Journal Cover JAMA Internal Medicine
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   ISSN (Print) 2168-6106 - ISSN (Online) 2168-6114
   Published by American Medical Association Homepage  [13 journals]
  • May 2018 Issue Highlights
    • Pages: 593 - 595
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2017.5209
      Issue No: Vol. 178, No. 5 (2018)
       
  • JAMA Internal Medicine
    • Pages: 596 - 596
      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: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2017.5210
      Issue No: Vol. 178, No. 5 (2018)
       
  • Does More Achievement Make Us Better Physicians'
    • Authors: Stock J.
      Pages: 597 - 598
      Abstract: This Perspective describes the increasing pressures for achievement experienced by physicians as they start their careers and how this leads to neglect of the very qualities of inner character that need to be cultivated by physicians.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.0023
      Issue No: Vol. 178, No. 5 (2018)
       
  • Toenails as the “Hemoglobin A 1c ” of Functional Independence
    • Authors: Orkaby AR; Schwartz A.
      Pages: 598 - 599
      Abstract: This article argues that the physical examination finding of long toenails should alert the clinician to other possible care needs and help guide questions as to the underlying differential diagnosis of the untrimmed toenails.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.0099
      Issue No: Vol. 178, No. 5 (2018)
       
  • Would Have—A Physician's Personal Reflection On Alzheimer Dementia
    • Authors: Melvin L.
      Pages: 599 - 600
      Abstract: The article describes a physician’s experience with a family member with Alzheimer disease.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.0129
      Issue No: Vol. 178, No. 5 (2018)
       
  • The Personal Care Products Safety Act
    • Authors: Feinstein D; Collins S.
      Pages: 601 - 602
      Abstract: This Viewpoint outlines goals of the proposed Personal Care Products Safety Act, a response to the problems associated with the current regulatory approach to cosmetics and personal care products in the United States.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.0064
      Issue No: Vol. 178, No. 5 (2018)
       
  • Medical Students in Puerto Rico After Hurricane Maria
    • Authors: Quiñones-Rivera A; Rubin A.
      Pages: 603 - 604
      Abstract: This Viewpoint explains the difficulties for medical students in Puerto Rico after Hurricane Maria.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.0633
      Issue No: Vol. 178, No. 5 (2018)
       
  • Improving Communication With Patients With Limited English Proficiency
    • Authors: Taira BR.
      Pages: 605 - 606
      Abstract: This Viewpoint stresses the importance of institutions providing clinicians who are fluent in the language of patients with limited English proficiency.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.0373
      Issue No: Vol. 178, No. 5 (2018)
       
  • Italy’s New Advance Directive Law
    • Authors: Sulmasy DP.
      Pages: 607 - 608
      Abstract: This Viewpoint describes the sociopolitical factors that led Italy to adopt its first advance directive legislation.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.0462
      Issue No: Vol. 178, No. 5 (2018)
       
  • USPSTF Recommendations for Behavioral Counseling for Skin Cancer
           Prevention
    • Authors: Linos E; Pagoto S.
      Pages: 609 - 611
      Abstract: In this week’s issue of JAMA, the US Preventive Services Task Force (USPSTF) discusses their recommendations on behavioral counseling for skin cancer prevention, supported by an evidence report and systematic review. Based on the available studies conducted in primary care settings between 2009 and 2017, the review concluded that “behavioral interventions can increase sun protection behavior, but there is no consistent evidence that interventions are associated with a reduction in the frequency of sunburn in children or adults and minimal evidence on skin cancer outcomes.” The Task Force recommended that clinicians should counsel children and young adults with fair skin types about minimizing exposure to UV radiation (grade B recommendation). In addition, for the first time, the USPSTF concluded that there may be a small benefit of counseling adults at high risk for skin cancer about minimizing UV exposure (grade C recommendation). Skin self-examinations were assigned an I statement, meaning that insufficient evidence is available to recommend for or against this intervention.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.0846
      Issue No: Vol. 178, No. 5 (2018)
       
