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JAMA Internal Medicine
Journal Prestige (SJR): 8.032
Citation Impact (citeScore): 4
Number of Followers: 276  
 
  Full-text available via subscription Subscription journal
ISSN (Print) 2168-6106 - ISSN (Online) 2168-6114
Published by American Medical Association Homepage  [14 journals]
  • August 2018 Issue Highlights
    • Pages: 1009 - 1110
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2017.5224
      Issue No: Vol. 178, No. 8 (2018)
       
  • JAMA Internal Medicine
    • Pages: 1011 - 1011
      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: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2017.5225
      Issue No: Vol. 178, No. 8 (2018)
       
  • Reviving the FDA’s Authority to Publicly Explain Why New Drug
           Applications Are Approved or Rejected
    • Authors: Herder M.
      Pages: 1013 - 1014
      Abstract: This Viewpoint examines the US Food and Drug Administration’s ability to make the reasons for its regulatory decisions to approve, and in some cases to reject, drugs clear to the public.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3137
      Issue No: Vol. 178, No. 8 (2018)
       
  • Expression of Concern
    • Authors: Bauchner H.
      Pages: 1015 - 1015
      Abstract: This Expression of Concern warns of potential validity issues with articles written by Brian Wansink and published in JAMA and the JAMA Network journals.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.1986
      Issue No: Vol. 178, No. 8 (2018)
       
  • Importance of User-Centered Design and Evaluation
    • Authors: Horwitz LI.
      Pages: 1023 - 1024
      Abstract: The 2002 severe acute respiratory syndrome outbreak in Asia and the 2014 Ebola virus disease outbreak in Africa collectively infected thousands of health care workers and dramatically raised their consciousness about the correct use of personal protective equipment (PPE). A combination of intensive training, ample equipment, rigorous protocols, direct observation, and triage of patients to specialized centers ensured that only 3 of the hundreds of health care workers who cared for 24 patients with Ebola infection in the United States and Europe became infected.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.1902
      Issue No: Vol. 178, No. 8 (2018)
       
  • Rates of Lower Extremity Amputation Among Patients With End-stage Renal
           Disease Who Receive Dialysis
    • Authors: Franz D; Zheng Y, Leeper NJ, et al.
      Pages: 1025 - 1032
      Abstract: This study uses more than 3 million records from the US national end-stage renal disease registry between 2000 and 2014 to assess the rates of lower extremity amputation among patients with end-stage renal disease who receive dialysis and whether those rates are associated with patient characteristics and comorbidities.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.2436
      Issue No: Vol. 178, No. 8 (2018)
       
  • Association of a Bundled Hospital-at-Home Program With Clinical Outcomes
           and Patient Experiences
    • Authors: Federman AD; Soones T, DeCherrie LV, et al.
      Pages: 1033 - 1040
      Abstract: This case-control study compares the patient outcomes and ratings of care between patients who received hospital-at-home care bundled with a 30-day postacute transitional care period vs traditional inpatient care.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.2562
      Issue No: Vol. 178, No. 8 (2018)
       
  • Hospital-at-Home Care Programs—Is the Hospital of the Future at
           Home'
    • Authors: Liao JM; Navathe A, Press MJ.
      Pages: 1040 - 1041
      Abstract: Medicare continues to lead the national effort to improve health care value by reforming how clinicians and hospitals are paid. Participation in Medicare’s prominent alternative payment models, such as accountable care organizations (ACOs) and bundled payments, has been associated with some promising early results. Under new incentives created by the 2015 Medicare Access and CHIP Reauthorization Act, engagement in these and other value-based payment models will continue to increase.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.2566
      Issue No: Vol. 178, No. 8 (2018)
       
