ; Schuur JD, Mehrotra A.
      Pages: 1342 - 1349
      Abstract: This cohort study investigates trends in patterns of care for low-acuity patients with acute conditions from 2008 to 2015 using data from a large commercial health plan in the United States.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3205
      Issue No: Vol. 178, No. 10 (2018)
       
  • Effect of Portable Air Filtration Systems on Blood Pressure in a Senior
           Facility
    • Authors: Morishita M; Adar SD, D’Souza J, et al.
      Pages: 1350 - 1357
      Abstract: This randomized, double-blind crossover trial investigates the effect of 2 air filtration systems vs a sham unfiltered system on personal exposures to fine particulate matter and blood presssure among older adults in a US urban location.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3308
      Issue No: Vol. 178, No. 10 (2018)
       
  • Patient-Reported Experiences of Dialysis Care Within a National
           Pay-for-Performance System
    • Authors: Brady BM; Zhao B, Niu J, et al.
      Pages: 1358 - 1367
      Abstract: This cross-sectional analysis examines associations of dialysis facility performance and patient, facility, with geographic characteristics using measures of patient experiences.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3756
      Issue No: Vol. 178, No. 10 (2018)
       
  • Effect of Mobile Device–Supported n-of-1 Trials on Chronic
           Musculoskeletal Pain
    • Authors: Kravitz RL; Schmid CH, Marois M, et al.
      Pages: 1368 - 1377
      Abstract: This randomized clinical trial examines outcomes of participation in an individually designed single-patient multi-crossover (n-of-1) trial supported by a mobile app compared with usual care among patients with chronic musculoskeletal pain.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3981
      Issue No: Vol. 178, No. 10 (2018)
       
  • A Randomized Clinical Trial of n-of-1 Trials—Tribulations of a Trial
    • Authors: Mirza RD; Guyatt GH.
      Pages: 1378 - 1379
      Abstract: In this issue of JAMA Internal Medicine, Kravitz and colleagues report, to our knowledge, the largest randomized trial comparing n-of-1 randomized clinical trials (RCTs) applied in clinical care to standard care. The investigators enrolled 215 patients undergoing management for chronic musculoskeletal pain. The investigation is noteworthy for its innovative methodology, use of mobile health tools, and failure to demonstrate any important benefit of applying the n-of-1 methodology in clinical practice.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3979
      Issue No: Vol. 178, No. 10 (2018)
       
  • Association of Rapid Molecular Testing With Duration of Respiratory
           Isolation for Patients With Possible Tuberculosis
    • Authors: Chaisson LH; Duong D, Cattamanchi A, et al.
      Pages: 1380 - 1388
      Abstract: This cohort study evaluates the association of implementation of a molecular testing strategy with length of isolation for patients with possible tuberculosis in a US hospital.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3638
      Issue No: Vol. 178, No. 10 (2018)
       
  • Molecular Assay Testing to Rule Out Tuberculosis—Be That Early
           Adopter
    • Authors: Salfinger M.
      Pages: 1388 - 1389
      Abstract: Tuberculosis (TB) infection is attributed to a slow-growing acid-fast bacilli (AFB), which requires weeks or even months for a culture to show a positive result. Since the resurgence of drug-susceptible and drug-resistant TB beginning in the mid-1980s, laboratories needed better and faster tools for diagnosis of tuberculosis. In 1991, Eisenach et al described the first laboratory-developed nucleic acid amplification test (NAAT), polymerase chain reaction (PCR), which allowed results to be available within 48 hours, being very sensitive and specific. In 1995, the US Food and Drug Administration (FDA) approved the first commercially available NAAT for tuberculosis. In 2009, the Centers for Disease Control and Prevention (CDC) recommended the universal use of a NAAT for patients with suspected pulmonary TB and “for whom the test result would alter case management or TB control activities.”(p7)
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3628
      Issue No: Vol. 178, No. 10 (2018)
       
  • Assessments of the Safety of Discharging Select Patients Directly Home
           From the Intensive Care Unit
    • Authors: Stelfox HT; Soo A, Niven DJ, et al.
      Pages: 1390 - 1399
      Abstract: This population-based cohort study of 6732 intensive care unit (ICU) patients from 9 hospitals evaluates the 30-day hospital readmission, health care utilization, and clinical outcomes of patients discharged home directly from the ICU vs from a hospital ward.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3675
      Issue No: Vol. 178, No. 10 (2018)
       
