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  • Error in Author Name
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-20

    In the Viewpoint titled “The Evolution of Procedural Competency in Internal Medicine Training,”1 published online October 23, 2017, there was an error in the spelling of Eli M. Miloslavsky's surname. The error occurred in both the byline and the Conflict of Interests Disclosure section. This article was corrected online.

    更新日期:2017-11-20
  • Communicating Through a Patient Portal to Engage Family Care Partners
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-20
    Mary E. Reed, Jie Huang, Richard Brand, Dustin Ballard, Cyrus Yamin, John Hsu, Richard Grant
    更新日期:2017-11-20
  • Palliative Care Eligibility, Symptom Burden, and Quality-of-Life Ratings in Nursing Home Residents
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-20
    Caroline E. Stephens, Lauren J. Hunt, Nhat Bui, Elizabeth Halifax, Christine S. Ritchie, Sei J. Lee
    更新日期:2017-11-20
  • Not Your Typical ST-Elevation Myocardial Infarction
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-20
    Alicia Morehead-Gee, Arun Padmanabhan, Nora Goldschlager
    更新日期:2017-11-20
  • Promoting High-Value Practice by Reducing Unnecessary Transfusions With a Patient Blood Management Program
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-20
    Divyajot Sadana, Ariella Pratzer, Lauren J. Scher, Harry S. Saag, Nicole Adler, Frank M. Volpicelli, Moises Auron, Steven M. Frank
    更新日期:2017-11-20
  • Comparison of Observational Data and the ONTARGET Results for Telmisartan Treatment of HypertensionBull’s-eye or Painting the Target Around the Arrow?
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-20
    Robert M. Califf

    In this issue of JAMA Internal Medicine, Fralick and colleagues1 create a straw man to demonstrate that observational treatment comparisons could be useful for expanding indications for medical products. The authors modeled the Ongoing Telmisartan Alone and in Combination with Ramipril Global End-point Trial (ONTARGET),2 which compared the angiotensin receptor antagonist telmisartan and the angiotensin-converting enzyme inhibitor ramipril for the treatment of hypertension. That trial,2 published in 2008, found that telmisartan was equally effective to ramipril, with fewer incidences of angioedema. Participants who received both drugs experienced more adverse events but no increase in benefits.

    更新日期:2017-11-20
  • Care Planning for Inpatients Referred for Palliative Care Consultation
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-20
    Kara Bischoff, David L. O’Riordan, Angela K. Marks, Rebecca Sudore, Steven Z. Pantilat
    更新日期:2017-11-20
  • Use of Health Care Databases to Support Supplemental Indications of Approved Medications
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-20
    Michael Fralick, Aaron S. Kesselheim, Jerry Avorn, Sebastian Schneeweiss
    更新日期:2017-11-20
  • Marijuana, Secondhand Smoke, and Social Acceptability
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-20
    Stanton A. Glantz, Bonnie Halpern-Felsher, Matthew L. Springer

    On April 20, 2017, at 4:20 in the afternoon, 15 000 people in San Francisco’s Golden Gate Park lit marijuana joints during the annual “420 Day.” In cannabis culture, April 20 has become an international countercultural holiday; people gather to celebrate and consume cannabis, typically around 4:20 pm. The giant cloud of secondhand marijuana smoke was visible from the University of California, San Francisco, half a mile away. The cloud embodied the revelers’ new freedom on this first 420 Day since California voters legalized recreational marijuana in November 2016. The smoke cloud, however, was also part of a growing source of air pollution.

    更新日期:2017-11-20
  • Unanticipated Outcomes: A Medical Memoir—A Book Review
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-20
    Vinay Prasad

    Unanticipated Outcomes: A Medical Memoir is the story of Jerome P. Kassirer, MD, MPH, who was born at the height of the Great Depression, grew up in a “two story-rat infested wooden house”1(p16) in Buffalo, New York, and, in 1991, became the sixth Editor in Chief of the New England Journal of Medicine (NEJM). Kassirer’s memoir1 takes us through the life of a legendary figure in modern medicine, a man who, above all else, embodied what it meant to be, and, what it still means to be, a professional. At a time when we increasingly read about disillusionment and burnout among physicians, the high costs of drugs and care, and the corrupting influences of money on medicine, Kassirer’s book1 reminds us why we became doctors. His life lessons are timeless.