  • Physician Participation in Medicaid Through the ACA Medicaid Primary Care
           Payment Increase
    • Authors: Mulcahy AW; Gracner T, Finegold K.
      Pages: 1042 - 1048
      Abstract: This longitudinal analysis evaluates the Patient Protection and Affordable Care Act Medicaid primary care payment increase policy and assesses whether it was associated with changes in Medicaid participation rates or Medicaid service volume among primary care physicians.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.2610
      Issue No: Vol. 178, No. 8 (2018)
       
  • Reforming Payment for Primary Care—It’s Not Just the Money, It’s the
           Payment System
    • Authors: Goroll AH.
      Pages: 1049 - 1050
      Abstract: Poor Medicaid reimbursement stands as a frequently cited cause of reluctance by many primary care practices to serve Medicaid’s expanding population. With payment rates a fraction of those for Medicare and commercial insurance, most primary care practices find Medicaid reimbursement insufficient. The expansion of Medicaid eligibility by the Patient Protection and Affordable Care Act (ACA) creates an urgent need to engage more primary care practices and, if already participating, to expand their Medicaid roles. To encourage this expansion, the ACA legislated a normalizing of Medicaid reimbursement so that the reimbursement matched Medicare fee-for-service (FFS) rates.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.2607
      Issue No: Vol. 178, No. 8 (2018)
       
  • Effect of Tamsulosin on Passage of Symptomatic Ureteral Stones
    • Authors: Meltzer AC; Burrows P, Wolfson AB, et al.
      Pages: 1051 - 1057
      Abstract: In this randomized clinical trial, participants were randomized to treatment with either tamsulosin, 0.4 mg, or matching placebo daily for 28 days to determine if tamsulosin promotes the passage of urinary stones within 28 days among emergency department patients.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.2259
      Issue No: Vol. 178, No. 8 (2018)
       
  • Characterization of Failures in Infectious Agent Transmission Precaution
           Practices in Hospitals
    • Authors: Krein SL; Mayer J, Harrod M, et al.
      Pages: 1051 - 1057
      Abstract: This qualitative study examines types of precaution practice violations and errors in reducing transmission of infectious agents by hospital personnel in clinical units.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.1898
      Issue No: Vol. 178, No. 8 (2018)
       
  • Medical Expulsive Therapy for Ureteral Stones
    • Authors: Dahm P; Hollingsworth JM.
      Pages: 1058 - 1059
      Abstract: In this issue of JAMA Internal Medicine, Meltzer and colleagues report the results of a randomized clinical trial assessing the role of an α-blocker, tamsulosin, among patients presenting to the emergency department with renal colic secondary to a ureteral stone. In the absence of indications for immediate intervention (eg, pyelonephritis, obstruction of a solitary kidney, intractable pain), a trial of conservative treatment is warranted in this population, given that many patients will pass their stones spontaneously. However, since a number will fail conservative treatment and require a procedure for stone removal, there is great interest in strategies for increasing the likelihood of stone passage. The use of α-blockers like tamsulosin and calcium channel blockers, commonly referred to as medical expulsive therapy, has been championed as one such strategy.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.2265
      Issue No: Vol. 178, No. 8 (2018)
       
  • Association of Obesity or Weight Change With Coronary Heart Disease in
           Young Adults in South Korea
    • Authors: Choi S; Kim K, Kim S, et al.
      Pages: 1060 - 1068
      Abstract: This population-based longitudinal study assesses whether an association exists between body mass index or a change in body mass index and coronary heart disease among more than 2.6 million young adults in South Korea.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.2310
      Issue No: Vol. 178, No. 8 (2018)
       
  • Effect of EHR-Based Medication Support and Nurse-Led Education on
           Hypertension Medication Self-management
    • Authors: Persell SD; Karmali KN, Lazar D, et al.
      Pages: 1069 - 1077
      Abstract: This cluster randomized clinical trial assesses medication management tools delivered through a commercial electronic health record (EHR) with and without a nurse-led education intervention vs usual care among patients with hypertension and complex drug regimens.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.2372
      Issue No: Vol. 178, No. 8 (2018)
       
