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JAMA Internal Medicine
Journal Prestige (SJR): 8.032
Citation Impact (citeScore): 4
Number of Followers: 278  
 
  Full-text available via subscription Subscription journal
ISSN (Print) 2168-6106 - ISSN (Online) 2168-6114
Published by American Medical Association Homepage  [14 journals]
  • November 2018 Issue Highlights
    • Pages: 1437 - 1439
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2017.5239
      Issue No: Vol. 178, No. 11 (2018)
       
  • JAMA Internal Medicine
    • Pages: 1440 - 1440
      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: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2017.5240
      Issue No: Vol. 178, No. 11 (2018)
       
  • Inappropriate Behavior by Patients and Their Families—Call It Out
    • Authors: Cowan A.
      Pages: 1441 - 1441
      Abstract: This essay describes the author’s experiences with inappropriate behavior by patients and their families and proposes techniques to overcome this challenge when treating these patients.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.4348
      Issue No: Vol. 178, No. 11 (2018)
       
  • Ambiguity in End-of-Life Care Terminology
    • Authors: Kelemen AM; Groninger H.
      Pages: 1442 - 1443
      Abstract: This Perspective uses an end-of-life care vignette to illustrate the need to clarify the meaning of the term comfort care.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.4291
      Issue No: Vol. 178, No. 11 (2018)
       
  • Memorial Day Reflections—The Invisible Enemy
    • Authors: Chen K.
      Pages: 1444 - 1445
      Abstract: This Perspective describes a Vietnam veteran with posttraumatic stress disorder including a debilitating startle response refractory to treatment.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3109
      Issue No: Vol. 178, No. 11 (2018)
       
  • Posttraumatic Stress Disorder in Primary Care Practice
    • Authors: Friedman MJ.
      Pages: 1445 - 1446
      Abstract: Imagine this. You are watching a movie. It is a grainy black-and-white film, clearly not a Hollywood production. The first thing you see in the center of the screen is a raised desk supporting an old-fashioned Underwood typewriter. Behind the typewriter sits a woman intermittently pecking at the keys. Each time she taps a key, there is a distinct sharp click—it is not too loud, but it is a sudden brief, crisp interruption of the silence.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3108
      Issue No: Vol. 178, No. 11 (2018)
       
  • Treating Obesity—Moving From Recommendation to Implementation
    • Authors: Haire-Joshu D; Hill-Briggs F.
      Pages: 1447 - 1449
      Abstract: Today 39.6% of adults in the United States are obese, placing them at high risk for chronic disease-related morbidity and mortality. Behavioral weight management is a proven treatment for obesity, with significant benefits associated with a weight loss of 5% to 7%. The US Preventive Services Task Force (USPSTF) recommendation for “Behavioral Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults,” supported by an evidence report and systematic review, provides evidence for effective programs to reverse obesity and reduce risk for negative health outcomes. The current USPSTF statement “recommends that clinicians offer or refer adults with a body mass index (BMI) of 30 or higher…to intensive, multicomponent behavioral interventions (B recommendation).” These interventions “can lead to clinically significant improvements in weight status and reduce the incidence of type 2 diabetes among adults with obesity and elevated plasma glucose levels.” This statement updates the 2012 USPSTF recommendation by further articulating core program elements and structure needed for effective counseling and impact. However, a recent study by Fitzpatrick and Stevens reported that obesity management in primary care settings remains suboptimal, with underdiagnoses of obesity and declines in weight management counseling from 33% in the 2008-2009 period to 21% in the 2012-2013 period. Despite evidence that intensive behavioral interventions work, most patients will not receive care that complies with that evidence. A critical priority then is how to promote the implementation and dissemination of evidence-based obesity interventions.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.5259
      Issue No: Vol. 178, No. 11 (2018)
       
  • Notice of Retractions: Wansink
    • Authors: Bauchner H.
      Pages: 1450 - 1450
      Abstract: These articles by Brian Wansink, PhD, are being retracted.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.5761
      Issue No: Vol. 178, No. 11 (2018)
       
  • Estimated Costs of Pivotal Trials for Therapeutic Agents Approved by the
           FDA, 2015-2016
    • Authors: Moore TJ; Zhang H, Anderson G, et al.
      Pages: 1451 - 1457
      Abstract: This study estimates the costs of pivotal clinical trials for all new therapeutic agents approved by the US Food and Drug Administration from 2015 to 2016 and examines how key features of the pivotal trials were associated with these costs.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3931
      Issue No: Vol. 178, No. 11 (2018)
       