    更新日期:2017-11-20
  • The Achilles Heel of Medical Cannabis Research—Inadequate Blinding of Placebo-Controlled Trials
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-20
    David Casarett

    Interest in medical cannabis in the United States has increased rapidly in the past 5 years, and now it is legal in 29 states and the District of Columbia. The evidence base to support the use of medical cannabis has developed too, albeit more slowly. For instance, there have been numerous randomized clinical trials that have evaluated the effectiveness of smoked or vaporized cannabis, as well as targeted trials of its principal cannabinoids, tetrahydrocannabinol (THC), and cannabidiol (CBD).1 Some of the strongest evidence is for neuropathic pain, spasticity associated with multiple sclerosis, and anorexia in the setting of serious illness. On the other hand, other common conditions for which cannabis is often used, such as posttraumatic stress disorder, so far have very little evidence of benefit.

    更新日期:2017-11-20
  • Acute Chest Pain in the Emergency Department
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-14
    Gregory Curfman

    In 2014, a total of 6 887 000 patients came to US emergency departments (EDs) because of symptoms of chest pain, representing 5% of all ED visits. While some of them have clinical evidence of acute coronary syndromes (ACS), many others have no ischemic changes on the electrocardiogram (ECG) and normal cardiac troponin levels. Uncertainty surrounds proper treatment of these low- to intermediate-risk patients. The 2014 American College of Cardiology/American Heart Association clinical guideline for non–ST-segment elevation acute coronary syndrome gives a class IIa recommendation to noninvasive testing (exercise testing or coronary computed tomographic angiography [CCTA]) in patients with chest pain but no evidence of ischemia. In most cases, however, the results of testing are negative in this low- to intermediate-risk population, and expensive resources may be consumed with no effect on clinical outcome.

    更新日期:2017-11-15
  • 更新日期:2017-11-15
  • Omitted Disclosures or Potential Conflicts of Interest
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-13

    In the Invited Commentary titled “Coronary Computed Tomographic Angiography—The First Test for Evaluating Patients With Chest Pain?,”1 published online first in JAMA Internal Medicine on October 2, 2017, the authors omitted disclosure of potential conflicts of interest. The disclosure statement should include the following: “Dr Villines reported volunteer affiliations related to cardiovascular imaging, including serving as president for the Society of Cardiovascular CT; chair-elect for the Imaging Council, American College of Cardiology; and member of the Council on Cardiovascular Radiology and Intervention, American Heart Association. He also reported serving as a paid a consultant and speaker for Boehringer-Ingelheim related to anticoagulation. Dr Shaw reported serving as a past president for the Society of Cardiovascular CT and the American Society of Nuclear Cardiology and as member of the Imaging Council for the American College of Cardiology.” The article has been corrected online.

    更新日期:2017-11-13
  • Missing Author Contributions
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-13

    In the Review titled “2017 Update on Medical Overuse: A Systematic Review,”1 published online October 2, 2017, author contributions were missing for Dr Korenstein. Dr Korenstein was added as a contributor to study concept and design; drafting of the manuscript; administrative, technical, and material support; and study supervision. This article has been corrected online.

