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  • Omission of Data and Errors in Meta-analysis
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-18

    In the article titled “Association of Intensive Blood Pressure Control and Kidney Disease Progression in Nondiabetic Patients With Chronic Kidney Disease: A Systematic Review and Meta-analysis,”1 an omission of data from 1 trial reported in the article occurred and has resulted in changes to the Abstract, text, Table 1, Table 2, and the Figure of the main article, and to eFigure 1, eFigure 4, and eTable 1 in the online-only Supplement. A letter of explanation describes how this error occurred.2 The article was corrected online.

    更新日期:2017-09-18
  • Omission of Data and Errors in Meta-analysis
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-18
    Hon-Yen Wu

    To the Editor On behalf of my coauthors, I write to report an omission of data from 1 trial reported in our article, “Association of Intensive Blood Pressure Control and Kidney Disease Progression in Nondiabetic Patients with Chronic Kidney Disease: A Systematic Review and Meta-analysis,” that was published online first on March 13, 2017, and in the June 2017 issue of JAMA Internal Medicine.1 We are grateful to the reader who pointed out this omission and for the opportunity to correct the article. Our meta-analysis included data from 9 trials comprising 8127 patients that compared major renal outcomes in nondiabetic patients with chronic kidney disease (CKD) who received intensive blood pressure (BP) control (<130/80 mm Hg) vs standard BP control (<140/90 mm Hg). We inadvertently failed to include mortality data from the SPRINT trial2 in the summary estimate for overall mortality.

    更新日期:2017-09-18
  • Trends and Disparities in the Number of Self-reported Healthy Older Adults in the United States, 2000 to 2014
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-18
    Matthew A. Davis, Cui Guo, Ketlyne Sol, Kenneth M. Langa, Brahmajee K. Nallamothu
    更新日期:2017-09-18
  • Narrow-Complex Tachycardia in a Woman With a 20-Year History of Supraventricular Tachycardia
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-18
    Niyada Naksuk, Krishna Kancharla, Malini Madhavan
    更新日期:2017-09-18
  • Nil per Os Orders for ImagingA Teachable Moment
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-18
    Andrew L. Wickerham, Eric J. Schultz, Eliza B. Lewine

    An older woman with a history of insulin-dependent type 2 diabetes and metastatic breast carcinoma presented for positron emission tomographic (PET) surveillance of her cancer. There was no institutional policy on PET scan preparation for patients with diabetes, so her status was nil per os (NPO) for the scan, but she took her regular dose of insulin, a sulfonylurea, and metformin as scheduled. The PET scan was cancelled when she had a syncopal episode. When she was seen in the emergency department, she was noted to have a blood glucose level of 19 mg/dL (1.05 mmol/L) and an oxygen saturation level of less than 92%. Findings from her physical examination and initial workup caused concern for a pleural effusion, so her status was kept as NPO per hospital policy for a computed tomographic (CT) scan of her chest, which confirmed an effusion; pleural fluid analysis supported a malignant etiology. The patient elected to pursue curative treatment of her cancer, so her status was kept as NPO again for a restaging CT. Later that day, she fell in her hospital room, which necessitated NPO status for a CT scan of her head, revealing cerebral metastases of her cancer and ruling out intracranial hemorrhage. During her hospitalization, the patient’s blood glucose level remained labile, and despite ordering fall precautions, she had multiple falls; fortunately, none of these resulted in serious injury.

    更新日期:2017-09-18
  • Strategies That Delay Market Entry of Generic Drugs
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-18
    Kerstin Noëlle Vokinger, Aaron S. Kesselheim, Jerry Avorn, Ameet Sarpatwari

    Increasing prescription drug expenditures in the United States are primarily driven by high brand-name drug prices. Although generic competition helps lower drug prices, manufacturers of brand-name drugs often work to delay the availability of generic versions of their products. Strategies to forestall generic competition include patenting peripheral aspects of a drug or modified formulations that do not add clinical value, paying generic manufacturers to settle lawsuits challenging the validity of patents on brand-name drugs (“reverse payment” settlements), denying generic manufacturers access to drug samples necessary for bioequivalence testing, misusing risk evaluation and mitigation strategies, and filing citizen petitions with the US Food and Drug Administration (FDA). To address such tactics, the federal government can interpret existing patenting standards more strictly and promote certain types of patent challenges to ensure that patents are granted or upheld only for true innovations. Congress can enact pending legislation that would help discourage reverse payment settlements and compel brand-name manufacturers to share drug samples for bioequivalence testing. Finally, the FDA can provide earlier guidance on bioequivalence determinations for complex generic products and adopt the presumption that late-filed citizen petitions should be summarily rejected.