  • The Complexity and Challenges of Intensive Care Unit Admissions and
           Discharges
    • Authors: Safavi K; Wiener-Kronish J, Hanidziar D.
      Pages: 1399 - 1400
      Abstract: Patients admitted to the intensive care unit (ICU) are heterogeneous in their underlying illnesses, comorbidities, and requirements for either invasive or nearly continuous monitoring of physiologic and laboratory values. There is also variance in their need for mechanical ventilation, renal replacement therapy, and other mechanical support. Given this heterogeneity, it has been difficult to make broad conclusions about “critically ill” patients.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3674
      Issue No: Vol. 178, No. 10 (2018)
       
  • Development of a Conceptual Map of Negative Consequences of Overuse for
           Patients
    • Authors: Korenstein D; Chimonas S, Barrow B, et al.
      Pages: 1401 - 1407
      Abstract: This Special Communication reviews case reports of overused medical tests and treatments and maps out 6 domains of negative consequences for patients.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3573
      Issue No: Vol. 178, No. 10 (2018)
       
  • Syncope With Bifascicular Block Due to Infra-Hisian Wenckebach Conduction
           Abnormality
    • Authors: Pham TH; Amsterdam E, Glassy MS.
      Pages: 1408 - 1410
      Abstract: This case report presents the electrocardiographic findings of a man in his 70s with a history of type 2 diabetes and hypertension who presented with syncope; there was no seizure activity or preceding chest pain, palpitations, or shortness of breath.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3951
      Issue No: Vol. 178, No. 10 (2018)
       
  • Electrocardiographic Abnormalities in a Woman in Her 70s With Syncope
    • Authors: Shah MM; Nishtala A, Goldschlager N.
      Pages: 1411 - 1413
      Abstract: This case report examines the electrocardiographic findings of a woman in her 70s with hypothyroidism and hypertension who experienced a syncopal episode.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.4069
      Issue No: Vol. 178, No. 10 (2018)
       
  • Elevated Pulmonary Pressure–Get With the Right Group
    • Authors: Riley L; Alnuaimat H, Ataya A.
      Pages: 1414 - 1415
      Abstract: This case report describes a man in his 50s with no medical history of heart or lung disease who presented with progressive dyspnea on exertion due to chronic thromboembolic pulmonary hypertension and was misdiagnosed with WHO group 1 idiopathic pulmonary arterial hypertension.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3645
      Issue No: Vol. 178, No. 10 (2018)
       
  • Implications of the New American College of Cardiology Guidelines for
           Hypertension Prevalence in India
    • Authors: Venkateshmurthy N; Geldsetzer P, Jaacks LM, et al.
      Pages: 1416 - 1418
      Abstract: This study analyzes whether the lowered blood pressure threshold for hypertension in the 2017 American College of Cardiology/American Heart Association guidelines vs the JNC7 guidelines are associated with diagnosis prevalence of hypertension among adults in India.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3511
      Issue No: Vol. 178, No. 10 (2018)
       
  • Assessment of Evidence for High-Risk Cardiovascular Devices Approved Under
           the FDA Priority Review
    • Authors: Jones L; Dhruva SS, Redberg RF.
      Pages: 1418 - 1420
      Abstract: This study uses publicly available FDA summaries to analyze the quality of evidence in pivotal studies that support cardiovascular premarket device approval under FDA priority review from 2007 to 2017.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3649
      Issue No: Vol. 178, No. 10 (2018)
       
  • Overdiagnosis of Lung Cancer in a Low-Dose CT Screening Trial
    • Authors: Heleno B; Siersma V, Brodersen J.
      Pages: 1420 - 1422
      Abstract: This study analyzes data from the Danish Lung Cancer Screening Trial to determine the amount of overdiagnosis of computed tomography–detected lung cancer.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3056
      Issue No: Vol. 178, No. 10 (2018)
       
  • Accounting for the Harms of Lung Cancer Screening
    • Authors: Ebell MH; Lin KW.
      Pages: 1422 - 1423
      Abstract: Overdiagnosis is an often underappreciated harm of screening. In the context of cancer screening, it refers to the detection of cancers that appear histopathologically to be invasive malignant tumors but grow so slowly that they never would have become clinically evident during a usual lifetime or occur in a person who dies of another cause before the cancer symptoms appear. The causes of overdiagnosis include more sensitive screening tests, increasing biopsy rates, and lower thresholds for reporting abnormal-appearing cells in biopsy specimens as malignant.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3061
      Issue No: Vol. 178, No. 10 (2018)
       
  • Association of Nausea and Vomiting in Pregnancy With Prenatal Marijuana
           Use
    • Authors: Young-Wolff KC; Sarovar V, Tucker L, et al.
      Pages: 1423 - 1424
      Abstract: This observational study of a health care system population assessed whether prenatal marijuana use is elevated among women with nausea and vomiting in pregnancy who underwent universal screening for marijuana use.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3581
      Issue No: Vol. 178, No. 10 (2018)
       