    更新日期:2017-11-13
  • Declining Medicaid Fees and Primary Care Appointment Availability for New Medicaid Patients
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-13
    Molly Candon, Stephen Zuckerman, Douglas Wissoker, Brendan Saloner, Genevieve M. Kenney, Karin Rhodes, Daniel Polsky
    更新日期:2017-11-13
  • Association of Coded Severity With Readmission Reduction After the Hospital Readmissions Reduction Program
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-13
    Andrew M. Ibrahim, Justin B. Dimick, Shashank S. Sinha, John M. Hollingsworth, Ushapoorna Nuliyalu, Andrew M. Ryan
    更新日期:2017-11-13
  • ST Elevations in the Setting of Hyperkalemia
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-13
    Mark Heckle, Manyoo Agarwal, Shadwan Alsafwah
    更新日期:2017-11-13
  • Evaluation of PolycythemiaA Teachable Moment
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-13
    Mia Djulbegovic, Lydia S. Dugdale, Alfred Ian Lee
    更新日期:2017-11-13
  • The Costs and Benefits of Hospital Care by Primary PhysiciansContinuity Counts
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-13
    Lisa L. Willett, C. Seth Landefeld

    In 1948, LIFE magazine published the “Country Doctor” (http://time.com/3456085/w-eugene-smiths-landmark-photo-essay-country-doctor/), the photographic essay by W. Eugene Smith that established the iconic American physician as one who provides comprehensive care for his or her patients wherever they were, whenever they were needed. In Kremmling, Colorado, Dr Ernest Ceriani cared for people at home, in the office, and in the hospital, sometimes carrying them bodily from one place to another. Since 1948, times have changed, and comprehensive care with continuity in the relationship of a patient with “my doctor” has decreased, especially during inpatient hospital care. In 1996, Wachter and Goldman1 heralded the emerging role of hospitalists, and the proportion of general medicine inpatient services attributed to hospitalists has increased rapidly, from 9% in 1995 to 37% in 2006 and 58% in 2013.2,3

    更新日期:2017-11-13
  • A Comparison of Laboratory Testing in Teaching vs Nonteaching Hospitals for 2 Common Medical Conditions
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-13
    Victoria Valencia, Vineet M. Arora, Sumant R. Ranji, Carlos Meza, Christopher Moriates
    更新日期:2017-11-13
  • 更新日期:2017-11-13
  • Comparison of Hospital Resource Use and Outcomes Among Hospitalists, Primary Care Physicians, and Other Generalists
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-13
    Jennifer P. Stevens, David J. Nyweide, Sha Maresh, Laura A. Hatfield, Michael D. Howell, Bruce E. Landon
    更新日期:2017-11-13
  • The Supreme Court Ruling in Sandoz v AmgenA Victory for Follow-on Biologics
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-13
    Ameet Sarpatwari, Abbe R. Gluck, Gregory D. Curfman
    更新日期:2017-11-13
  • Typographical Errors in the Table
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-01

    In the Original Investigation titled “Research and Development Spending to Bring a Single Cancer Drug to Market and Revenues After Approval,”1 published online September 11, 2017, there were 2 typographical errors in the Table. In row 1 of column 4, the date was changed from January 2002 to January 1992. In row 9 of the last column, 7689.1 was changed to the correct value of 6789.1. This article has been corrected online.

    更新日期:2017-11-10
  • Utilization, Cost, and Outcome of Branded vs Compounded 17-Alpha Hydroxyprogesterone Caproate in Prevention of Preterm Birth
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-01
    Inbar Fried, Andrew L. Beam, Isaac S. Kohane, Nathan P. Palmer
    更新日期:2017-11-10
  • Evaluation of a Trainee-Led Project to Reduce Inappropriate Proton Pump Inhibitor Infusion in Patients With Upper Gastrointestinal BleedingSkip the Drips
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-01
    Emmanuel Coronel, Nikhil Bassi, Sarah Donahue-Rolfe, Ellen Byrne, Sarah Sokol, Gautham Reddy, Vineet M. Arora
    更新日期:2017-11-10
  • Basal Cell Carcinoma in an Elderly Man
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-01
    Jason M. Lunt, Ahmad Al-Taee, Fred R. Buckhold