    更新日期:2017-09-18
  • If We Are Smart Enough to Stop HIV From Replicating, Why Can’t We Help People to Stop Smoking?
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-18
    Mitchell H. Katz

    For those of us who cared for patients with AIDS during the 1980s and 1990s, when death was rampant and around every corner, how wonderful it is it to read that human immunodeficiency virus (HIV) treatment has improved so much that HIV-infected persons who take their medicines but smoke cigarettes are at greater risk of dying of lung cancer than of dying of AIDS.1 Believe me when I say that death from lung cancer due to tobacco use was not high on our list of worries during those dark years. But in the face of such rapid progress in developing therapies against the deadly HIV virus, discovered only a little more than 30 years ago, how sad that our efforts on preventing the harms of tobacco are stagnant.

    更新日期:2017-09-18
  • Association of Thyroid Function With Life Expectancy With and Without Cardiovascular DiseaseThe Rotterdam Study
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-18
    Arjola Bano, Klodian Dhana, Layal Chaker, Maryam Kavousi, M. Arfan Ikram, Francesco U. S. Mattace-Raso, Robin P. Peeters, Oscar H. Franco
    更新日期:2017-09-18
  • Lung Cancer Mortality Associated With Smoking and Smoking Cessation Among People Living With HIV in the United States
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-18
    Krishna P. Reddy, Chung Yin Kong, Emily P. Hyle, Travis P. Baggett, Mingshu Huang, Robert A. Parker, A. David Paltiel, Elena Losina, Milton C. Weinstein, Kenneth A. Freedberg, Rochelle P. Walensky
    更新日期:2017-09-18
  • 更新日期:2017-09-18
  • The Road to Zero Deaths From Motor Vehicle Crashes
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-18
    Deborah A. P. Hersman, Mark R. Rosekind
    更新日期:2017-09-18
  • An Appeal for Evidence-Based Resident Duty Hours Reform
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-18
    Elaine C. Khoong, Anne S. Linker

    Resident duty hour regulations help balance the often conflicting goals of patient safety, trainee education, and physician well-being. Over the past few decades, there have been many changes in duty hour regulations. The Accreditation Council for Graduate Medical Education (ACGME) announced a change effective July, 2017 allowing interns and resident clinicians to work 24-hour shifts. Although an 80-hour per week limit on resident clinicians’ work, averaged over 4 weeks, was maintained, the limit on work shifts for first-year resident clinicians was extended from 16 hours to 24 hours. A limit of 24 hours per shift had already been established for those in the second year of residency and beyond.

    更新日期:2017-09-18
  • Notice of Retraction and Replacement: Colla et al. Association between Medicare accountable care organization implementation and spending among clinically vulnerable beneficiaries. JAMA Internal Medicine. 2016;176(8):1167-1175
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-11
    Carrie H. Colla, Valerie A. Lewis, Lee-Sien Kao, A. James O’Malley, Chiang-Hua Chang, Elliott S. Fisher

    To the Editor We write to report and explain errors that occurred in the Original Investigation, titled “Association Between Medicare Accountable Care Organization Implementation and Spending Among Clinically Vulnerable Beneficiaries,”1 that was published online on June 20, 2016, and in the August 2016 issue of JAMA Internal Medicine. The article reported the results of a cohort study designed to estimate the association between Medicare accountable care organization (ACO) contracts with spending and high-cost institutional use for the overall Medicare population and a clinically vulnerable subgroup of Medicare beneficiaries from January 2009 through December 2013. The main outcome measures of our study were total spending per beneficiary-quarter, spending categories, use of hospitals and emergency departments, ambulatory care–sensitive admissions, and 30-day readmissions. We determined that the Medicare ACO programs were associated with modest reductions in spending and use of hospitals and emergency departments and that savings were realized through reductions in use of institutional settings in clinically vulnerable patients.