  • Is There a Future for Ovarian Cancer Screening'
    • Authors: Narod SA.
      Pages: 611 - 612
      Abstract: Currently, about 65% of the 22 000 women diagnosed with ovarian cancer annually in the United States will die of their cancer, and we all would like to reduce the mortality rate. Possible approaches to reducing mortality include prevention, screening, and better treatment. In the current issue of JAMA, the US Preventive Services Task Force issued a grade D recommendation, against population-based screening for ovarian cancer, based on a review of 4 randomized screening trials. The 2 largest studies in the review were the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) and the Prostate, Lung, Colorectal and Ovarian screening trial (PLCO); UKCTOCS used a proprietary algorithm that incorporates changes in cancer antigen 125 (CA-125) over time, whereas the smaller PLCO trial assigned women to CA-125 and ultrasonography vs usual care. Both screening interventions failed to reduce ovarian cancer mortality.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.0591
      Issue No: Vol. 178, No. 5 (2018)
       
  • Alcohol-Related Nurse Care Management in Primary Care
    • Authors: Bradley KA; Bobb JF, Ludman EJ, et al.
      Pages: 613 - 621
      Abstract: This randomized clinical trial assessed the effect of 12 months of patient-centered nurse care management vs usual care on heavy drinking and alcohol-related problems among patients in primary care.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.0388
      Issue No: Vol. 178, No. 5 (2018)
       
  • Cardiovascular Safety of Varenicline, Bupropion, and Nicotine Patch
    • Authors: Benowitz NL; Pipe A, West R, et al.
      Pages: 622 - 631
      Abstract: This randomized clinical trial evaluates the cardiovascular risk associated with use of varenicline, bupropion, and nicotine replacement therapy in individuals who smoke.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.0397
      Issue No: Vol. 178, No. 5 (2018)
       
  • Sex Differences in Outcomes After STEMI
    • Authors: Cenko E; Yoon J, Kedev S, et al.
      Pages: 632 - 639
      Abstract: This observational study examines sex differences in outcomes in patients after ST-segment elevation myocardial infarction.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.0514
      Issue No: Vol. 178, No. 5 (2018)
       
  • CMS Partnership to Improve Dementia Care and Use of Antipsychotics and
           Other Psychotropics
    • Authors: Maust DT; Kim H, Chiang C, et al.
      Pages: 640 - 647
      Abstract: This interrupted time-series analysis of a 20% Medicare sample examines the association of CMS’s National Partnership to Improve Dementia Care in Nursing Homes with trends in prescribing of antipsychotic and other psychotropic medication among older adults in long-term care.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.0379
      Issue No: Vol. 178, No. 5 (2018)
       
  • Medicare Accountable Care Organization Enrollment and Cancer Screening
           Appropriateness
    • Authors: Resnick MJ; Graves AJ, Thapa S, et al.
      Pages: 648 - 654
      Abstract: This population-based analysis of Medicare data examines whether Medicare Shared Savings Program accountable care organization enrollment changes appropriateness of screening for breast, colorectal, and prostate cancers.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2017.8087
      Issue No: Vol. 178, No. 5 (2018)
       
  • Accountability for Underuse and Overuse of Cancer Screening
    • Authors: Lipitz-Snyderman A.
      Pages: 655 - 656
      Abstract: In this issue of JAMA Internal Medicine, Resnick and colleagues test the hypothesis that Medicare Accountable Care Organizations (ACOs) are associated with changes in cancer screening among beneficiaries. Accountable Care Organizations are intended to provide incentives for care coordination and promote high-quality care. In addition, measures for underuse of breast and colorectal cancer screening are routinely used to evaluate ACO quality of care. While no measures specifically address overuse of cancer screening, ACOs are responsible for downstream negative effects from overscreening—harms from the test, overdiagnosis, and overtreatment. Therefore, one would expect ACOs to increase cancer screening when appropriate and reduce cancer screening when inappropriate, reducing both underuse and overuse.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2017.8086
      Issue No: Vol. 178, No. 5 (2018)
       
  • Dialysis Use and Mortality in Veterans Affairs vs Medicare
    • Authors: Kurella Tamura M; Thomas I, Montez-Rath ME, et al.
      Pages: 657 - 664
      Abstract: This cohort study compares use of dialysis and survival in patients with end-stage renal disease who receive care through Veterans Affairs vs Medicare.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.0411
      Issue No: Vol. 178, No. 5 (2018)
       