  • Clinical Trials—We Get What We Pay For
    • Authors: Ross JS.
      Pages: 1457 - 1457
      Abstract: It is universally agreed that a clinical trial provides invaluable insights and knowledge, particularly when done well, through the use of randomization, blinded allocation, by including a control arm, and by focusing on a clinical outcome as opposed to a surrogate marker of disease. Clinical trials form the basis of many of the most important determinations in medicine and health care broadly, including the US Food and Drug Administration’s (FDA’s) determination of medical product safety and efficacy, the determination made by the Centers for Medicare & Medicaid Services and other commercial payers to provide coverage for a medical product, and clinical recommendations made by professional societies and government agencies to guide practice. But a common objection to performing a clinical trial is that trials are expensive, requiring extensive time and resources (although such costs pale in comparison to the costs of the health care interventions spent after approval, with or without coverage).
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3930
      Issue No: Vol. 178, No. 11 (2018)
       
  • Labeling Changes and Costs Under the US Food and Drug Administration
           Pediatric Exclusivity Extension
    • Authors: Sinha MS; Najafzadeh M, Rajasingh EK, et al.
      Pages: 1458 - 1466
      Abstract: This study assesses the benefits of the US Food and Drug Administration’s pediatric exclusivity program in terms of new safety and efficacy data in pediatric populations and the costs to all consumers of extending market exclusivity by 6 months.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3933
      Issue No: Vol. 178, No. 11 (2018)
       
  • Association of Medical Scribes in Primary Care With Physician Workflow and
           Patient Experience
    • Authors: Mishra P; Kiang JC, Grant RW.
      Pages: 1467 - 1472
      Abstract: This crossover study of primary care physicians evaluates whether the use of medical scribes in primary care improves physician productivity and patient satisfaction.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3956
      Issue No: Vol. 178, No. 11 (2018)
       
  • Use of Medical Scribes to Reduce Documentation Burden
    • Authors: Bates DW; Landman AB.
      Pages: 1472 - 1473
      Abstract: Physician burnout is epidemic today in health care. For example, Shanafelt et al found in a 2012 national sample that 46% of physicians reported at least 1 symptom of burnout. In that study, burnout was more frequent in frontline practitioners. Although there are many contributors, one of the most important ones may be the use of the electronic health record (EHR).
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3945
      Issue No: Vol. 178, No. 11 (2018)
       
  • Efficacy of Low-Dose Amitriptyline for Chronic Low Back Pain
    • Authors: Urquhart DM; Wluka AE, van Tulder M, et al.
      Pages: 1474 - 1481
      Abstract: This randomized clinical trial examines the efficacy of low-dose amitriptyline vs an active comparator in reducing pain, disability, and work absence and hindrance in individuals with chronic low back pain.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.4222
      Issue No: Vol. 178, No. 11 (2018)
       
  • Venous Thromboembolism Risk With Extended- and Continuous-Cycle Combined
           Oral Contraceptive Use
    • Authors: Li J; Panucci G, Moeny D, et al.
      Pages: 1482 - 1488
      Abstract: This cohort study compares the risk for venous thromboembolism among women who use extended cyclic and continuous combined oral contraceptives (COCs) with that among women who use traditional cyclic COCs, while holding the progestogen type constant.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.4251
      Issue No: Vol. 178, No. 11 (2018)
       
  • Association Between Patient Cognitive and Functional Status and Medicare
           Cost of Care
    • Authors: Johnston KJ; Wen H, Hockenberry JM, et al.
      Pages: 1489 - 1497
      Abstract: This study analyzes data from the Medicare Current Beneficiary Survey to determine if patient cognitive and functional status and local area health care supply and economic conditions are associated with Medicare total annual cost of care.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.4143
      Issue No: Vol. 178, No. 11 (2018)
       
  • Guggenheim Museum, New York City
    • Pages: 1497 - 1497
      Abstract: Courtesy of: Manfred Hauben, MD, MPH, Pfizer, Worldwide Safety Strategy, 235 E 42nd St, New York, NY 10017
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.5415
      Issue No: Vol. 178, No. 11 (2018)
       