    更新日期:2017-09-11
  • Association of Insurance Gains and Losses With Access to Prescription Drugs
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-11
    K. Robin Yabroff, James Kirby, Marc Zodet
    更新日期:2017-09-11
  • Trends and Characteristics of US Medicare Spending on Repository Corticotropin
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-11
    Daniel M. Hartung, Kirbee Johnston, Shelby Van Leuven, Atul Deodhar, David M. Cohen, Dennis N. Bourdette
    更新日期:2017-09-11
  • Possible Insufficiency of Generic Price Competition to Contain Prices for Orally Administered Anticancer Therapies
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-11
    Ashley L. Cole, Hanna K. Sanoff, Stacie B. Dusetzina
    更新日期:2017-09-11
  • Determinants of Market Exclusivity for Prescription Drugs in the United States
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-11
    Aaron S. Kesselheim, Michael S. Sinha, Jerry Avorn
    更新日期:2017-09-11
  • A Much-Needed Corrective on Drug Development Costs
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-11
    Merrill Goozner

    Contemporary pharmaceutical industry pricing practices are threatening to undermine the health care industry’s and policymakers’ efforts at cost control. Egregious as the price hikes are, the hedge fund managers who gained notoriety for exorbitant price increases on some generics are the least of the problem. The 2 biggest drivers of high drug costs in recent years have been the steady increase in prices for existing on-patent drugs, which account for more than 70% of all drug spending, and the 6-figure retail prices set for the latest generation of specialty and cancer therapeutics.

    更新日期:2017-09-11
  • Research and Development Spending to Bring a Single Cancer Drug to Market and Revenues After Approval
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-11
    Vinay Prasad, Sham Mailankody
    更新日期:2017-09-11
  • New (Very High) Prices on Old Drugs
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-11
    Saate Shakil, Rita F. Redberg

    H. P. Acthar gel, or repository corticotropin (rACTH), was approved by the US Food and Drug Administration (FDA) in 1952 and currently is indicated for the treatment of infantile spasms, exacerbations of multiple sclerosis, and, nebulously, “rheumatic; collagen; dermatologic; allergic states; ophthalmic; respiratory; and edematous state.”1 The unremarkable history of this little-known drug is in contrast to its astounding rise in price, detailed in this issue of JAMA Internal Medicine, by Hartung and colleagues.2 The authors found that the price of the drug to Medicare increased almost overnight from $1650 to over $24 000 per 5-mL vial when it was acquired by Questcor in 2001 and continued to rise. It was acquired by Mallinckrodt in 2014, who increased the price yet again. It is currently $34 034 per 5 mL vial. Remarkably, Medicare spent $1.3 billion dollars on Acthar gel between 2011 and 2015.2

    更新日期:2017-09-11
  • Distribution of Medical Education Debt by Specialty, 2010-2016
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-05
    Justin Grischkan, Benjamin P. George, Krisda Chaiyachati, Ari B. Friedman, E. Ray Dorsey, David A. Asch
    更新日期:2017-09-05
  • Tachyarrhythmia Onset Captured on Telemetry Deciphers the Diagnosis
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-05
    Maen D. Abou Ziki, Lynda E. Rosenfeld
    更新日期:2017-09-05
  • The Harms of Empirical Bowel RegimensA Teachable Moment
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-05
    Arjun Gupta, Deepak Agrawal, Carol Croft

    A woman in her 40s with metastatic squamous cell carcinoma of the chest wall and anorexia nervosa presented to the emergency department with 4 weeks of fatigue and chronic poor oral intake. On examination, she was tachycardic (heart rate, 114 beats/min) with a body mass index (calculated as weight in kilograms divided by height in meters squared) of 16.4. Alopecia and muscle wasting were present. Laboratory analysis revealed a serum albumin level of 1.5 g/dL (reference range, 2.5-5.2 g/dL; to convert to grams per liter, multiply by 10), and prealbumin level of 10 mg/dL (reference range, 20-40 mg/dL; to convert to milligrams per liter, multiply by 10). She received a diagnosis of severe protein calorie malnutrition, was admitted to the hospital, and underwent placement of a percutaneous endoscopic gastrostomy tube on hospital day 3. Enteral formula feedings were initiated and tolerated. The next day, she developed 4 to 5 loose nonbloody bowel movements per day (baseline, 1-2 solid bowel movements per day) without fever, abdominal pain, or cramping.