  • Multicenter Study of Patient-Reported Complications Associated With
           Indwelling Urethral Catheters
    • Authors: Saint S; Trautner BW, Fowler KE, et al.
      Pages: 1078 - 1085
      Abstract: This multicenter cohort study examines infectious and noninfectious complications reported by patients up to a month after receiving an indwelling urethral catheter.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.2417
      Issue No: Vol. 178, No. 8 (2018)
       
  • Association of Coffee Drinking With Mortality by Genetic Variation in
           Caffeine Metabolism
    • Authors: Loftfield E; Cornelis MC, Caporaso N, et al.
      Pages: 1086 - 1097
      Abstract: This population-based study of UK Biobank data assesses the association between coffee intake and mortality according to genetic caffeine metabolism scores.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.2425
      Issue No: Vol. 178, No. 8 (2018)
       
  • The Carbohydrate-Insulin Model of Obesity
    • Authors: Ludwig DS; Ebbeling CB.
      Pages: 1098 - 1103
      Abstract: This article discusses the association of a high-carbohydrate diet with postprandial hyperinsulinemia, deposition of calories in fat cells instead of oxidation in lean tissues, and predisposion to weight gain through increased hunger, slowing metabolic rate, or both.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.2933
      Issue No: Vol. 178, No. 8 (2018)
       
  • The Carbohydrate-Insulin Model of Obesity Is Difficult to Reconcile With
           Current Evidence
    • Authors: Hall KD; Guyenet SJ, Leibel RL.
      Pages: 1103 - 1105
      Abstract: Ludwig and Ebbeling compare 2 mechanistic models of obesity, the so-called conventional model (CM) and the carbohydrate-insulin model (CIM). The CM considers energy intake and expenditure to be functionally independent processes receiving no feedback from circulating fuels or endocrine signals. Food intake and physical activity are portrayed to be under conscious control, albeit subject to environmental influences. Thus, preventing and treating obesity simply requires the willpower to eat less and move more.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.2920
      Issue No: Vol. 178, No. 8 (2018)
       
  • Corticosteroid Use and Pneumocystis Pneumonia Prophylaxis
    • Authors: LoPiccolo J; Mehta SA, Lipson EJ.
      Pages: 1106 - 1107
      Abstract: This Teachable Moment uses the details of a case report to illustrate the need for Pneumocystis pneumonia prophylaxis in certain immunocompromised but HIV-negative patients.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.2387
      Issue No: Vol. 178, No. 8 (2018)
       
  • Partner Therapy in Sexually Transmitted Infections
    • Authors: Keshvani N; Nijhawan A, Gupta A.
      Pages: 1108 - 1109
      Abstract: This Teachable Moment describes novel strategies for notification and treatment of patients’ partners with gonorrhea infection to help reverse the trend of rising gonococcal infection and resistance.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.2406
      Issue No: Vol. 178, No. 8 (2018)
       
  • Effectiveness and Value of 2 Novel Treatments for Tardive Dyskinesia
    • Authors: Atlas SJ; Agboola F, Curfman G.
      Pages: 1110 - 1112
      Abstract: This Evidence to Practice review provides a summary and commentary on a recent commissioned report examining 2 new vesicular monoamine transporter 2 (VMAT2) inhibitors for treatment of tardive dyskinesia.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.2463
      Issue No: Vol. 178, No. 8 (2018)
       
  • An Unusual Occurrence of Dual Tachycardia
    • Authors: Rosenblum AM; Rosenblum AL.
      Pages: 1113 - 1114
      Abstract: This case report describes a case of concomitant sinus tachycardia and spontaneous focal tachycardia arising from the atrioventricular junction.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.2393
      Issue No: Vol. 178, No. 8 (2018)
       