  • Assessment of the Effect of Adjustment for Patient Characteristics on
           Hospital Readmission Rates
    • Authors: Roberts ET; Zaslavsky AM, Barnett ML, et al.
      Pages: 1498 - 1507
      Abstract: This observational study analyzes Medicare claims and US Census data to evaluate differences in hospital readmission rates associated with measurable patient characteristics not used by Medicare to adjust for risk of readmissions in pay-for-performance programs.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.4481
      Issue No: Vol. 178, No. 11 (2018)
       
  • Value-Based Payments and Inaccurate Risk Adjustment—Who Is
           Harmed'
    • Authors: Bynum J; Lewis V.
      Pages: 1507 - 1508
      Abstract: The principles of value-based payment models in health care are elegant, intuitive, and appealing: pay clinicians for delivering high-quality care. In practice, however, we have not yet agreed on many of the important details on either cost or quality. The goal of measuring true quality remains elusive, with important unresolved issues of conceptualizing, operationalizing, and implementing quality measurement. In addition, technical and philosophical challenges remain on determining how to appropriately pay clinicians. Risk adjustment of payments and penalties raises the fundamental question of how to determine the right amount to pay for the highly varied patients that each clinician sees, and it has a profound impact on how clinicians function under value-based models. Risk adjustment can influence how organizations develop clinician networks, invest in service lines, plan locations, and treat patients. Under value-based payment models, avoidance of treating high-risk populations may be an appealing option for physician organizations, hospitals, or payers concerned that they will need to expend more resources for certain patients than they will receive to care for them. This phenomenon is known by many names, including adverse selection, cherry picking, cream skimming, and patient dumping, and has been found in a variety of contexts related to quality reporting or pay for performance. Adverse selection is a serious threat to successful value-based payment. Poorly executed risk adjustment is perhaps the biggest potential harm to high-risk patients, who may experience decreased access to high-quality clinicians as a result.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.4142
      Issue No: Vol. 178, No. 11 (2018)
       
  • Increased Daily Water Intake in Premenopausal Women With Recurrent Urinary
           Tract Infections
    • Authors: Hooton TM; Vecchio M, Iroz A, et al.
      Pages: 1509 - 1515
      Abstract: This randomized clinical trial assesses the efficacy of increased daily water intake vs usual fluid intake on the frequency of recurrent cystitis in premenopausal women experiencing recurrent cystitis who drink low volumes of total fluid daily.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.4204
      Issue No: Vol. 178, No. 11 (2018)
       
  • Drinking More Water for Prevention of Recurrent Cystitis
    • Authors: Grady D.
      Pages: 1515 - 1515
      Abstract: For decades, it has been said that increasing fluid intake could help prevent or cure urinary tract infections. In this issue of JAMA Internal Medicine, a randomized clinical trial confirms that folk wisdom. Hooton and colleagues randomized women with 3 or more episodes of cystitis in the prior year to consume 1.5 L of water per day (three 0.5-L bottles) in addition to their usual intake, or to consume no additional water. The women who consumed additional water had an approximately 50% reduction in number of cystitis episodes in the year after randomization and were prescribed fewer antibiotics. We realize that this trial was not blinded, the primary outcome was self-reported, and it was sponsored by Danone Research, which sells the bottled water used in this study. However, the research question is important and the intervention was safe, easy, and effective (and it would be impossible to blind a trial in which drinking water is the intervention). As the authors note, the reduction in episodes of cystitis is likely due to increased urine volume and voids that reduce bacterial load in the bladder. Given this, it seems clear that any safe-to-drink water will do, including your local tap water, which will also spare the environmental impact of bottled water and improve the cost-effectiveness of the intervention.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.4195
      Issue No: Vol. 178, No. 11 (2018)
       
  • NSAID Use Among Patients With a Musculoskeletal Disorder and Hypertension,
           Heart Failure, or CKD
    • Authors: Bouck Z; Mecredy GC, Ivers NM, et al.
      Pages: 1516 - 1525
      Abstract: This cohort study uses drug benefit claims data in Ontario, Canada, to estimate the frequency of and variation in prescription nonsteroidal anti-inflammatory drug (NSAID) use among high-risk patients with musculoskeletal disorders and hypertension, heart failure, or chronic kidney disease (CKD) and identifies characteristics associated with prescription NSAID use and its potential association with short-term, safety-related outcomes.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.4273
      Issue No: Vol. 178, No. 11 (2018)
       