    更新日期:2017-09-05
  • The Ideal Blood Pressure Target for Patients With Chronic Kidney Disease—Searching for the Sweet Spot
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-05
    Csaba P. Kovesdy
    更新日期:2017-09-05
  • Association Between More Intensive vs Less Intensive Blood Pressure Lowering and Risk of Mortality in Chronic Kidney Disease Stages 3 to 5A Systematic Review and Meta-analysis
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-05
    Rakesh Malhotra, Hoang Anh Nguyen, Oscar Benavente, Mihriye Mete, Barbara V. Howard, Jonathan Mant, Michelle C. Odden, Carmen A. Peralta, Alfred K. Cheung, Girish N. Nadkarni, Ruth L. Coleman, Rury R. Holman, Alberto Zanchetti, Ruth Peters, Nigel Beckett, Jan A. Staessen, Joachim H. Ix
    更新日期:2017-09-05
  • Association of Evidence-Based Care Processes With Mortality in Staphylococcus aureus Bacteremia at Veterans Health Administration Hospitals, 2003-2014
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-05
    Michihiko Goto, Marin L. Schweizer, Mary S. Vaughan-Sarrazin, Eli N. Perencevich, Daniel J. Livorsi, Daniel J. Diekema, Kelly K. Richardson, Brice F. Beck, Bruce Alexander, Michael E. Ohl
    更新日期:2017-09-05
  • Mistakes Were Made (by Me)
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-05
    Reza Manesh

    I still remember taking care of a particular patient when I was a medical student. She was a middle-aged woman with cyclic vomiting syndrome who presented with nausea, vomiting, and abdominal pain. The plan was the same as always: nothing by mouth, intravenous fluid, antiemetics, and discharge once she could eat. On hospital day 2 she suddenly developed chest pain. An electrocardiogram (EKG) revealed ST-segment elevations, which prompted emergent cardiac catheterization. I reviewed her admission EKG and realized it had identical ST-segment elevations. I became nauseated myself, because no one from our team had looked at the initial EKG. The angiogram excluded acute coronary syndrome, but the guilt of a potentially tragic mistake remained. I wanted to share this experience with my colleagues so we could learn from it. I asked a colleague for the best forum to discuss our mistake, and my colleague gestured “hush” and said, “There is no need to tell anyone because she didn’t have plaque rupture.” I was confused by that reaction. Was I to be ashamed of my mistake?

    更新日期:2017-09-05
  • Using Risk Stratification to Reduce Medical Errors in Cervical Cancer Prevention
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-05
    Rebecca B. Perkins, Joanna M. Cain, Sarah Feldman
    更新日期:2017-09-05
  • JAMA Internal Medicine
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-01

    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. The JAMA Network is a consortium of peer-reviewed print and online medical publications that includes JAMA, JAMA Internal Medicine, and other specialty journals. JAMA Internal Medicine does not hold itself responsible for statements made by any contributor. All articles published, including opinion articles, represent the view of the authors and do not reflect the policy of the Journal, the American Medical Association, or the institution with which the author is affiliated, unless otherwise indicated.

    更新日期:2017-09-05
  • Omitted Affiliation and Disclaimer
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-01

    In the Research Letter titled “Inclusion of Demographic-Specific Information in Studies Supporting US Food & Drug Administration Approval of High-Risk Medical Devices,”1 published online July 24, 2017, a journal affiliation for author Ross was omitted: Dr Ross is Associate Editor of JAMA Internal Medicine. In addition, the disclaimers for authors Ross and Redberg were omitted: Disclaimer: Dr Ross is Associate Editor of JAMA Internal Medicine, and Dr Redberg is Editor of JAMA Internal Medicine, but neither author was involved in any of the decisions regarding review of the manuscript or its acceptance. This article was corrected online.

    更新日期:2017-09-05
  • Sentence Added to Author Contributions
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-01

    In the Original Investigation titled “Association of Ozone Exposure With Cardiorespiratory Pathophysiologic Mechanisms in Healthy Adults,” published online July 17, 2017, in JAMA Internal Medicine,1 a sentence was missing from the beginning of the Author Contributions section. The first 2 sentences now read: “Drs Y. Zhang and J. Zhang contributed equally and are considered co–senior authors of this work. In addition, they had full access to all the data in the study and take responsibility for the integrity of the data and accuracy of the data analysis.” This article was corrected online.

    更新日期:2017-09-05
  • Data Transcription Errors and Missing Footnote in Table
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-01

    In the Research Letter titled “A National Survey of Medicaid Beneficiaries’ Experiences and Satisfaction With Health Care,”1 published online July 10, 2017, and corrected August 7, 2017, for an error in the title,2 there were data transcription errors (not affecting conclusions) in the text, Figure caption, and Table. The Table was also missing a footnote, which should read “Standard errors were clustered by state and eligibility grouping.” This article was corrected online.