  • Electrocardiographic Findings in a Woman With Dextrocardia and Cyanosis
    • Authors: Zhang Y; Jiang H, Liu R.
      Pages: 1115 - 1116
      Abstract: This case report presents the electrocardiographic findings of a woman with a history of progressive cyanosis and dyspnea developing chest tightness and shortness of breath after a cold.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.2682
      Issue No: Vol. 178, No. 8 (2018)
       
  • Irregular Narrow Complex Tachycardia in the Setting of Congenital Heart
           Disease
    • Authors: Oesterle A; Tseng ZH.
      Pages: 1117 - 1119
      Abstract: A man with complex congenital heart disease that included D-transposition of the great arteries, single ventricle physiology, and Fontan circulation was admitted to a hospital with lightheadedness and syncope that occurred while he was walking; he had a heart rate of 183 bpm in the emergency department. What is your diagnosis'
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.2477
      Issue No: Vol. 178, No. 8 (2018)
       
  • Association of Hydrochlorothiazide Use With Risk of Malignant Melanoma
    • Authors: Pottegård A; Pedersen S, Schmidt S, et al.
      Pages: 1120 - 1122
      Abstract: This case-control study assesses the association of hydrochlorothiazide with risk of malignant melanoma among Danish adults.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.1652
      Issue No: Vol. 178, No. 8 (2018)
       
  • Use of Venous Thromboembolism Prophylaxis in Hospitalized Patients
    • Authors: Grant PJ; Conlon A, Chopra V, et al.
      Pages: 1122 - 1124
      Abstract: This study examines the use of pharmacologic and mechanical prophylaxis in hospitalized patients at low and high risk for venous thromboembolism.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.2022
      Issue No: Vol. 178, No. 8 (2018)
       
  • Diversity of Participants in the 340B Drug Pricing Program for US
           Hospitals
    • Authors: Nikpay S; Buntin M, Conti RM.
      Pages: 1124 - 1127
      Abstract: This study examines how uncompensated care, provision of low-profit services, and financial stability differed between nonprofit and public hospitals in the United States that were participating in the 340B drug pricing plan compared with nonparticipating hospitals in 2015.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.2015
      Issue No: Vol. 178, No. 8 (2018)
       
  • Reforming the 340B Drug Pricing Program
    • Authors: Coukell AJ; Dickson S.
      Pages: 1127 - 1128
      Abstract: The maligned and ardently defended 340B drug pricing program allows qualifying hospitals and clinics (those serving a disproportionate share of low-income patients or receiving federal grants to provide specific services) to generate revenue by purchasing prescription drugs from pharmaceutical manufacturers at discounted prices while being reimbursed by Medicare and other payers at standard levels. The discounted price available to 340B purchasers has 2 components: a fixed base discount (23.1% for brand drugs) and an additional discount triggered by manufacturer price increases greater than inflation (termed the inflation penalty). This inflation penalty accounts for more than one-half of the 340B discount.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.2007
      Issue No: Vol. 178, No. 8 (2018)
       
  • Health Insurance for Asian Americans, Native Hawaiians, and Pacific
           Islanders Under the ACA
    • Authors: Park JJ; Humble S, Sommers BD, et al.
      Pages: 1128 - 1129
      Abstract: This cohort study analyzed the extent of post–Affordable Care Act (ACA) health insurance coverage gains for Asian Americans, Native Hawaiians, and Pacific Islanders and whether disparities in coverage have narrowed over time.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.1476
      Issue No: Vol. 178, No. 8 (2018)
       
  • Barriers to Breastfeeding for US Physician Mothers
    • Authors: Melnitchouk N; Scully RE, Davids JS.
      Pages: 1130 - 1132
      Abstract: This survey study evaluates the barriers to breastfeeding among a large representative nationwide cohort of physicians who are mothers.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.0320
      Issue No: Vol. 178, No. 8 (2018)
       