  • Appropriate Time for Chronic Dialysis Initiation
    • Authors: Chen Z; Hsu C.
      Pages: 664 - 666
      Abstract: The best time to initiate chronic dialysis in patients approaching end-stage renal disease (ESRD) is unclear. In this issue of JAMA Internal Medicine, Kurella Tamura and colleagues demonstrate the substantial variation in the initiation of dialysis among 11 215 older veterans with kidney failure (defined as sustained estimated glomerular filtration rate [eGFR]<15 mL/min/1.73 m2). They found that patients who exclusively used Medicare for pre-ESRD nephrology care had a 28 percentage point higher frequency of dialysis initiation and a 5 percentage point higher frequency of death compared with their counterparts who exclusively used the Veterans Affairs (VA) health care system for pre-ESRD nephrology care. These data extend prior reports regarding temporal and geographic variations in the likelihood and timing of dialysis initiation and add to previous studies finding that earlier initiation of dialysis is not associated with improved survival in many patients.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.0470
      Issue No: Vol. 178, No. 5 (2018)
       
  • Medical Cannabis Laws and Opioid Prescribing in the Medicare Part D
           Population
    • Authors: Bradford AC; Bradford W, Abraham A, et al.
      Pages: 667 - 672
      Abstract: This longitudinal study examines the association between prescribing patterns for opioids in Medicare Part D and the implementation of state medical cannabis laws.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.0266
      Issue No: Vol. 178, No. 5 (2018)
       
  • Medical and Adult-Use Marijuana Laws and Opioid Prescribing for Medicaid
           Enrollees
    • Authors: Wen H; Hockenberry JM.
      Pages: 673 - 679
      Abstract: This population-based, cross-sectional study examines the association of state implementation of medical and adult-use marijuana laws with opioid prescribing rates and spending among Medicaid enrollees.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.1007
      Issue No: Vol. 178, No. 5 (2018)
       
  • The Role of Cannabis Legalization in the Opioid Crisis
    • Authors: Hill KP; Saxon AJ.
      Pages: 679 - 680
      Abstract: The United States remains gripped by the opioid crisis. Each day, 90 Americans die from opioid overdoses. Owing to the incredible reach of the opioid crisis—it has affected people of every race, sex, and age across our country—many stakeholders are trying to combat the crisis using multipronged approaches emphasizing prevention, treatment, and law enforcement.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.0254
      Issue No: Vol. 178, No. 5 (2018)
       
  • Efficacy of Vaginal Estradiol or Moisturizer vs Placebo for Postmenopausal
           Vulvovaginal Symptoms
    • Authors: Mitchell CM; Reed SD, Diem S, et al.
      Pages: 681 - 690
      Abstract: This randomized clinical trial compares the efficacy of a low-dose vaginal estradiol tablet and a vaginal moisturizer, each vs placebo, for treatment of moderate-to-severe postmenopausal vulvovaginal symptoms.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.0116
      Issue No: Vol. 178, No. 5 (2018)
       
  • Rethinking Management of Postmenopausal Vulvovaginal Symptoms
    • Authors: Huang AJ; Grady D.
      Pages: 690 - 691
      Abstract: In this issue of JAMA Internal Medicine, Mitchell et al present the results of a randomized, double-blind, placebo-controlled, multisite trial of 2 existing, widely used treatments for postmenopausal vulvovaginal atrophy symptoms—a low-dose prescription vaginal estradiol tablet (Vagifem) and an over-the-counter nonhormonal vaginal moisturizing gel (Replens). Participants were postmenopausal women who rated the severity of their vulvovaginal symptoms including itching, pain, dryness, irritation, and pain with vaginal intercourse on a standardized scale. Consistent with US Food and Drug Administration guidance, the investigators examined change in severity of participants’ “most bothersome symptom” over 4 and 12 weeks as the primary outcome, along with a variety of secondary symptom-based outcomes and tissue-specific markers of vulvovaginal atrophy.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.0094
      Issue No: Vol. 178, No. 5 (2018)
       
  • State Firearm Laws and Interstate Firearm Deaths
    • Authors: Kaufman EJ; Morrison CN, Branas CC, et al.
      Pages: 692 - 700
      Abstract: This cross-sectional analysis of US county data examines whether counties in states located closer to states with lenient firearm policies have higher firearm death rates.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.0190
      Issue No: Vol. 178, No. 5 (2018)
       