    更新日期:2017-09-05
  • Incorrect Author Affiliation
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-01

    In the article titled “Sharing Clinical Research Data—Finding the Right Balance,”1 the affiliation for Steven N. Goodman, MD, PhD, was incorrect. Dr Goodman’s correct affiliations are the Departments of Medicine and Health Research & Policy, Stanford University, Stanford, California. This article was corrected online.

    更新日期:2017-09-05
  • All Types of Hemorrhagic Stroke Are Not Created Equally—Reply
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-01
    Peter Brønnum Nielsen, Torben Bjerregaard Larsen, Gregory Y. H. Lip

    In Reply Decision making on the use of oral anticoagulant treatment in patients with atrial fibrillation is often uncomplicated due to the positive risk-benefit ratio, ie, balancing risk of bleeding against benefit from thromboprophylaxis. Observational data on patients with atrial fibrillation sustaining an intracranial hemorrhage are increasing, recognizing the treatment conundrum of resuming oral anticoagulant treatment since the risk-benefit ratio of treatment is shifted substantially.

    更新日期:2017-09-05
  • All Types of Hemorrhagic Stroke Are Not Created Equally
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-01
    Marion Hanley, Laura Morrison, Rónán O’Caoimh

    To the Editor The decision to initiate oral anticoagulation (OAC) posthemorrhagic stroke or traumatic intracerebral hemorrhage (ICH) in those with atrial fibrillation (AF) is a gray area in clinical practice. By showing that the decision to resume OAC may have a favorable risk-benefit ratio, the article by Nielsen et al1 published in a recent issue of JAMA Internal Medicine brings us closer to understanding if and when to do this. However, important questions remain, which may be difficult to clarify using such an observational approach.

    更新日期:2017-09-05
  • Benefits of Electronic Medical Record Banks
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-01
    Richard F. Gibson

    To the Editor In a Viewpoint in a recent issue of JAMA Internal Medicine, Jaspers et al1 note that HIPAA (Health Insurance Portability and Accountability Act of 1996) requires “covered entities” (physician offices, hospitals, and health plans) to provide patients with a complete electronic copy of their medical record if the health care provider has their medical record in electronic form, which today almost all health care providers do. Furthermore, HIPAA mandates that an individual has a right to direct the covered entity to transmit the protected health information about the individual directly to another person or entity designated by the individual. For 10 years, the nonprofit Health Record Banking Alliance2 has been advocating for a consumer-controlled, unified, lifetime electronic health record. The model envisions that, after each visit, the health care provider sends a copy of the visit information to the patient’s medical record depository.3,4 The next health care provider can then turn to exactly one place for a consolidated medical record for the patient. The consumer can permit their medical record to be viewed by health care providers, family members, and even medical researchers if they so choose. Such a record bank promotes consumer engagement in their care, error correction, and data for population health management and research. Use of health record banks would avoid the need for patients to request either electronic or hardcopy versions of their records when moving or changing physicians.

    更新日期:2017-09-05
  • Inaccuracies Describing Results of a Lung Cancer Screening Demonstration Project—Reply
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-01
    Rita F. Redberg, Patrick G. O'Malley

    In Reply We appreciate the questions raised by Humphrey et al regarding the accuracy of our numbers in the Editorial1 accompanying an Original Investigation about the Veterans Health Administration (VA)’s experience with lung cancer screening.2

    更新日期:2017-09-05
  • Inaccuracies Describing Results of a Lung Cancer Screening Demonstration Project
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-01
    Linda L. Humphrey, Mark Deffebach, David E. Midthun

    To the Editor We are writing to convey our concerns about an Editorial by Redberg and O’Malley1 accompanying an article2 describing the preliminary results of the Veterans Health Administration (VA)’s lung cancer screening demonstration project.