  • Changes in Ability of Hospitals to Provide Pricing for Total Hip
           Arthroplasty From 2012 to 2016
    • Authors: Mahomed S; Rosenthal J, Matelski J, et al.
      Pages: 1132 - 1133
      Abstract: This survey study examines whether a group of 122 hospitals originally surveyed in 2011 had improved in their ability to provide price for a total hip arthroplasty when resurveyed in 2016.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.1473
      Issue No: Vol. 178, No. 8 (2018)
       
  • Clinicians and Health Care Price Transparency—Buyers vs Sellers'
    • Authors: Sinaiko AD.
      Pages: 1133 - 1135
      Abstract: The inaccessibility of price information in the US health care system prevents patients from anticipating and incorporating their health care costs into care-seeking decisions and from choosing the best-value clinician (physician or facility). There is wide price variation across clinicians in the same geographic areas, which means that patients, especially those enrolled in high-deductible health plans, can potentially spend less for many services. The goal behind health care price transparency is that prices can be part of a patient’s decision about where to seek care, giving clinicians an incentive to lower costs or make a compelling case for the comparative quality of care to attract patients. Increasing transparency could also benefit the health care system broadly because it would be increasingly difficult for clinicians to charge significantly higher prices than others without commensurate differences in quality; these high prices are a key contributor to higher health care spending in the US relative to other countries who are members of the Organisation for Economic Co-operation and Development.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.1503
      Issue No: Vol. 178, No. 8 (2018)
       
  • Revised Meta-analysis of Vitamin K and Fractures
    • Authors: Grey A; Avenell A, Bolland M.
      Pages: 1135 - 1135
      Abstract: To the Editor Torgerson and colleagues are to be congratulated in addressing the effect on their meta-analysis of trials of vitamin K and fractures following the recognition that 3 of 7 contributing trials are problematic. However, we are concerned that the conclusions of the updated article are no longer consistent with the results of the updated analysis presented in their Figure 4.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.2853
      Issue No: Vol. 178, No. 8 (2018)
       
  • Revised Meta-analysis of Vitamin K and Fractures—Reply
    • Authors: Torgerson DJ.
      Pages: 1135 - 1135
      Abstract: In Reply I thank the authors for their considered response to our note of caution about our vitamin K review, with respect to problems of including trials by Sato et al. In our original review, the phrase we used of there being a large effect (odds ratio, 0.30) is technically correct, because this kind of treatment effect is rarely seen in trials of treatments for osteoporosis. Nevertheless, Grey and colleagues are right to be concerned that this effect is based on a tiny number of events and is not statistically significant. Consequently, the findings from our review should, at best, be used to inform future research studies that could confirm or refute the suggestion that there might be a clinically important difference in fracture rates using vitamin K supplements rather than informing current clinical practice. Similarly, their concerns about generalizability are also well founded given that the populations where an effect was noted had unusually high event rates.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.2865
      Issue No: Vol. 178, No. 8 (2018)
       
  • Good Clinical Practice in Diagnosis of Vulvovaginal Symptoms
    • Authors: Reichman O; Sobel JD.
      Pages: 1135 - 1136
      Abstract: To the Editor We read with great interest the recent report by Mitchell and colleagues regarding the efficacy of topical low-dose vaginal estrogen vs topical vaginal moisturizer or placebo for treating postmenopausal vulvovaginal symptoms.(p681) We are concerned with the authors’ conclusion that “…neither prescribed vaginal estradiol tablet nor over-the-counter vaginal moisturizer provides additional benefit over placebo vaginal tablet and gel in reducing postmenopausal vulvovaginal symptoms.”
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.2872
      Issue No: Vol. 178, No. 8 (2018)
       