  • Interstate Effects of State Firearm Laws on Suicide and Homicide
    • Authors: Steinbrook R.
      Pages: 701 - 701
      Abstract: Firearm death rates vary widely between states, as do the strength of their firearm laws. The overall death rate from firearm injury in 2015 was 11.3 per 100 000; rates in the contiguous 48 states ranged from a low of 3.1 in Massachusetts to a high of 20.4 in Kentucky. If the upward trend in deaths from firearm injury in the United States is to be reversed—there were 7.9% more deaths in 2015 than in 2014–then the death rates in each state must decrease.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.0200
      Issue No: Vol. 178, No. 5 (2018)
       
  • Unnecessary Repeat Enzyme Testing in Acute Pancreatitis
    • Authors: Reisman A; Cho HJ, Holzer H.
      Pages: 702 - 703
      Abstract: This Teachable Moment questions the value of repeat lipase level assay as a follow-up measure for patients with a diagnosis of acute pancreatitis and proposes a more effective alternative.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.0106
      Issue No: Vol. 178, No. 5 (2018)
       
  • Overtreatment of Asymptomatic Hypertension
    • Authors: Yang J; Chiu S, Krouss M.
      Pages: 704 - 705
      Abstract: This Teachable Moment differentiates between hypertensive emergency and hypertensive urgency and examines the case of a woman who was incorrectly treated for hypertensive emergency when treatment for hypertensive urgency would have been more appropriate.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.0126
      Issue No: Vol. 178, No. 5 (2018)
       
  • Opioid Tapering in Community Outpatients With Chronic Pain
    • Authors: Darnall BD; Ziadni MS, Stieg RL, et al.
      Pages: 707 - 708
      Abstract: This education intervention study reports on voluntary, patient-centered opioid tapering in outpatients with chronic pain without behavioral treatment.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2017.8709
      Issue No: Vol. 178, No. 5 (2018)
       
  • Using Chaplains to Facilitate Advance Care Planning in Medical Practice
    • Authors: Lee AC; McGinness CE, Levine S, et al.
      Pages: 708 - 710
      Abstract: This quality improvement study examines the effectiveness of having a board-certified chaplain conduct advance care planning conversations and end of life preferences with patients at the time of a routine office visit with a physician.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2017.7961
      Issue No: Vol. 178, No. 5 (2018)
       
  • Association of Ontario’s Ban on Menthol Cigarettes With Smoking
           Behavior
    • Authors: Chaiton M; Schwartz R, Cohen JE, et al.
      Pages: 710 - 711
      Abstract: This study compares respondents’ planned behavior before the 2017 menthol cigarette ban in Ontario with actual behavior 1 month after the ban.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2017.8650
      Issue No: Vol. 178, No. 5 (2018)
       
  • Local Movement to Ban Menthol Tobacco Products
    • Authors: Glantz SA; Gardiner P.
      Pages: 711 - 713
      Abstract: The article by Chaiton et al in this issue of JAMA Internal Medicine is the first empirical confirmation that banning the sale of menthol tobacco products is good for public health. The investigators surveyed individuals in Ontario, Canada, who smoked menthol cigarettes before and 1 month after the province implemented a full menthol cigarette ban on January 1, 2017. They found that 40% of menthol smokers attempted to quit smoking and 12% succeeded, substantial increases over historical levels and higher than the percentage who predicted that they would try to quit before experiencing the ban. In addition, they found that a larger proportion (29%) reported using other flavored tobacco or e-cigarette products (menthol was not banned in e-cigarette products) compared with preban self-predictions (6%).
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.0053
      Issue No: Vol. 178, No. 5 (2018)
       
  • Hypoglycemia in Hospice Patients With Type 2 Diabetes
    • Authors: Petrillo LA; Gan S, Jing B, et al.
      Pages: 713 - 715
      Abstract: This retrospective cohort study examines whether patients with type 2 diabetes on hospice are assessed for dysglycemia, receive insulin or oral hypoglycemic medications, or experience hypoglycemia and hyperglycemia in the nursing home setting.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2017.7744
      Issue No: Vol. 178, No. 5 (2018)
       
  • Veterans Health Administration Programs and Cardiac Rehabilitation
    • Authors: Schopfer DW; Krishnamurthi N, Shen H, et al.
      Pages: 715 - 717
      Abstract: This study examines whether implementing new home-based cardiac rehabilitation programs is associated with cardiac rehabilitation participation in the Veterans Health Administration.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2017.8039
      Issue No: Vol. 178, No. 5 (2018)
       