    A robust man in his 90s, who was active and living independently, presented to a dermatologist’s office after a punch biopsy specimen of an asymptomatic mass he noticed on his left cheek revealed basal cell carcinoma (BCC). Examination of the mass showed a 1.5 × 2.0-cm crusted plaque on the left marionette line. Without a discussion with his physician regarding alternative treatment options, he underwent Mohs micrographic surgery 7 weeks later, which confirmed a micronodular BCC. After a 3-stage surgery, the patient was left with a 4.5 × 5.7-cm defect with resection of most of the buccinator muscle and a partial laceration of the parotid gland. After each stage, the patient was given the option to stop the procedure. Each time, he opted to continue in hopes for a cure. He was sent home with an otolaryngology follow-up. Given the large facial defect and complications from Mohs surgery, he subsequently had another operation for further removal of positive tissue margins, parotid duct laceration repair, and cervicofacial flap reconstruction.

    更新日期:2017-11-10
  • Coronary Computed Tomographic Angiography—The First Test for Evaluating Patients With Chest Pain?
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-01
    Todd C. Villines, Leslee J. Shaw

    In November 2016, the National Institute for Health and Care Excellence (NICE), the evidence-based organization that provides authoritative national guidance to improve health care quality in the United Kingdom (UK), updated its clinical guideline on the evaluation of patients with chest pain of recent onset.1 On the basis of a thorough literature review, NICE updated the guideline to recommend coronary computed tomographic angiography (CCTA) as the initial test for all patients without known coronary artery disease (CAD) who present with atypical and typical angina, and for those with nonanginal chest pain who have an abnormal resting electrocardiogram. This dramatic change to national health care policy in the UK resonated across the Atlantic, where office-based single-photon emission computed tomography (SPECT) has served for decades as the dominant noninvasive test for CAD in the United States.

    更新日期:2017-11-10
  • Communication-and-Resolution ProgramsThe Jury Is Still Out
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-01
    Kathryn Zeiler

    Genuine concern for patients and an intrinsic drive to provide high-quality care are primary motivators for individuals and institutions to take steps to avoid iatrogenic injuries. Despite these drivers, a recent estimate suggests that preventable medical error is the third most common cause of death in the United States.1 The medical malpractice liability system is not only a mechanism for compensating injured patients but also a motivational backstop. When functioning properly, the system applies external pressure on physicians and hospitals to expend resources to reduce the number of negligently caused injuries. It complements intrinsic incentives and attempts to weed out those who repeatedly inflict preventable injuries.

    更新日期:2017-11-10
  • 更新日期:2017-11-10
  • The Unrecognized Challenges of the Patient-Physician Relationship
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-01
    Tamara L. McCarron, Manal S. Sheikh, Fiona Clement

    In this issue of JAMA Internal Medicine, DeFilippis1 describes how her relationship with her hospitalized patients doesn’t end after her service rotation. She recounts virtually following her patients after she transfers care, making social calls to check up, and remaining connected, possibly unbeknownst to the patient. The patient may do the same: finding his or her mind wandering to the physician who cared for them, asking the nurses how the physician is doing, and wondering if the physician will return for a check-in or progress update. It would seem that the impact of the patient-physician relationship is often unrecognized by both parties.

    更新日期:2017-11-10
  • Effect of Promoting High-Quality Staff Interactions on Fall Prevention in Nursing HomesA Cluster-Randomized Trial
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-01
    Cathleen S. Colón-Emeric, Kirsten Corazzini, Eleanor S. McConnell, Wei Pan, Mark Toles, Rasheeda Hall, Michael P. Cary, Melissa Batchelor-Murphy, Tracey Yap, Amber L. Anderson, Andrew Burd, Sathya Amarasekara, Ruth A. Anderson
    更新日期:2017-11-10
  • Coronary Computed Tomography Angiography vs Functional Stress Testing for Patients With Suspected Coronary Artery DiseaseA Systematic Review and Meta-analysis
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-01
    Andrew J. Foy, Sanket S. Dhruva, Brandon Peterson, John M. Mandrola, Daniel J. Morgan, Rita F. Redberg
    更新日期:2017-11-10
  • Patients’ Experiences With Communication-and-Resolution Programs After Medical Injury
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-01
    Jennifer Moore, Marie Bismark, Michelle M. Mello
    更新日期:2017-11-10
  • Effect of a Game-Based Intervention Designed to Enhance Social Incentives to Increase Physical Activity Among FamiliesThe BE FIT Randomized Clinical Trial
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-01
    Mitesh S. Patel, Emelia J. Benjamin, Kevin G. Volpp, Caroline S. Fox, Dylan S. Small, Joseph M. Massaro, Jane J. Lee, Victoria Hilbert, Maureen Valentino, Devon H. Taylor, Emily S. Manders, Karen Mutalik, Jingsan Zhu, Wenli Wang, Joanne M. Murabito
    更新日期:2017-11-10
  • Saying Goodbye
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-01
    Ersilia M. DeFilippis