  • Good Clinical Practice in Diagnosis of Vulvovaginal Symptoms—Reply
    • Authors: Mitchell CM; Reed SD, Guthrie KA.
      Pages: 1136 - 1137
      Abstract: In Reply We appreciate the comments of Drs Reichman and Sobel in regard to our recent report of efficacy of hormonal and nonhormonal treatments for postmenopausal vaginal discomfort. They express concern that we enrolled participants based on symptoms rather than objective physical findings of vulvovaginal atrophy. We opted to use an outcome that is relevant to patients—symptom severity—in a 12-week trial, the standard duration for studying interventions for genitourinary syndrome of menopause. Trials of longer duration have not shown greater benefit. Our study was powered to detect a difference of half a standard deviation between treatment arms in the change from baseline of most bothersome vulvovaginal symptom severity (approximately 0.5 on a 0- to 3-point scale; mean baseline score, 2.5). Smaller differences, arguably, would not reflect a clinically relevant benefit. As to objective endpoints, several studies show that physician assessment of the appearance of vulvovaginal atrophy does not correlate with patient report of symptoms, which is why we chose symptoms as our inclusion criteria and primary outcome. That said, the majority of our participants did meet the objective criteria for atrophy, with vaginal maturation index less than 5% superficial cells and a pH greater than 5 (81%).
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.2856
      Issue No: Vol. 178, No. 8 (2018)
       
  • Acute Kidney Injury Due to Concomitant Vancomycin and
           Piperacillin-Tazobactam
    • Authors: Wu PE; Leong D.
      Pages: 1137 - 1137
      Abstract: To the Editor Bergstrom and colleagues present a very important case that highlights the dangers of medical overuse and specifically brings to light an increasingly recognized adverse event of acute kidney injury due to concomitant vancomycin and piperacillin-tazobactam. The Infectious Diseases Society of America guidelines do not routinely recommend empirical vancomycin use, and, as the authors highlight, this patient was low risk and did not have an indication for additional gram-positive coverage with intravenous vancomycin. This is especially important given the emerging data that concomitant use of vancomycin with piperacillin-tazobactam independently puts patients at risk of acute kidney injury. A 2017 systematic review and meta-analysis of 14 observational studies involving 3549 patients found a more than 3-fold increased risk of acute kidney injury with vancomycin and piperacillin-tazobactam when compared with vancomycin alone or in combination with another β-lactam (including cefipime or carbapenem). Following this, a more recent systematic review and meta-analysis in 2018 involving more than 24 000 patients found that the rate of acute kidney injury was 22.2% for vancomycin and piperacillin-tazobactam vs 12.9% for comparators (eg, vancomycin plus cefipime, vancomycin plus carbapenem, monotherapy with vancomycin or piperacillin-tazobactam), yielding a number needed to harm of 11.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.2930
      Issue No: Vol. 178, No. 8 (2018)
       
  • Acute Kidney Injury Due to Concomitant Vancomycin and
           Piperacillin-Tazobactam—Reply
    • Authors: Bergstrom C; Nagalla S, Gupta A.
      Pages: 1137 - 1138
      Abstract: In Reply We concur with and thank Wu and Leong for emphasizing the risk of acute kidney injury with concomitant vancomycin and piperacillin-tazobactam therapy. This is especially relevant in low-risk patients with febrile neutropenia who do not have an indication for empirical vancomycin as in the patient described. In 1 large retrospective study conducted at an academic medical center, combination vancomycin and piperacillin-tazobactam therapy was associated with twice the odds of developing acute kidney injury compared with combination vancomycin and cefepime. Compared with cefepime, piperacillin-tazobactam is also associated with greater risk of developing thrombocytopenia, which is often already present in cancer patients with febrile neutropenia due to myelosuppression. Thus, cefepime alone is a reasonable first-line drug for most cases of neutropenic fever. However, ultimately it requires thoughtful clinical judgment that considers the likely source of infection, severity of illness, the hospital or unit antibiograms, prior antibiotic exposure, and prior infections or colonization with multidrug resistant pathogens to determine when to choose an alternative antipseudomonal β-lactam or to add vancomycin.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.2921
      Issue No: Vol. 178, No. 8 (2018)
       