  • Association of Chronic Kidney Disease With Allopurinol Use in Gout
           Treatment
    • Authors: Vargas-Santos A; Peloquin CE, Zhang Y, et al.
      Pages: 1526 - 1533
      Abstract: This cohort study uses data from the UK Health Improvement Network to examine the association of allopurinol use in patients with gout with the risk of developing chronic kidney disease stage 3 or higher.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.4463
      Issue No: Vol. 178, No. 11 (2018)
       
  • Studying Drug Safety in the Real World
    • Authors: Zipursky J; Juurlink DN.
      Pages: 1533 - 1534
      Abstract: Drugs are typically brought to market based on the results of randomized clinical trials (RCTs). In their simplest construction, 1 group of patients receives the new drug while another receives something else—usually placebo or another therapy. If the 2 groups of patients are similar at baseline, any differences in outcome (positive or negative) can be reasonably attributed to the drug being tested. The appeal of RCTs rests in their simplicity, and avoidance of biases and confounding. Randomized clinical trials are generally the best way to establish the risks and benefits of a therapeutic intervention for a particular group of patients.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.5766
      Issue No: Vol. 178, No. 11 (2018)
       
  • Acute Clinical Care for Transgender Patients
    • Authors: Rosendale N; Goldman S, Ortiz GM, et al.
      Pages: 1535 - 1543
      Abstract: This narrative review discusses the acute clinical care of transgender patients, whether in the hospital, the emergency department, or urgent care.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.4179
      Issue No: Vol. 178, No. 11 (2018)
       
  • Potential Biases in Machine Learning Algorithms Using Electronic Health
           Record Data
    • Authors: Gianfrancesco MA; Tamang S, Yazdany J, et al.
      Pages: 1544 - 1547
      Abstract: This Special Communication explores potential biases in machine learning–based clinical decision support tools that use electronic health record (EHR) data and possible solutions to those biases.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.3763
      Issue No: Vol. 178, No. 11 (2018)
       
  • Education and Reporting of Diagnostic Errors Among Physicians in Internal
           Medicine Training Programs
    • Authors: Wijesekera TP; Sanders L, Windish DM.
      Pages: 1548 - 1549
      Abstract: This survey study investigates education and reporting of diagnostic errors among resident and attending physicians in internal medicine training programs in Connecticut.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.4184
      Issue No: Vol. 178, No. 11 (2018)
       
  • Analysis of Work Requirement Exemptions and Medicaid Spending
    • Authors: Goldman AL; Woolhandler S, Himmelstein DU, et al.
      Pages: 1549 - 1552
      Abstract: This study estimates the number of Medicaid enrollees at risk of losing coverage if work requirements are implemented and calculates current Medicaid spending for those enrollees at the national level and among states with approved or pending waivers.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.4194
      Issue No: Vol. 178, No. 11 (2018)
       
  • Estimates of Individuals Subject to and Not Meeting Proposed Medicaid Work
           Requirements
    • Authors: Silvestri DM; Holland ML, Ross JS.
      Pages: 1552 - 1555
      Abstract: This cross-sectional analysis of 2014 Survey on Income and Program Participation data estimates the potential impact of work requirements on Medicaid eligibility on a state-by-state basis.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.4196
      Issue No: Vol. 178, No. 11 (2018)
       
  • Medicaid Work Requirements—English Poor Law Revisited
    • Authors: Chokshi DA; Katz MH.
      Pages: 1555 - 1557
      Abstract: In 1563, Elizabethan English law distinguished between the deserving poor, or those who wanted to work but could not because of infirmity or lack of available work, and the idle poor, or those who were judged able to work but would not. While the deserving poor were to be aided, the idle poor were to be punished. Four hundred fifty years later, the United States is still debating which of the poor are deserving and what they are deserving of.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.4193
      Issue No: Vol. 178, No. 11 (2018)
       
  • Trends in the Use of Knee Arthroscopy in Adults
    • Authors: Howard DH.
      Pages: 1557 - 1558
      Abstract: This study uses the Florida State Ambulatory Surgery and State Inpatient Databases to assess the trends in knee arthroscopy use among patients with osteoarthritis, meniscal tears, and knee pain.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.4175
      Issue No: Vol. 178, No. 11 (2018)
       