    As residents in training, we say goodbye to our patients many times over the course of our career. I am not referring to the encounters with dying patients in the hospital, but rather the goodbyes that accompany rotating “off service,” from one team to another. One day, I sat in a room surrounded by multiple family members to update them on their loved one’s condition. He had been hospitalized for weeks, initially with a subarachnoid hemorrhage followed by hypernatremia and post–intensive care unit delirium among other diagnoses. I discussed with them his current medications and the next steps moving forward, adding that the overall plan would continue to be reevaluated as the new team rotates on.

    更新日期:2017-11-10
  • I’ve Had a Vision of Improved Primary Care
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-01
    Brent W. Beasley

    I’ve had a vision, and I have to share it. I was working late one night, trying to make our clinic finances make sense, and I began to doze. Suddenly, I was dressed in surgical scrubs, with one of those little blue hats on my head and a mask over my mouth and nose. A medical assistant pushing a patient on a cart brushed passed me and said, “I’m putting your next patient in the room, Dr. Beasley.” “Thanks!” I called after them and looked at my watch. I’m always looking at my watch at work to see how far behind I am, so that wasn’t surprising in this dream. What was surprising is that I’m an internist, and I never wear scrubs.

    更新日期:2017-11-10
  • JAMA Internal Medicine
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-01

    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:2017-11-06
  • Fade Away
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-01
    更新日期:2017-11-06
  • Error in Text and Table Footnote
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-01

    In the Original Investigation titled “Association of Thyroid Function With Life Expectancy With and Without Cardiovascular Disease: The Rotterdam Study,”1 published online September 18, 2017, the words “with CVD” and “without CVD” in the last sentence of the second paragraph of the Results were reversed. The sentence should read as follows: “Compared with the lowest tertile, the highest thyrotropin tertile was associated with a lower risk of mortality among participants without CVD (HR, 0.76; 95% CI, 0.64-0.91) and with CVD (HR, 0.82; 95% CI, 0.67-1.01) (Table 2).” Also, a covariate was omitted in Table 2, footnote a. The footnote should read “Adjustment: age, sex, and cohort.” This article was corrected online.

    更新日期:2017-11-06
  • Typographical Error in Reports of a P Value
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-01

    In the Original Investigation titled “Improving Adherence to Long-term Opioid Therapy Guidelines to Reduce Opioid Misuse in Primary Care: A Cluster-Randomized Clinical Trial,”1 published in the September issue of JAMA Internal Medicine, a typographical error resulted in the incorrect reporting of a P value for discontinuation of opioid treatment in intervention vs control groups in 2 article locations, one in Table 3, the other in the text body on the same page. This article has been corrected online.