  • Further Considerations Regarding Duration of Antibiotic Therapy for
           Sinusitis
    • Authors: Chang EY; Fatima S, Stevens ES.
      Pages: 1138 - 1138
      Abstract: To the Editor We read with great interest the article by King et al regarding the high prevalence of prolonged antibiotic usage in US adults with sinusitis, especially given the high costs associated with the management of sinusitis along with the potential for selecting antibiotic resistant organisms.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3010
      Issue No: Vol. 178, No. 8 (2018)
       
  • Further Considerations Regarding Duration of Antibiotic Therapy for
           Sinusitis—Reply
    • Authors: King LM; Hicks LA, Fleming-Dutra KE.
      Pages: 1138 - 1139
      Abstract: Less is More
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3013
      Issue No: Vol. 178, No. 8 (2018)
       
  • Considering Pharmaceutical Rebates
    • Authors: Johansen ME; Richardson CR.
      Pages: 1139 - 1140
      Abstract: To the Editor We read the recent article by Warraich and colleagues with much interest. The authors concluded that despite the availability of generic atorvastatin, payers continue to pay substantial excess expenditures for Lipitor (Pfizer). Unfortunately, proprietary pharmaceutical industry rebates make it difficult to assess the validity of this conclusion.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3044
      Issue No: Vol. 178, No. 8 (2018)
       
  • Considering Pharmaceutical Rebates—Reply
    • Authors: Warraich H; Salami JA, Nasir K.
      Pages: 1140 - 1141
      Abstract: In Reply We appreciate Johansen et al raising the critical issue of varying levels of rebates offered via pharmacy benefit managers (PBMs) to pharmacies and payers, and associated challenges with robust estimation of payer-level expenditure related to specific pharmaceutical products. We used similar methods employed in prior studies leveraging Medical Expenditures Panel Survey data to estimate potential national level savings for both total and/or associated out-of-pocket costs with potential substitution of branded drugs with generic medications. The complexity of rebates makes it difficult to assume the true impact of these existing rebate agreements between PBMs and insurers. By tying rebates to claims rather than drugs, PBMs elude transparency by not having to account each rebate for each drug. Pharmacy benefit managers also conceal the amount they save with each rebate, returning only the guaranteed rebate amount to the manufacturer. In some instances, the amount of rebate pocketed by the PBM can be greater than the total cost of the drug. Additionally, these pervasive agreements may actually increase national health care costs due to barriers in access for generic drugs. If the goals are truly to pass cost-effective options as well as savings to consumers (patients and payers) and enhance transparency, drug manufacturers are better off eliminating these rebate programs and lowering costs directly at point of sales. Furthermore, we agree with the assertion by Johansen et al that company drug-specific financial statements may not equate to national expenditure, even when rebates may be accounted for because of sales to wholesalers that may not have subsequently been purchased by pharmacies in those specific years. Finally, Johansen et al point to our finding of higher out-of-pocket cost for Lipitor vs generic atorvastatin in 2014, which has been previously reported on by other sources and which is a difference that was not noted in subsequent years given that Pfizer stopped investing in those price-reduction programs beyond 2014. In summary, given the proprietary and complex nature of rebates, there is no reliable measure to estimate them, which is why the majority of analyses do not perform such calculations. Furthermore, accounting for these rebates might lead to a false underestimation of the costs associated with these drugs borne by the entire health system.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3047
      Issue No: Vol. 178, No. 8 (2018)
       
  • The Hindsight Problem in Evaluating the Value of Ultrasonography in
           Cellulitis
    • Authors: Cho HJ; Truong TN, Loebel EM.
      Pages: 1141 - 1141
      Abstract: To the Editor We commend Ko et al for their article, and we wholeheartedly agree that there is overuse of both imaging and blood cultures in cellulitis. In regard to ultrasonography in cellulitis, the driver of overtesting may not be concern for complications (eg, abscess) but rather in ascertaining the correct initial diagnoses. As the authors stated, the Infectious Diseases Society of America does not recommend routine imaging for cellulitis except in patients with febrile neutropenia. However, the possibility of a deep venous thrombosis (DVT), either as an alternate or concurrent diagnosis, is concerning for many front-line clinicians.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3248
      Issue No: Vol. 178, No. 8 (2018)
       