    更新日期:2017-09-05
  • Intensive Blood Pressure Control on Gait Speed and Mobility Limitation for Older Adults—Reply
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-01
    Michelle C. Odden, Jeff D. Williamson, Nicholas M. Pajewski

    In Reply We welcome this opportunity to make some clarifications, and to direct readers to previous publications that address many of the concerns raised by Zhang et al. There has been substantial interest from the scientific community in a complete picture of the net balance of benefits and harms of intensive blood pressure control.1 Because physical function represents one component of this evaluation, our study2 examined changes in gait speed in the subgroup of SPRINT participants 75 years or older at baseline.3 While procedures for the measurement of gait speed were specified in the SPRINT protocol, the authors are correct that gait speed and mobility limitation were not prespecified as outcomes in the protocol or on clinicaltrials.gov. However, gait speed is well-established, well-accepted measure of physical function, and so we reject any allusion that there was selective reporting of the outcomes in our study.2

    更新日期:2017-09-05
  • Intensive Blood Pressure Control on Gait Speed and Mobility Limitation for Older Adults
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-01
    Yu Zhang, Xiaoming Huang, Lvlin Chen

    To the Editor In the SPRINT (Systolic Blood Pressure Intervention Trial) randomized clinical trial published in a recent issue of JAMA Internal Medicine, Odden and colleagues1 conclude that intensive blood pressure lowering was not associated with changes in gait speed or transitions in mobility status among adults 75 years or older. SPRINT1 is an important randomized clinical trial that should have a substantial influence on future clinical practice. However, it was not well designed to test the effect of intensive blood pressure control on gait speed and mobility limitation in older adults.

    更新日期:2017-09-05
  • Redefining Unexplained Anemia in Elderly—Reply
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-01
    Harvey Jay Cohen, Cindy N. Roy, Peter J. Snyder

    In Reply We appreciate the comments of Eisenga et al regarding our classification of the anemias in our Original Investigation.1 They question our choices of the levels of ferritin and B12 used to classify patients as iron-deficient or Vitamin B12–deficient, respectively. Their questions raise the more general issue that there is no universally accepted cut-off level by which either anemia can be diagnosed using a single test. We concede that we might have misclassified a few participants in either direction for each type of anemia.

    更新日期:2017-09-05
  • Redefining Unexplained Anemia in Elderly
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-01
    Michele F. Eisenga, Suzanne P. Stam, Stephan J. L. Bakker

    To the Editor The Original Investigation by Roy et al1 recently published in JAMA Internal Medicine showed in a well-executed double-blind placebo-controlled trial the efficacy of testosterone supplementation in correcting anemia among older men with low testosterone concentrations. The authors concluded that testosterone supplementation is a feasible approach to increase hemoglobin levels of both unexplained anemia as well as anemia from known causes. The authors first defined known causes of anemia by choosing specific cut-off values and subsequently categorized the remaining group of patients as having an unexplained anemia. However, regarding 2 known causes of anemia, we question whether the authors did not underestimate its prevalence.

    更新日期:2017-09-05
  • Testosterone Replacement Therapy and Cardiovascular Risk—A Closer Look to Additional Parameters
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-01
    T. Craig Cheetham, Stephen K. VanDenEeden, Steven J. Jacobsen

    In Reply We appreciate the letter and comments from Stavropoulos and colleagues; they bring up several relevant topics with respect to stratified and subanalyses of our testosterone study.1 Specifically, they are interested in the normalization of serum testosterone following testosterone replacement therapy,2 an analysis stratified according to a Framingham Risk Score and an analysis in patients receiving antihypertensive and hypolipidemic therapy. Unfortunately, time and resources will not allow us to conduct additional analyses.

    更新日期:2017-09-05
  • Testosterone Replacement Therapy and Cardiovascular Risk—A Closer Look at Additional Parameters
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-01
    Konstantinos Stavropoulos, Konstantinos P. Imprialos, Michael Doumas

    To the Editor We read with great interest the study by Cheetham et al1 published in a recent issue of JAMA Internal Medicine that provides clinically meaningful data on a controversial issue2 and suggests beneficial effects of testosterone replacement therapy (TRT) on cardiovascular events. We would like to draw attention to some additional aspects.

    更新日期:2017-09-05
  • Meta-Epidemiology of Testosterone’s Risks and Benefits—Will We Ever Know the Answer?—Reply
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-01
    Peter J. Snyder, Susan S. Ellenberg

    In Reply We disagree with Dr Haring’s statements that The Testosterone Trials (T-Trials)1- 3 had low generalizability and showed some benefits in one area and some risks in others. The goal of the T-Trials1- 3 was to determine if testosterone treatment of symptomatic older men with low testosterone would be efficacious in any way. Toward this goal, we selected only men 65 years or older who had unequivocally low testosterone values. The median baseline testosterone level of 234 ng/dL confirms that the participants indeed had low testosterone levels. In addition, men had to have symptoms that could be ascribed to low testosterone. We included men with the comorbidities common at this age, although we did exclude men at high risk of conditions, such as prostate cancer, that testosterone might exacerbate. The results of the T-Trials1- 3 are therefore highly generalizable to men 65 years and older who have low testosterone levels and symptoms that might motivate them to seek treatment.