    更新日期:2017-11-06
  • Omission of Data and Errors in Meta-analysis
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-01

    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:2017-11-06
  • Women Also Use 5α-Reductase Inhibitors—Reply
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-01
    Blayne Welk, Eric McArthur, Michael Ordon

    In Reply Our article1 is indeed specific only to men taking this medication for benign prostatic hyperplasia. Unfortunately, our administrative data sources only have reliable prescribing information for people older than 65 years, thus we could not include the many younger men taking this medication at a lower dose for hair loss. Added to this limitation, we did not include the comparatively small number of women older than 65 years who may be using a 5α-reductase inhibitor for other indications (such as hirsutism or alopecia). Of the 799 997 prescriptions for a 5α-reductase inhibitor in 2015 in Ontario, only 0.04% (n = 302) were filled by women. Even if we did include them in our study,1 we would not have been powered to detect outcomes (which were only occurring among <2% of men) in this subgroup, which, as pointed out, could be very different based on gender. While there is certainly some evidence suggesting it may be used in women in certain situations, the product monographs for finasteride 5 mg or 1 mg and dutasteride 0.5 mg still state that use in women is contraindicated.2- 4 We obviously support studies with maximal generalizability whenever feasible; however, in this case we feel limiting the study population to men was justified.

    更新日期:2017-11-06
  • 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 : 2017-11-01
    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:2017-11-06
  • Women Also Use 5α-Reductase Inhibitors
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-01
    Sidika E. Karakas

    To the Editor The Original Investigation by Welk at al1 and the accompanying Invited Commentary by Thielke2 both published in a recent issue of JAMA Internal Medicine should have included the words “in Men” in the titles. It is clear that there are significant differences between sex-specific and gender-specific responses to hormonal manipulations. In men androgen deficiency or deprivation can promote insulin resistance, metabolic syndrome, and vascular disease. In contrast, in women androgen excess leads to cardiometabolic disorders. Striking parallels between the metabolic consequences of male hypogonadism and female hyperandrogenism have been recognized.3 5α-Reductase inhibitors are now approved for treatment for hirsutism and alopecia in women.4 Use of 5α-reductase inhibitors can be associated with increased estrogen levels in women.5 It is anticipated that inhibition of testosterone bioactivity will exert different endocrine, metabolic, vascular, and psychological responses in men vs women. It is important to acknowledge the sex specificity of the research findings and, whenever possible, to conduct the studies in both sexes.

    更新日期:2017-11-06
  • Sample Size Matters When Drawing Conclusions on Alternate-Day Fasting Diet—Reply
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-01
    John F. Trepanowski, Eric Ravussin, Krista A. Varady

    In Reply Dr Portillo-Sanchez and colleagues have pointed to limitations in our study1 that, although previously discussed in the main article, are important enough to merit extra discussion. These limitations include sample size, dropout rate in the alternate-day fasting group, and (mostly) metabolically healthy trial participants. Dr Portillo-Sanchez and colleagues express concern that these limitations threaten the validity of the study results—that is, that alternate-day fasting does not produce superior adherence, weight loss, weight loss maintenance, or cardioprotection vs daily calorie restriction.1

    更新日期:2017-11-06
  • Sample Size Matters When Drawing Conclusions on Alternate-Day Fasting Diet
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-01
    Paola Portillo-Sanchez, Camilo Gonzalez-Velazquez, Leonardo Mancillas-Adame

    To the Editor We read with interest the Original Investigation by Trepanowski et al1 published in a recent issue of JAMA Internal Medicine; to the authors’ knowledge, it was the longest and largest randomized trial evaluating alternate-day fasting diet against calorie restriction diet and placebo. Trepanowski et al1 concluded the investigational intervention’s lack of superiority in terms of weight loss or metabolic outcomes against the comparators. We found this publication provocative and interesting; however, we want to highlight some design characteristics that may have impacted the trial outcomes and, thus, limited the power and external validity of the results.