  • The Hindsight Problem in Evaluating the Value of Ultrasounds in
           Cellulitis—Reply
    • Authors: Ko LN; Garza-Mayers AC, Kroshinsky D.
      Pages: 1141 - 1142
      Abstract: In Reply We thank Cho et al for their letter to the editor and are grateful for the opportunity to discuss the important points raised therein. Given the word limit of our original article, we were not able to elaborate on this important subject matter and appreciate the opportunity to more clearly elucidate the methodology on where and how the “presumed diagnosis of cellulitis” was determined. We retrospectively analyzed the results of a larger prospective study performed in the emergency department and internal medicine units. The cohort included patients who had been evaluated and suspected of having cellulitis by an emergency department physician prior to admission, rather than patients identified by an International Classification of Diseases code of cellulitis. We agree that a retrospective analysis of patients who had International Classification of Diseases codes for cellulitis following hospitalization would present a biased view of the population and their subsequent imaging. Thus, in this study, the patients who received imaging were already suspected of having cellulitis at the time of imaging.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3240
      Issue No: Vol. 178, No. 8 (2018)
       
  • The Health Care System Flies in the Face of Airline Security Concepts
    • Authors: Braillon A; Bewley S, Ross N.
      Pages: 1142 - 1143
      Abstract: To the Editor Freund et al must be commended for their randomized trial showing an association with systematic cross-checking between emergency physicians and reduced adverse events.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3550
      Issue No: Vol. 178, No. 8 (2018)
       
  • The Health Care System Flies in the Face of Airline Security
           Concepts—Reply
    • Authors: Freund Y; Bloom B, Philippon A.
      Pages: 1143 - 1143
      Abstract: In Reply We thank Braillon et al for their comment on the CHARMED study.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3553
      Issue No: Vol. 178, No. 8 (2018)
       
  • Revised Version of Research Letter by Nikpay et al and Associated Changes
           for Accompanying Commentary
    • Authors: Coukell AJ; Dickson S.
      Pages: 1143 - 1144
      Abstract: To the Editor Due to an inadvertent journal error, when preparing our Invited Commentary regarding the Research Letter by Nikpay et al, we were not sent the final version of the Research Letter, after its revision. As there were important differences, we are updating our commentary to reflect the final published study results.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.4151
      Issue No: Vol. 178, No. 8 (2018)
       
  • Changes to Wording and Descriptions Throughout Text
    • Pages: 1144 - 1144
      Abstract: In the Invited Commentary “Reforming the 340B Drug Pricing Program: Tradeoffs Between Hospital and Manufacturer Revenues” by Coukell and Dickson, there were several inaccuracies throughout the text, specifically in paragraphs 5, 6, 7, and 9, owing to the authors’ review of an earlier version of the accompanying Research Letter, on which they based their commentary. A letter of explanation describes the changes. This article has been corrected online.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.4085
      Issue No: Vol. 178, No. 8 (2018)
       
  • Transposed Figure Numbering
    • Pages: 1144 - 1144
      Abstract: In the Original Investigation titled “Intra-aortic Balloon Pump Therapy for Acute Myocardial Infarction: A Meta-analysis,” published in the June 2015 issue of JAMA Internal Medicine, the positive and negative numbers on the x-axis of Figure 5 were transposed. The numbers should read from 0 to 5 on the left side of the axis and from 0 to −5 on the right side. This article was corrected online.
      PubDate: Wed, 01 Aug 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3977
      Issue No: Vol. 178, No. 8 (2018)
       
 
 
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