    更新日期:2017-09-05
  • Meta-Epidemiology of Testosterone’s Risks and Benefits—Will We Ever Know the Answer?—Reply
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-01
    T. Craig Cheetham, Stephen K. VanDenEeden, Steven J. Jacobsen

    In Reply We appreciate the letter from Dr Haring questioning if we will ever know the risks and benefits associated with testosterone replacement therapy. We first note that Dr Haring incorrectly included our study as part of the T-Trials; ours was a separate observational study. He correctly states that residual confounding and reverse causation are potential issues that can plague observational research and also points out that large, long-term clinical trials are still needed but that none are listed on clinicaltrials.gov. We agree with these points. However, we also note that the use of exogenous testosterone, currently in widespread clinical practice, includes a significant number of men who would not be included in randomized clinical trials because they do not meet eligibility criteria.1 Thus, more observational safety studies are needed, and all will struggle with the concerns noted by Dr Haring, as well as other methodological issues. We believe that an understanding of the impact of exogenous testosterone therapy among those with normal testosterone levels, those without classical symptoms, with prior prostate cancer, or even without documented reasons for the prescribing and taking of the drug can only be generated from observational studies. We are hopeful that clinicians, patients, and funding agencies will recognize this and strive to better understand the long-term safety of these treatments.

    更新日期:2017-09-05
  • Meta-Epidemiology of Testosterone’s Risks and Benefits—Will We Ever Know the Answer?
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-01
    Robin Haring

    To the Editor Five-years ago, we published the first Mendelian randomization study1 of the cardiometabolic and mortality risk related to testosterone and concluded that reported observational associations might largely result from residual confounding or reverse causation. To overcome these inherent limitations of observational research, the recently published series of results from the Testosterone Trials (T-Trials)2- 4 promised to deliver much-awaited evidence about the risks and benefits of testosterone treatment.

    更新日期:2017-09-05
  • Inclusion of Demographic-Specific Information in Studies Supporting US Food & Drug Administration Approval of High-Risk Medical Devices
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-01
    Sanket S. Dhruva, Carolyn M. Mazure, Joseph S. Ross, Rita F. Redberg
    更新日期:2017-09-05
  • A Survey of Unregulated Direct-to-Consumer Treatment Centers Providing Stem Cells for Patients With Heart Failure
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-01
    Zackary D. Goff, Andrew B. Kichura, John T. Chibnall, Paul J. Hauptman

    Stem cell therapy for the treatment of heart failure (HF) is under investigation but not approved by the US Food and Drug Administration (FDA).1 Nevertheless, through direct-to-consumer promotion, “stem cell centers” claim to offer this treatment to patients. We sought to assess the type of treatments, cost, and statements made about efficacy. Stem cell centers marketing treatment for HF were identified using a published database.2 We used a standardized script in a telephone survey to ensure consistency in data collection. Several centers had multiple satellite locations; for these, only 1 was contacted. Inquiries included stem cell source, infusion method, treatment number, preprocedural evaluation, follow-up, and price. Representative statements by stem cell center personnel were chronicled. The board certifications of physicians named on center websites were compared against online registries.3,4