  • Inconsistent Reporting of Potential Conflicts of Interest
    • Authors: Prasad V.
      Pages: 1424 - 1425
      Abstract: To the Editor I write to acknowledge inconsistent reporting of potential conflict of interest disclosures in several articles and Letters I published in JAMA Internal Medicine during the past 2 years. In some cases, I included relevant disclosures; in others I did not include all relevant disclosures, or disclosures were added following prompting by a manuscript editor, or funding was erroneously removed by a manuscript editor during the editing process. In each of these cases, my disclosure statement should have read as follows: “Dr Prasad reports receiving royalties from his book Ending Medical Reversal; that his work is funded by the Laura and John Arnold Foundation; that he has received honoraria for Grand Rounds/lectures from several universities, medical centers, and professional societies; and that he is not compensated for his work at the Veterans Affairs Medical Center in Portland, Oregon, or the Health Technology Assessment Subcommittee of the Oregon Health Authority.” I apologize for any confusion this has caused and have requested that these articles be corrected online.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3695
      Issue No: Vol. 178, No. 10 (2018)
       
  • Hydrochlorothiazide and the Risk of Malignant Melanoma
    • Authors: van den Born BH; Olde-Engberink R, Vogt L.
      Pages: 1425 - 1425
      Abstract: To the Editor We read with interest the Research Letter by Pottegård and colleagues on the association between hydrochlorothiazide and risk of malignant melanoma. In their letter, the authors showed that patients using hydrochlorothiazide had 22% higher odds of melanoma compared with nonhydrochlorothiazide users. To evaluate potential confounding by indication, the authors performed an additional analysis showing that there was no significant association between the risk of melanoma and other blood pressure–lowering medication. Unfortunately, the authors concluded that it is worrying that hydrochlorothiazide use appears to be associated with an increased risk of melanoma, whereas we think that based on their evidence no such conclusion should be drawn.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.4312
      Issue No: Vol. 178, No. 10 (2018)
       
  • Hydrochlorothiazide and the Risk of Malignant Melanoma—Reply
    • Authors: Pottegård A; Gaist D.
      Pages: 1425 - 1426
      Abstract: In Reply We appreciate the well-considered comments by van den Born and colleagues about our recent study on use of hydrochlorothiazide and risk of malignant melanoma. We agree that the possibility of residual confounding should always be entertained in observational studies, particularly when considering risk estimates in the order reported by us (eg, an odds ratio of 1.22 for hydrochlorothiazide use and melanoma risk). Confounding by indication (in this context, hypertension) is often a potential concern in pharmacoepidemiologic studies. However, we find it unlikely that confounding by indication explains the results of the analyses by subtype of melanoma, which we were particularly concerned by, because they yielded higher risk estimates for nodular and lentigo melanoma, with some evidence of a dose-response pattern. Similar associations with melanoma subtypes were not seen for other antihypertensive drugs.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.4315
      Issue No: Vol. 178, No. 10 (2018)
       
  • Reduced Opioid Marketing Could Limit Prescribing Information for
           Physicians—Reply
    • Authors: Hadland SE; Cerdá M, Marshall BL.
      Pages: 1426 - 1427
      Abstract: In Reply In response to the letter from Ippolito and Veuger, our Research Letter provides support for an association between pharmaceutical industry marketing and opioid prescribing by physicians.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.4366
      Issue No: Vol. 178, No. 10 (2018)
       
  • Reduced Opioid Marketing Could Limit Prescribing Information for
           Physicians
    • Authors: Ippolito B; Veuger S.
      Pages: 1427 - 1427
      Abstract: To the Editor A Research Letter recently published in JAMA Internal Medicine by Hadland and colleagues reported on the relationship between pharmaceutical industry marketing of opioid products to physicians in 2014 and the frequency of opioid prescriptions by physicians in 2015. The authors carried out a difference-in-differences analysis to show that among physicians who prescribed opioids in 2015, those who received payments involving opioid products in 2014 had higher opioid prescribing levels in 2015. Hadland and colleagues are forthright in noting that the findings “establish an association, not cause and effect.”(p863) While this correlation undoubtedly exists, the authors then concluded that these results support policy changes that only make sense if this correlation also represents a causal link that flows from payments to opioid prescriptions. In particular, Hadland and colleagues recommended “a voluntary decrease or complete cessation of marketing to physicians”(p863) by manufacturers, as well as consideration of “legal limits on the number and amount of payments” by federal and state governments. If the implied causal link does not exist, these measures would merely limit the information and other resources available to physicians without reducing unwarranted opioid prescriptions.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.4369
      Issue No: Vol. 178, No. 10 (2018)
       