  • Association Between Antibiotic Prescribing for Respiratory Tract
           Infections and Patient Satisfaction
    • Authors: Martinez KA; Rood M, Jhangiani N, et al.
      Pages: 1558 - 1560
      Abstract: This study assesses the association between antibiotic prescribing for respiratory tract infections and satisfaction ratings among patients using a direct-to-consumer telemedicine platform.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.4318
      Issue No: Vol. 178, No. 11 (2018)
       
  • Factors Associated With Long-term Benzodiazepine Use Among Older Adults
    • Authors: Gerlach LB; Maust DT, Leong SH, et al.
      Pages: 1560 - 1562
      Abstract: This cohort study evaluates factors associated with the transition to long-term benzodiazepine use among older adults newly prescribed this drug by a nonpsychiatric clinician.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.2413
      Issue No: Vol. 178, No. 11 (2018)
       
  • Meeting the Criteria of Medication Therapy Management
    • Authors: Moon JY; Walek S, Walburg K.
      Pages: 1562 - 1563
      Abstract: To the Editor Persell and colleagues evaluated the effectiveness of electronic health record–based medication support and nurse-led medication therapy management on hypertension and medication self-management. The authors used the American Pharmacists Association’s definition of medication therapy management to support their study methods. According to that definition, medication therapy management includes “medication therapy review, a personal medication record, a medication action plan, intervention and referral, and documentation and follow-up.”(p574)
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.5789
      Issue No: Vol. 178, No. 11 (2018)
       
  • Meeting the Criteria of Medication Therapy Management—Reply
    • Authors: Persell SD; Wolf MS.
      Pages: 1563 - 1563
      Abstract: In Reply Moon and colleagues question whether the nature of the intervention delivered by nurses in the Northwestern and Access Community Health Network Medication Education Study should be considered to be medication therapy management. The way the intervention is characterized in their letter does not reflect the full range of actions included in the nurse intervention that are described in the article and in the longer description of the nurse-led intervention provided in the article reporting the study design and methods. The intervention did not only include patient education, but also was aimed at diagnosing and mitigating medication problems. It is important to note that the nurses in this study were embedded in the health center network where participants were receiving care, had access to patients’ medical records, and were empowered to work directly with patients’ treating clinicians to make medication changes when needed. Lastly, we point out that the trial was designed and conducted before the publication of the Academy of Managed Care Pharmacy statement from 2016.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.5792
      Issue No: Vol. 178, No. 11 (2018)
       
  • Limited Focus in Evaluation of Vaccine Cost-effectiveness
    • Authors: Curran D; Van Oorschot D, Buck P.
      Pages: 1563 - 1564
      Abstract: To the Editor The research letter by Le and Rothberg provides an economic evaluation of the adjuvanted recombinant zoster vaccine (RZV) in adults aged 50 to 59 years, as well as additional vaccination with RZV following initial vaccination with the zoster vaccine live (ZVL). In 2017, the Advisory Committee on Immunization Practices (ACIP) recommended the RZV vaccination: (1) for immunocompetent adults 50 years and older, (2) for immunocompetent adults previously vaccinated with ZVL, and (3) over ZVL. Based on their analysis, Le and Rothberg concluded that neither of the first 2 ACIP recommendations is cost-effective. However, their analysis focuses only on limited aspects of the ACIP recommendations (eg, vaccination at exact ages, such as 50 years), rather than vaccination of a population 50 years and older, which would better reflect the ACIP recommendation. They also focused on immediate additional vaccination with RZV, whereas the ACIP recommendation leaves open the time interval for additional vaccination with RZV (with the exception that it should not be given <2 months after receipt of ZVL).
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.5801
      Issue No: Vol. 178, No. 11 (2018)
       
  • Limited Focus in Evaluation of Vaccine Cost-effectiveness—Reply
    • Authors: Le P; Rothberg MB.
      Pages: 1564 - 1564
      Abstract: In Reply Curran and colleagues raised several issues with our research letter on the cost-effectiveness of the recent recommendations by the Advisory Committee on Immunization Practices for the adjuvanted recombinant zoster vaccine (RZV). First, they were concerned that our analysis focused on vaccination at age 50 years rather than the full range of 50 years and older, and on immediate revaccination rather than a range of vaccination intervals. We did this to avoid obfuscating a cost-ineffective strategy (vaccination at 50 years old or immediate revaccination) by averaging it with a very cost-effective one (vaccination at age 60 years or revaccination after 5 years). Importantly, a recommendation to vaccinate at 50 years and older is essentially a recommendation to vaccinate at 50, because clinical reminder systems will prompt physicians to order the vaccine when a patient turns 50 years old. Similarly, recommending revaccination more than 2 months after the live attenuated zoster vaccine (ZVL) would lead to some patients being vaccinated immediately. Instead, we identified the point at which vaccination or revaccination would be cost-effective.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.5804
      Issue No: Vol. 178, No. 11 (2018)
       