    更新日期:2017-11-06
  • Perplexing Conclusions Concerning Heat-Not-Burn Tobacco Cigarettes—Reply
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-01
    Reto Auer, Jacques Cornuz, Aurélie Berthet

    In Reply There is general agreement on the need for rigorous independent studies of IQOS that will accurately inform the public. When we began our research,1 Phillip Morris International (PMI) advertisements claimed IQOS produced “no smoke.” We thus designed our exploratory study to detect chemicals typical of pyrolysis, the presence of which defines an aerosol as “smoke.” We chose a comparison cigarette (a brand regularly smoked by millions) based on convenience, because the comparison was incidental, rather than the heart of the experiment. We did not set out to provide a benchmark for the regulatory industry, so comparison with a 3R4F standard cigarette was unnecessary. Tobacco content naturally varies, and differences may be compounded by process fluctuations in cigarette manufacture.2 Standard cigarettes reduce such variations, but they are no more representative of cigarettes used by smokers worldwide than any other single brand of cigarette. Because we were not benchmarking, using the more expensive standard cigarette and waiting for its delivery would have held up our real work, which was identifying the presence of harmful chemicals in IQOS smoke. Our validated and standardized analytical methods are not likely to have caused the wide standard deviation in our measures of IQOS smoke: variation in IQOS tobacco content is the likely explanation.

    更新日期:2017-11-06
  • Perplexing Conclusions Concerning Heat-Not-Burn Tobacco Cigarettes
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-01
    Massimo Caruso, Riccardo Polosa

    To the Editor We read with great interest the Research Letter in a recent issue of JAMA Internal Medicine by Auer et al1 showing the presence of volatile organic compounds, polycyclic aromatic hydrocarbons, and carbon monoxide in the emissions of a tobacco heating product (THP) recently marketed by Philip Morris International (PMI). These findings differ significantly from those presented by PMI as well as by PMI’s competitors,2- 4 and Auer et al1 argue that this information should come from independent research rather than from manufacturers.

    更新日期:2017-11-06
  • Considerations for County-Level Inequalities in Life Expectancy—Reply
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-01
    Ali H. Mokdad, Laura Dwyer-Lindgren, Christopher J. L. Murray

    In Reply Our study1 on inequalities in life expectancy found that a combination of socioeconomic and race/ethnicity factors, behavioral and metabolic risk factors, and health care factors could explain 74% of the variation in life expectancy among counties. We agree with Dr Mestral that other factors such as diet quality and housing conditions may play a role in explaining the remaining variation. This is an important area of future research and will require identifying appropriate county-level data sources that relate to these factors.

    更新日期:2017-11-06
  • Perplexing Conclusions Concerning Heat-Not-Burn Tobacco Cigarettes
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-01
    Serge Maeder, Manuel C. Peitsch

    To the Editor While we welcome independent studies on our products, in a Research Letter published in a recent issue of JAMA Internal Medicine Auer et al1 described a chemical analysis of the IQOS aerosol that we find perplexing in several respects. Accuracy in science is, of course, always important. We believe that it is especially important in relation to potentially less harmful alternatives to cigarettes to ensure that adult smokers receive accurate information.

    更新日期:2017-11-06
  • Considerations for County-Level Inequalities in Life Expectancy
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-01
    Carlos de Mestral

    To the Editor In an Original Investigation published in a recent issue of JAMA Internal Medicine, Dwyer-Lindgren and colleagues1 showed the existence and growth of alarmingly large inequalities in life expectancy across counties in the United States—up to a disturbing 20-year gap between the highest and lowest life expectancies between counties. I agree with the authors that these findings demand action because inequalities will continue to grow unabatedly in the face of inaction.

    更新日期:2017-11-06
  • The Need for Better Data Breach Statistics—Reply
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-01
    Ge Bai, John (Xuefeng) Jiang, Renee Flasher

    In Reply We thank Drs Fabbri et al for their insightful comments. We would like to clarify several points that might help readers interpret our study. We agree with Drs Fabbri et al that the “500 affected individual threshold” established by the US Department of Health and Human Services (HHS) for public reporting makes it more likely to identify data breaches in large hospitals. We acknowledged this as an important limitation in the letter.1 However, large hospitals possess a significant amount of protected health information (PHI). Combined with teaching hospitals’ needs for broad data access, this creates significant targets for cyber criminals compared with smaller institutions that might be the main reason for their relatively high risks of data breaches.