  • Lactic Acidosis, Metformin Use, and Dose-Response Association—Reply
    • Authors: Lazarus B; Shin J, Grams ME.
      Pages: 1427 - 1428
      Abstract: In Reply We used the term lactic acidosis in the title of our study to be consistent with previous literature and to facilitate study identification. However, our study does not use lactate concentration to define acidosis events. In addition, our study is observational, and the ability to infer causality—even with techniques such as propensity score matching and active comparator analyses—is limited.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.4430
      Issue No: Vol. 178, No. 10 (2018)
       
  • Lactic Acidosis, Metformin Use, and Dose-Response Association
    • Authors: Gulli G.
      Pages: 1428 - 1428
      Abstract: To the Editor Lazarus and collegues, both in the title and in the introduction of their article published in a recent issue of JAMA Internal Medicine, used the term lactic acidosis, which endorses the concept that lactic acidosis is a state of acidosis determined by an elevated plasma lactate concentration. This term, based on the old lactate paradigm, does not consider that, since the 1980s, this paradigm has radically shifted, and lactate is not considered responsible for acidosis. The same lactic acidosis is deemed a misnomer and should be replaced by the term lactate anion acidosis. Indeed, the intermediate acids—another misleading definition—of glycolysis (including lactic acid) have a low pKa; therefore, at body pH levels, they all exist in their base form, and in their production process, no molecules are ever in an acid form and do not function as sources of protons. The acidosis associated with hypoxia is induced by the increased H+ production from the cytosolic adenosine triphosphate hydrolysis. As a matter of fact, the production of lactate also consumes 2 protons and, by definition, retards acidosis. Although blood lactate accumulation is a good proxy of increased proton release, and the potential for decreased cellular and blood pH, such relationships should not be interpreted as cause and effect, but rather “guilt by association.” More explicitly, high levels of lactate are only a marker for the acidosis. As physiologist Robert A. Robergs put it, “The lactic acidosis explanation of metabolic acidosis is not supported by fundamental biochemistry, has no research base of support, and remains a negative trait of all clinical, basic, and applied science fields and professions that still accept this construct.”(pR502)
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.4433
      Issue No: Vol. 178, No. 10 (2018)
       
  • Lactic Acidosis, Metformin Use, and Dose-Response Association
    • Authors: Carland JE; Smith FC, Day RO.
      Pages: 1428 - 1429
      Abstract: To the Editor We read with interest the article by Lazarus and colleagues that was published in a recent issue of JAMA Internal Medicine. Their work reiterates our own, whereby with caution, metformin use can be continued in patients with creatinine clearance as low as 15 mL/min. As metformin is eliminated by the kidneys, there are concerns that in patients with reduced renal function, it will accumulate and precipitate lactic acidosis. However, the authors also acknowledged that the concerns regarding the risk of lactic acidosis due to metformin alone are largely historical. Indeed, the nominated safety limit for plasma metformin, 5 mg/L, has unclear origins. Although found in the US Food and Drug Administration–approved product information, little evidence is publically available to support it. Studies of cautious dosing in patients with renal dysfunction, when plasma metformin concentrations are maintained below 5 mg/L, fail to find a relationship between metformin and lactate concentrations, and there are case reports of high metformin concentrations without lactic acidosis.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.4448
      Issue No: Vol. 178, No. 10 (2018)
       
  • Lactic Acidosis, Metformin Use, and Dose-Response Association
    • Authors: Mohammedi K; Blanco L, Rigalleau V.
      Pages: 1429 - 1429
      Abstract: To the Editor In a recent issue of JAMA Internal Medicine, Lazarus and colleagues investigated the relationship between metformin treatment and lactic acidosis across different categories of estimated glomerular filtration rate (eGFR) in 2 large community-based cohorts of patients with diabetes. They did not observe an increased risk of incident hospitalization with lactic acidosis in metformin users with eGFR greater than 30 mL/min/1.73 m2 compared with patients who received alternative diabetes management. However, there was an excess risk of lactic acidosis in metformin users with eGFR less than 30 mL/min/1.73 m2.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.4451
      Issue No: Vol. 178, No. 10 (2018)
       
  • The Patient Experience and Use of Telemetry Monitoring—Reply
    • Authors: Strohbehn GW; Yeow RY, Pahwa AK.
      Pages: 1429 - 1430
      Abstract: Less is More
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.4654
      Issue No: Vol. 178, No. 10 (2018)
       