  • Decedents’ Expenditures Among Reductions in Medicare Expenditures
    • Authors: Weeks WB; Kirkland KB, Freeh C, et al.
      Pages: 717 - 719
      Abstract: This cohort study uses Medicare data from the Dartmouth Atlas Project to determine the source of recent changes in end-of-life Medicare expenditures.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2017.8213
      Issue No: Vol. 178, No. 5 (2018)
       
  • Use and Expenditures of Brand-name Atorvastatin vs Generic
    • Authors: Warraich HJ; Salami JA, Khera R, et al.
      Pages: 719 - 721
      Abstract: This study uses the Medical Expenditure Panel Survey (MEPS) database to analyze trends in use and expenditures of brand-name atorvastin after generic atorvastatin became available.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.0990
      Issue No: Vol. 178, No. 5 (2018)
       
  • Delayed Generic Market Saturation After Patent Expiration—A
           Billion-Dollar Problem
    • Authors: Luo J; Kesselheim AS.
      Pages: 721 - 722
      Abstract: In this issue of JAMA Internal Medicine, Warraich and colleagues examine excess expenditures associated with use of the proprietary form of atorvastatin (Lipitor) at the national level. Using data from the Medical Expenditure Panel Survey (MEPS) from 2012 to 2014, they report that, in the first year after loss of market exclusivity, the US health care system could have saved approximately $1.9 billion if the estimated 3.9 million users of brand-name Lipitor had used lower-cost generic atorvastatin.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.0989
      Issue No: Vol. 178, No. 5 (2018)
       
  • Admitting What We Do Not Know in Rheumatologic Disease
    • Authors: Lockwood MM; O’Malley PG.
      Pages: 722 - 723
      Abstract: This essay examines the levels of evidence used by specialty societies for creating treatment and diagnosis guidelines for patients with rheumatologic diseases.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2017.8557
      Issue No: Vol. 178, No. 5 (2018)
       
  • Admitting What We Do Not Know in Rheumatologic Disease—The First
           Step Toward Learning More
    • Authors: Caplan L; FitzGerald J.
      Pages: 723 - 724
      Abstract: To the Editor We read with interest the Research Letter by Duarte-García and colleagues in a recent issue of JAMA Internal Medicine. As chairs of the American College of Rheumatology (ACR) Quality of Care Committee and Guideline Subcommittee, we welcome critical evaluation of ACR guideline efforts because these efforts help direct guideline development. We agree that high-quality evidence is ideal, but unfortunately, many rheumatic conditions are rare and require complex treatment choices, making it impossible to have sufficient large-scale trials. As Duarte-García and colleagues note, integration of such evidence is comparable with guidelines in other subspecialties.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.1251
      Issue No: Vol. 178, No. 5 (2018)
       
  • Admitting What We Do Not Know in Rheumatologic Disease—The First Step
           Toward Learning More—Reply
    • Authors: Wong JB; Duarte-García A.
      Pages: 724 - 724
      Abstract: In Reply We welcome the comments provided by Caplan and FitzGerald, the respective Chairs of the American College of Rheumatology (ACR) Guideline and Quality of Care Committees, about our characterization of the evidentiary basis of ACR guidelines with a median of 50% of recommendations being level of evidence C, attributable to expert opinion, case studies, or standard of care as indicated. We acknowledge the reference limitations in older ACR guidelines and agree on many points with Caplan and FitzGerald, but particularly with their assertion that high-quality evidence is ideal, but unfortunately, many rheumatic conditions are rare with complex treatment choices, making it impossible to have sufficient large-scale trials.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.0986
      Issue No: Vol. 178, No. 5 (2018)
       
  • Rigor in Quality Improvement Studies and the Role of Time-Series
           Methodologies
    • Authors: Wong BM; Shojania KG.
      Pages: 724 - 725
      Abstract: To the Editor In response to the Editorial by Grady and colleagues about quality improvement for quality improvement studies that was published in a recent issue of JAMA Internal Medicine, we disagree that rigor always requires concurrent controls and randomization. Time series with multiple data points provide comparable evaluative rigor to controlled, nonrandomized trials. When an intervention needs refinement, as is often the case in quality improvement, they often represent a more efficient evaluative strategy. The SQUIRE guidelines, which Grady and colleagues recommend to encourage improved reporting, explicitly list analyses that include the effects of time as a variable as appropriate.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.0863
      Issue No: Vol. 178, No. 5 (2018)
       