  • Re-examining the Association Between “4/20” and Fatal
           Crashes—Doobie-ous Data'
    • Authors: Aydelotte JD; Mardock AL, Teixeira PG, et al.
      Pages: 1565 - 1565
      Abstract: To the Editor In an analysis published in a recent issue of JAMA Internal Medicine, Staples and Redelmeier reported higher numbers of drivers involved in fatal motor vehicle crashes on April 20, the “counterculture holiday known as ‘4/20,’”(p569) when compared with the corresponding day of the previous (April 13) and following (April 27) weeks. However, analyzing the number of drivers involved in crashes—rather than the number of crashes—inflates crash numbers (and absolute differences in comparative crash numbers) because the majority of crashes included in the Fatality Analysis Reporting System database involved more than 1 vehicle. We were also concerned that the authors appeared to have aggregated data for the 2 control dates, which can create the impression of an effect when one does not exist. For example, the number of crashes could be exactly the same on April 20 and on April 13, but a 20% lower crash count on April 27 would give the impression of a 10% excess in crashes attributable to 4/20. Finally, the analysis as presented did not fully convey the longitudinal nature of the data or more recent evolutions in any observed effect.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.5856
      Issue No: Vol. 178, No. 11 (2018)
       
  • Further Lessons in Pneumocystis Pneumonia Prophylaxis
    • Authors: Schmajuk G; Yazdany J.
      Pages: 1565 - 1566
      Abstract: To the Editor We read with great interest the Teachable Moment by LoPiccolo and collegues that was published in a recent issue of JAMA Internal Medicine. Although we found the article to be highly relevant, we are concerned that it understated the potential harms of Pneumocystis pneumonia (PCP) prophylaxis and overstated its potential benefits.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.5930
      Issue No: Vol. 178, No. 11 (2018)
       
  • Further Lessons in Pneumocystis Pneumonia Prophylaxis—Reply
    • Authors: LoPiccolo J; Mehta SA, Lipson EJ.
      Pages: 1566 - 1567
      Abstract: In Reply We agree with Schmajuk and Yazdany that adverse events occur in a small fraction of patients using trimethoprim-sulfamethoxazole, as they pointed out in response to our recent Teachable Moment. However, at doses used for Pneumocystis pneumonia (PCP) prophylaxis, the drug combination is generally well tolerated, and gastrointestinal and cutaneous adverse effects, such as nausea and rash, occur in only 3% to 5% of patients. In HIV-uninfected patients, most of the adverse reactions (eg, nausea, vomiting, skin rash, pruritus) are not severe and resolve with discontinuation of the drug; this is in contrast to the 25% to 50% of HIV-infected patients who experience adverse effects (eg, neutropenia, anaphylaxis, toxic dermatologic reactions), which are more likely to be severe. Hyperkalemia, which can be life-threatening, has most commonly occurred in HIV-infected patients receiving high doses (trimethoprim, 20 mg/kg/d, and sulfamethoxazole, 100 mg/kg/d) for PCP treatment. Additionally, it is well known that the trimethoprim-sulfamethoxazole–induced creatinine increase is most often reflective of decreased tubular secretion and not an actual decline in glomerular filtration rate. It should also be noted that the risk of serious adverse effects with trimethoprim-sulfamethoxazole is not dissimilar to many other antibiotics.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.5933
      Issue No: Vol. 178, No. 11 (2018)
       