  • The Patient Experience and Use of Telemetry Monitoring
    • Authors: Bansal AK; Lacy ME, Tsega S.
      Pages: 1430 - 1430
      Abstract: To the Editor We commend Yeow and colleagues on compiling the available research on the use of cardiac telemetry monitoring in the adult, non–intensive care unit setting. We share the concerns of the authors that inappropriate use of telemetry monitoring results in the overuse of limited resources, disrupted provider workflow, higher costs of care, and false alarms with resultant alarm fatigue. Moreover, identifying a useful implementation blueprint is an important component of promoting appropriate telemetry monitoring, given the myriad of players and interests involved in caring for these patients.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.4681
      Issue No: Vol. 178, No. 10 (2018)
       
  • Association of Increased Attending Physician Supervision With Patient
           Safety and Educational Outcomes
    • Authors: Oud L.
      Pages: 1430 - 1431
      Abstract: To the Editor The recently published study by Finn and colleagues, which showed no substantial association of increased attending physician supervision with preventable error rate, raises questions about the study intervention, sources of reported errors, and future efforts in this area.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.4740
      Issue No: Vol. 178, No. 10 (2018)
       
  • Association of Increased Attending Physician Supervision With Patient
           Safety and Educational Outcomes—Reply
    • Authors: Finn KM; Metlay JP, Iyasere C.
      Pages: 1431 - 1432
      Abstract: In Reply We thank Dr Oud for his thoughtful comments. In terms of his question about supervision “dose,” this was a pragmatic trial in that we did not stipulate what the supervising attending physicians should do on work rounds given they were all highly skilled educators. However, we do know the attending physicians were present for review of overnight updates, laboratory findings, and radiology, and examined the patient with the team and listened to the plan. The supervision dose was the presence of the attending physician during the entire length of rounds on established patients. While the time attending physicians spoke is 1 measure of their supervision, there are other ways to assert supervision, including nonverbal cues. As trained educators, if a team was making an error, the supervising attending physician would simply not agree. It does not take substantial time to correct an intervention to prevent an error. While we don’t know the content of the attending physicians’ comments, they did serve as their own control so their teaching style was the same in both arms.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.4760
      Issue No: Vol. 178, No. 10 (2018)
       
  • Psychotherapeutics for Chronic Pain Extends Beyond Cognitive Behavioral
           Therapy—Reply
    • Authors: Reid M; Henderson CR, Jr, Niknejad B.
      Pages: 1432 - 1432
      Abstract: In Reply Our study focused appropriately on cognitive behavioral therapy (CBT) approaches to pain management in older adults because the overwhelming majority of psychologically based intervention studies in the pain field have used this modality. Abbass and colleagues are correct to point out that other psychological therapies, such as short-term dynamic psychotherapy and emotion-focused methods, may have value in the management of later-life pain. However, few studies have examined the efficacy of these modalities in older adults with chronic pain, which contrasts with the growing number of investigations that have evaluated CBT-based approaches. Given that the results of our study showed only modest benefits associated with CBT-based modalities and increasing calls for the use of nonpharmacologic approaches to manage pain, it is important to evaluate other psychological therapies, including short-term dynamic psychotherapy and emotion-focused methods, as treatments for later-life pain.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.4866
      Issue No: Vol. 178, No. 10 (2018)
       
  • Psychotherapeutics for Chronic Pain Extends Beyond Cognitive Behavioral
           Therapy
    • Authors: Abbass A; Burke N, Clarke DD.
      Pages: 1432 - 1433
      Abstract: To the Editor We are pleased to see JAMA Internal Medicine focus on psychotherapy for chronic pain in the recent article by Niknejad and colleagues. We write to further the conversation by raising 2 points.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.5332
      Issue No: Vol. 178, No. 10 (2018)
       
  • Missing Conflict of Interest Disclosure
    • Pages: 1433 - 1433
      Abstract: In a number of articles published in JAMA Internal Medicine, conflict of interest disclosures were not reported completely by Vinay Prasad, MD, MPH. Dr Prasad has written a letter to the journal, explaining this inconsistent reporting of potential conflict of interest disclosures. All articles have been corrected online.
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3298
      Issue No: Vol. 178, No. 10 (2018)
       
  • Ladyfinger Point, Antelope Island State Park, Utah
    • Pages: 1433 - 1433
      Abstract: Courtesy of: David E. Winchester, MD, MS, University of Florida College of Medicine, 1600 SW Archer Rd, PO Box 100277, Gainesville, FL 32610-0277
      PubDate: Mon, 01 Oct 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3826
      Issue No: Vol. 178, No. 10 (2018)
       
 
 
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