  • Rigor in Quality Improvement Studies and the Role of Time-Series
           Methodologies
    • Authors: Kamal AH; Agrawal S.
      Pages: 725 - 725
      Abstract: To the Editor In response to the editorial by Grady et al published in a recent issue of JAMA Internal Medicine, most quality improvement activities in medicine are not research, which is defined as “a systematic investigation, including research development, testing and evaluation, designed to develop or contribute to generalizable knowledge.”(p94) Because of expectations for generalizability, study designs that test hypotheses, maximize external validity, and test multiple contexts, are expected. Conversely, most quality improvement, though such activities may be systematic and data driven, is not designed to be generalizable, prompting recommendations exempting quality improvement from usual human subjects research review.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.0866
      Issue No: Vol. 178, No. 5 (2018)
       
  • Rigor in Quality Improvement Studies and the Role of Time-Series
           Methodologies—Reply
    • Authors: O’Malley PG; Redberg RF, Grady D.
      Pages: 725 - 726
      Abstract: In Reply We thank Wong and Shojania and Kamal and Agrawal for their interest and commentary on our recent Editorial. Wong and Shojania appropriately discuss the value of interrupted time series as a method to study quality improvement. A time series is a sequence of repeated measurements of an outcome over time. An interrupted time series is a sequence of repeated measurements taken both before and after the time series is “interrupted” by an intervention at a specific point in time. In theory, if the intervention is effective, the expected slope of the outcome measure based on measurements before the intervention should change significantly at the time of the intervention.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.0872
      Issue No: Vol. 178, No. 5 (2018)
       
  • Stopping and Eating and Drinking Among Patients With Advanced Illness
    • Authors: Mueller PS; Strand JJ, Tilburt JC.
      Pages: 726 - 727
      Abstract: To the Editor In a Special Communication published in a recent issue of JAMA Internal Medicine, Quill et al offer a thoughtful analysis of circumstances when dying patients voluntarily stop eating and drinking (VSED). We suggest several amendments to their analysis.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.1150
      Issue No: Vol. 178, No. 5 (2018)
       
  • Stopping and Eating and Drinking Among Patients With Advanced
           Illness—Reply
    • Authors: Quill TE; Ganzini L, Truog RD, et al.
      Pages: 727 - 727
      Abstract: In Reply We appreciate the well-considered comments made by Dr Mueller and colleagues on our recent Special Communication. While we agree that stopping eating and drinking is often a gradual and normal part of the dying process, doing so voluntarily is often substantially different both ethically and practically, especially because it requires compensating for and adjusting to a strong physiological desire to keep drinking.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.1147
      Issue No: Vol. 178, No. 5 (2018)
       
  • Uncoupling Diagnosis and Treatment of Incidentally Imaged Renal Masses
    • Authors: Nayan M; Jewett MS, Finelli A.
      Pages: 727 - 728
      Abstract: To the Editor We read with interest the Original Investigation published in a recent issue of JAMA Internal Medicine by Welch et al that used Medicare claims to demonstrate that the use of thoracoabdominal imaging was positively correlated with the risk of any renal procedure including partial or radical nephrectomy or ablation. Despite potentially earlier detection with increased rates of imaging, survival rates in kidney cancer have only marginally improved over time, prompting the notion of overtreatment. Given the increasing use of thoracoabdominal imaging, these findings emphasize the increasing need for a risk-adapted approach to managing incidentally detected renal masses.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.1180
      Issue No: Vol. 178, No. 5 (2018)
       
  • Uncoupling Diagnosis and Treatment of Incidentally Imaged Renal Masses
    • Authors: Neves JB; Tran MB.
      Pages: 728 - 728
      Abstract: To the Editor We would like to commend Welch et al for their recently published population-based analysis that clearly illustrates that the more we image, the more we treat and, the more potential harm we cause. As Welch et al note, previous work has shown that the diagnostic rate of incidental small renal masses has increased since the 1970s and that this has been fuelled by uptake of imaging methods, but earlier diagnosis has had no impact in kidney cancer mortality. Welch et al go 1 step further by providing, for the first-time to our knowledge, evidence that overdiagnosis of kidney masses does indeed lead to overtreatment.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.1186
      Issue No: Vol. 178, No. 5 (2018)
       