  • Mineralocorticoid Receptor Antagonism Treatment for All Patients With
           ST-Segment Myocardial Infarction'
    • Authors: Weir RP.
      Pages: 1567 - 1567
      Abstract: To the Editor Dahal and colleagues attempt to shed more light on whether mineralocorticoid receptor antagonism (MRA) benefits outcomes in acute myocardial infarction (MI) with left ventricular ejection fraction (LVEF) greater than 40%, but without heart failure, focusing on ST-segment elevation MI (STEMI). The conclusion of this meta-analysis—that MRA confers a mortality benefit in this group—is somewhat controversial given that none of the 10 trials included showed any mortality benefit in such patients; only 1 (ALBATROSS) suggested a mortality benefit in a nonprespecified STEMI subgroup. Moreover, there is significant heterogeneity in MRA prescribed, time to commencing MRA, reperfusion and revascularization strategies, and medical therapy, all known to influence outcome. The benefits of eplerenone therapy begun 3 to 14 days post-MI in the landmark EPHESUS trial were confined to those who began MRA treatment between days 3 and 7. Day 1 eplerenone treatment reduced a composite clinical/biochemical end point measure in patients with STEMI in REMINDER, driven by reductions in natriuretic peptides but without any mortality benefit. The results of the meta-analysis by Dahal and colleagues must therefore be interpreted with considerable caution.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.5950
      Issue No: Vol. 178, No. 11 (2018)
       
  • Mineralocorticoid Receptor Antagonism Treatment for All Patients With
           ST-Segment Myocardial Infarction'—Reply
    • Authors: Dahal K; Modi K.
      Pages: 1567 - 1568
      Abstract: In Reply We thank Dr Weir for his interest in our article. Although none of the individual trials showed statistically significant reduction in mortality except for ALBATROSS study, cumulative evidence supported the role of mineralocorticoid receptor antagonist (MRA) treatment in patients with acute ST-elevation myocardial infarction (STEMI) without heart failure or left ventricular ejection (LVEF) fraction greater than 40%. The findings of our meta-analysis are consistent with a recently published individual patient level analysis of 2 trials that evaluated MRA therapy in such patients. Although individual studies may be inconclusive, or show conflicting results, meta-analysis may help with cumulative analysis of available research in a topic of interest, which has been demonstrated in the past.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.5964
      Issue No: Vol. 178, No. 11 (2018)
       
  • Caution Advised for Readers of Comments Related to Retracted Article
    • Pages: 1568 - 1568
      Abstract: The Research Letter “First Foods Most: After 18-Hour Fast, People Drawn to Starches First and Vegetables Last,” was retracted on September 19, 2018. An Invited Commentary was published prior to the Retraction notice. This formal Correction notice is published to alert readers and remind them to not rely on the subsequently retracted article.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.6240
      Issue No: Vol. 178, No. 11 (2018)
       
  • Caution Advised for Readers of Comments Related to Retracted Article
    • Pages: 1568 - 1568
      Abstract: The Research Letter “Fattening Fasting: Hungry Grocery Shoppers Buy More Calories, Not More Food,” was retracted on September 19, 2018. An Editor’s Note was published prior to the Retraction notice. This formal Correction notice is published to alert readers and remind them to not rely on the subsequently retracted article.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.6238
      Issue No: Vol. 178, No. 11 (2018)
       
  • Caution Advised for Readers of Letters Related to Retracted Article
    • Pages: 1568 - 1568
      Abstract: The Research Letter “Watch What You Eat: Action-Related Television Content Increases Food Intake,” was retracted on September 19, 2018. A letter to the editor and a reply to that letter were published prior to the Retraction notice. This formal Correction notice is published to alert readers and remind them to not rely on the subsequently retracted articles.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.6048
      Issue No: Vol. 178, No. 11 (2018)
       
  • Numeric Errors in Table 1
    • Pages: 1568 - 1568
      Abstract: In the Original Investigation titled “Dialysis Initiation and Mortality Among Older Veterans With Kidney Failure Treated in Medicare vs the Department of Veterans Affairs,” published online April 9, 2018, and in the May print edition of JAMA Internal Medicine, the values listed in the Race category of column 5 were in error. The values in No. (%) for White, Black, Other, and Missing should have been 2490 (84.0), 259 (8.7), 188 (6.3), and 29 (1.0), respectively. The article has been corrected online.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.6396
      Issue No: Vol. 178, No. 11 (2018)
       
  • I Have Insomnia—What Should I Do'
    • Authors: Incze M; Redberg RF, Gupta A.
      Pages: 1572 - 1572
      Abstract: This Patient Page provides information on insomnia—how to recognize it and how it is best treated.
      PubDate: Thu, 01 Nov 2018 00:00:00 GMT
      DOI: 10.1001/jamainternmed.2018.2626
      Issue No: Vol. 178, No. 11 (2018)
       
 
 
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