    更新日期:2017-09-05
  • Injurious Falls and Syncope in Older Community-Dwelling Adults Meeting Inclusion Criteria for SPRINT
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-01
    Donal J. Sexton, Mark Canney, Matthew D. L. O’Connell, Patrick Moore, Mark A. Little, Conall M. O’Seaghdha, Rose-Anne Kenny
    更新日期:2017-09-05
  • Multitasking and Silent Electronic Health Record Use in Ambulatory Visits
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-01
    Neda Ratanawongsa, George Y. Matta, Courtney R. Lyles, Christopher J. Koenig, Jennifer L. Barton, Kaylin Yu, Dean Schillinger
    更新日期:2017-09-05
  • Women’s Awareness and Perceived Importance of the Harms and Benefits of Mammography ScreeningResults From a 2016 National Survey
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-01
    Jiani Yu, Rebekah H. Nagler, Erika Franklin Fowler, Karla Kerlikowske, Sarah E. Gollust
    更新日期:2017-09-05
  • A National Survey of Medicaid Beneficiaries’ Experiences and Satisfaction With Health Care
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-01
    Michael L. Barnett, Benjamin D. Sommers
    更新日期:2017-09-05
  • Temporal Trends in the Numbers of Skilled Nursing Facility Specialists From 2007 Through 2014
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-01
    Joan M. Teno, Pedro L. Gozalo, Amal N. Trivedi, Susan L. Mitchell, Jennifer N. Bunker, Vincent Mor
    更新日期:2017-09-05
  • Association Between Sponsorship and Findings of Medical Home Evaluations
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-01
    Anna Oh, Grant R. Martsolf, Mark W. Friedberg
    更新日期:2017-09-05
  • Association Between Contemporary Trends in Inferior Vena Cava Filter Placement and the 2010 US Food and Drug Administration Advisory
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-01
    Satyajit Reddy, Vladimir Lakhter, Chad J. Zack, Huaqing Zhao, Saurav Chatterjee, Riyaz Bashir
    更新日期:2017-09-05
  • Possible Device Malfunction in a Dual-Chamber Pacemaker
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-01
    Jared W. Hornberger, Emilio Fentanes, Gregg G. Gerasimon
    更新日期:2017-09-05
  • Antinuclear Antibody and Subserology Testing in the Evaluation of FibromyalgiaA Teachable Moment
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-01
    Nivedita Arora, Arjun Gupta, Swathi B. Reddy

    A man in his 40s with gastroesophageal reflux disease presented to his primary care physician with an 8-month history of “pain all over.” He reported an insidious onset of waxing and waning diffuse pain in and around the neck, elbows, shoulder blades, hips and knees, along with fatigue, unrefreshing sleep, and depressed mood. He denied morning stiffness, trauma, weight loss, joint swelling or redness, or personal or family history of rheumatological conditions. His only medications were ranitidine, and as needed naproxen and topical menthol with minimal relief of pain.

    更新日期:2017-09-05
  • A Research Agenda for Communication Between Health Care Professionals and Patients Living With Serious Illness
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-01
    James A. Tulsky, Mary Catherine Beach, Phyllis N. Butow, Susan E. Hickman, Jennifer W. Mack, R. Sean Morrison, Richard L. Street, Rebecca L. Sudore, Douglas B. White, Kathryn I. Pollak

    Importance  Poor communication by health care professionals contributes to physical and psychological suffering in patients living with serious illness. Patients may not fully understand their illness, prognosis, and treatment options or may not receive medical care consistent with their goals. Despite considerable research exploring the role of communication in this setting, many questions remain, and a clear agenda for communication research is lacking. Observations  Through a consensus conference and subsequent activities, we reviewed the state of the science, identified key evidence gaps in understanding the impact of communication on patient outcomes, and created an agenda for future research. We considered 7 broad topics: shared decision making, advance care planning, communication training, measuring communication, communication about prognosis, emotion and serious illness communication, and cultural issues. We identified 5 areas in which further research could substantially move the field forward and help enhance patient care: measurement and methodology, including how to determine communication quality; mechanisms of communication, such as identifying the specific clinician behaviors that patients experience as both honest and compassionate, or the role of bias in the clinical encounter; alternative approaches to advance care planning that focus on the quality of serious illness communication and not simply completion of forms; teaching and disseminating communication skills; and approaches, such as economic incentives and other clinician motivators, to change communication behavior. Conclusions  Our findings highlight the urgent need to improve quality of communication between health care professionals and patients living with serious illness through a broad range of research that covers communication skills, tools, patient education, and models of care.

    更新日期:2017-09-05
  • Growth of Skilled Nursing Facility SpecialistsNavigating Between What Is Ideal and What Is Practical
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-09-01
    Mitchell H. Katz

    In an ideal world, primary care physicians would follow their patients from the office to the hospital and to the nursing home. This would improve continuity of care and increase the chances that the patients’ preferences, generally better known by the primary care clinician than a new clinician, are respected; additional specialty referrals can always be obtained when needed. However, in the real world, primary care physicians are seeing office patients every 20 minutes, following up on laboratory tests, reconciling medications, filling out forms, returning telephone calls, and often leading a team of other clinicians. In areas where there are many hospitals and/or nursing homes, a primary care physician might have patients in multiple locations, making daily visits unfeasible.

    更新日期:2017-09-05
Some contents have been Reproduced with permission of the American Chemical Society.
Some contents have been Reproduced by permission of The Royal Society of Chemistry.
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