  • Potential Methods to Reduce Unnecessary Use of Laboratory Testing
    • Authors: Boice JL.
      Pages: 729 - 729
      Abstract: To the Editor I read with interest an Original Investigation by Valencia and colleagues published in a recent issue of JAMA Internal Medicine and wish to share some thoughts. The ordering and interpretation of laboratory tests by resident physicians in teaching hospitals is an important and integral part of their training. It has long been recognized that laboratory testing in teaching institutions may be excessive. With the implementation of diagnosis-related group reimbursement for hospital admissions, greater emphasis was placed on length of hospital stay than efficient laboratory use.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.1216
      Issue No: Vol. 178, No. 5 (2018)
       
  • Uncoupling Diagnosis and Treatment of Incidentally Imaged Renal
           Masses—Reply
    • Authors: Welch H; Schroeck FR.
      Pages: 729 - 729
      Abstract: In Reply We appreciate both responses to our Original Investigation, as well as the fact that they are from urological surgeons in Canada and the United Kingdom. We hope all surgeons will agree with the need for more conservative, risk-based strategies for small renal masses.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.1183
      Issue No: Vol. 178, No. 5 (2018)
       
  • Potential Methods to Reduce Unnecessary Use of Laboratory
           Testing—Reply
    • Authors: Moriates C; Valencia V.
      Pages: 729 - 730
      Abstract: Less is More
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.1213
      Issue No: Vol. 178, No. 5 (2018)
       
  • Dual Bronchodilators and β-Blockade for Cardiovascular Risk in Chronic
           Obstructive Pulmonary Disease
    • Authors: Zaheen A; Anand A, Stanbrook MB.
      Pages: 730 - 731
      Abstract: To the Editor Our Twitter-based journal club (@respandsleepjc [#rsjc]) discussed with interest the Original Investigation published by Wang et al in a recent issue of JAMA Internal Medicine, which analyzed the association between cardiovascular disease (CVD) and the use of long-acting bronchodilators in chronic obstructive pulmonary disease (COPD). While these findings confirm those of a prior study coauthored by one of us (M.B.S.) using similar methods, several important issues were raised by our discussants.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.1442
      Issue No: Vol. 178, No. 5 (2018)
       
  • Dual Bronchodilators and β-Blockade for Cardiovascular Risk in Chronic
           Obstructive Pulmonary Disease—Reply
    • Authors: Wang M; Wang Y, Tsai C.
      Pages: 731 - 731
      Abstract: Less is More
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.1450
      Issue No: Vol. 178, No. 5 (2018)
       
  • Correcting Errors That Modify Descriptive Statistics
    • Authors: Chaiyachati KH; Grande D.
      Pages: 731 - 732
      Abstract: To the Editor Our article titled “Association of Rideshare-Based Transportation Services and Missed Primary Care Appointments: A Clinical Trial” was published in the March 2018 issue of JAMA Internal Medicine. It showed that Medicaid patients offered rideshare-based transportation services did not have significantly different missed appointment rates compared with controls. We are writing to inform readers that we have identified 2 errors.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.1447
      Issue No: Vol. 178, No. 5 (2018)
       
  • Errors in Abstract, Results Section, and Table 2
    • Pages: 732 - 732
      Abstract: In the Original Investigation titled “Association of Rideshare-Based Transportation Services and Missed Primary Care Appointments: A Clinical Trial,” published in the March 2018 issue of JAMA Internal Medicine, in the Results section of the , in the last sentence of the first paragraph of the Results section of the text, and in the last row of Table 2, the number of patients who used the rideshare-based transportation service for an appointment was 57 (19.8%), not 85 (26.0%). Also in Table 2, the total number of patients in the intervention arm was 394, not 392. This article was corrected online.
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.1367
      Issue No: Vol. 178, No. 5 (2018)
       
  • February Sunrise
    • Pages: 732 - 732
      Abstract: Courtesy of: Thomas Ashley, MD, Gen Re, 120 Long Ridge Rd, Stamford, CT 06901
      PubDate: Tue, 01 May 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.1463
      Issue No: Vol. 178, No. 5 (2018)
       
 
 
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