    更新日期:2017-11-06
  • The Need for Better Data Breach Statistics
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-01
    Daniel Fabbri, Mark E. Frisse, Bradley Malin

    To the Editor In a Research Letter published in a recent issue of JAMA Internal Medicine, Bai and colleagues1 reported on an analysis of data breaches to protected health information (PHI) documented by the US Department of Health and Human Services (HHS). The study indicated that hospital size and teaching status were associated with the risk of breach, suggesting that larger teaching hospitals are less secure. However, such a broad claim neglects inherent biases in data collection and reporting practices.

    更新日期:2017-11-06
  • 更新日期:2017-11-06
  • Omission of Data and Errors in Meta-analysis
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-01
    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:2017-11-06
  • Intensive Blood Pressure Control in Autosomal Dominant Polycystic Kidney Disease—How Safe Is It?
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-01
    Mohammadreza Ardalan, Samad E. J. Golzari

    To the Editor Maintaining optimal blood pressure in patients without diabetes with chronic kidney disease (CKD) has always been controversial. In a systematic review and meta-analysis published in a recent issue of JAMA Internal Medicine, Tsai et al1 assessed the clinical data of 8127 patients; they focused on detecting an association between intensive blood pressure control and renal outcomes in patients without diabetes with CKD. Consequently, no significant difference in major renal outcomes was found between intensive (<130/80 mm Hg) and standard BP control (<140/90 mm Hg) groups during a median follow-up of 3.3 years. Nevertheless, nonblack patients or those with higher levels of proteinuria were found to benefit from the intensive BP-lowering strategy.

    更新日期:2017-11-06
  • Thyroid Dysfunction in Torsades de Pointes—Reply
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-01
    Saman Rezazadeh, Robert J. H. Miller, Derek S. Chew

    In Reply We would like to thank Dr Rizvi for the insightful comments on our case report.1 Dr Rizvi has eloquently detailed the association of hypothyroidism with QT prolongation and subsequent torsades de pointes (TdP). In our case, hypothyroidism did not play a role in the mechanism of TdP because the patient’s thyroid function tests were within normal limits. However, the mechanisms underlying hypothyroidism and amiodarone-induced QT prolongation cover important concepts that can be applied more broadly.

    更新日期:2017-11-06
  • Thyroid Dysfunction in Torsades de Pointes
    JAMA Intern. Med. (IF 16.538) Pub Date : 2017-11-01
    Ali A. Rizvi

    To the Editor The Challenges in Clinical Electrocardiography article by Chew et al1 published in a recent issue of JAMA Internal Medicine describes the occurrence of recurrent syncope secondary to torsades de pointes (TdP) in a middle-aged woman.1 Alcohol and dextromethorphan use coupled with electrolyte abnormalities contributed to life-threatening polymorphic ventricular tachycardia treated with intravenous magnesium, amiodarone, and a temporary pacemaker. Although the clinical presentation, risk factors, and management aspects are well described, the patient’s thyroid function is not mentioned. Hypothyroidism has been reported as a rare but treatable cause of electrocardiographic QT prolongation and TdP.2,3 Severe or prolonged hypothyroidism, especially when accompanied by structural cardiac changes, cardiomyopathy, and congestive heart failure,4 can lead to bradycardia and first-degree block, and in some situations, precipitate ventricular dysrhythmias. Appropriate management has been reported to abolish the latter and may obviate the need for an implantable cardioverter-defibrillator.5 It is conceivable that in many of these cases a multitude of causative factors are involved, as in the patient described by Chew et al.1 However, satisfactory improvement may not occur if the hypothyroid state is overlooked and left untreated. In addition, the patient received the antiarrythmic drug amiodarone, which is high in iodine content and can induce thyroid dysfunction. Thus, an additional important reason to have knowledge of the thyroid status would be prior to the consideration of amiodarone administration. It is recommended that thyroid function be assessed early in the presentation of ventricular tachyarrythmias and TdP so that proper therapy can be instituted.

    更新日期:2017-11-06
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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