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 Showing 1-20 of 68 Articles
Meghan O’Brien, MD, MBE

One predawn morning during my medical school surgery rotation, I noticed threatening shadows in my groin—lymph nodes decorating my normally smooth inguinal creases. I had lost a little weight too, despite deliberate attempts to bulk up, symptoms that stuck in the refining sieve of my developing medical intuition. ...

Original Investigation 
Justine E. F. Moonen, MD; Jessica C. Foster-Dingley, MSc; Wouter de Ruijter, MD, PhD; Jeroen van der Grond, PhD; Anne Suzanne Bertens, MD; Mark A. van Buchem, MD, PhD; Jacobijn Gussekloo, MD, PhD; Huub A. Middelkoop, PhD; Marieke J. H. Wermer, MD, PhD; Rudi G. J. Westendorp, MD, PhD; Anton J. M. de Craen, PhD; Roos C. van der Mast, MD, PhD
Includes: Supplemental Content

Importance  Observational studies indicate that lower blood pressure (BP) increases risk for cognitive decline in elderly individuals. Older persons are at risk for impaired cerebral autoregulation; lowering their BP may compromise cerebral blood flow and cognitive function.

Objective  To assess whether discontinuation of antihypertensive treatment in ...

Invited Commentary: Discontinuation Trial of Antihypertensive Treatment; Michelle C. Odden, PhD
Original Investigation 
Jing Luo, MD; Jerry Avorn, MD; Aaron S. Kesselheim, MD, JD, MPH

Importance  Insulin is a vital medicine for patients with diabetes mellitus. Newer, more expensive insulin products and the lack of generic insulins in the United States have increased costs for patients and insurers.

Objective  To examine Medicaid payment trends for insulin products. Cost information is available ...

Invited Commentary 
Michelle C. Odden, PhD

The overwhelming majority of research and guidelines has focused on the initiation and intensification of medication therapy. Not surprisingly, the burden of medication use in older adults is high; nearly 40% of adults 65 years or older and 50% of those 80 years or older are using 5 ...

Invited Commentary 
Laura E. Riley, MD

In their study of the diversity of graduate medical education in the United States, Deville and colleagues1 call attention yet again to the continued underrepresentation of women and minority groups in medicine compared with the population as a whole. Among the many interesting findings, I was most ...

Research Letter 
Michael E. Johansen, MD, MS; Lee A. Green, MD, MPH

This survey investigates the use of statins in individuals older than 79 years by vascular disease.

Research Letter 
Curtiland Deville, MD; Wei-Ting Hwang, PhD; Ramon Burgos, AB; Christina H. Chapman, MD; Stefan Both, PhD; Charles R. Thomas Jr, MD

In this data analysis, graduate medical education diversity was assessed by race, ethnicity, and sex in 2012.

Invited Commentary: Ensuring a Diverse Physician Workforce; Laura E. Riley, MD
Jennifer DeVoe, MD, DPhil

I recently went home to spend spring break with my 73-year-old father, who lived alone with emphysema. I had planned to discuss a move to assisted living; I had no intimation that this would, instead, be his last week of life. When I arrived, he could barely breathe. ...

Original Investigation 
Lainie Rutkow, JD, PhD, MPH; Hsien-Yen Chang, PhD; Matthew Daubresse, MHS; Daniel W. Webster, ScD, MPH; Elizabeth A. Stuart, PhD; G. Caleb Alexander, MD, MS
Includes: Supplemental Content

Importance  Prescription Drug Monitoring Program (PDMP) and pill mill laws are among the principal means states use to reduce prescription drug abuse and diversion, yet little high-quality evidence exists regarding their effect.

Objective  To quantify the effect of Florida’s PDMP and pill mill laws on overall ...

This commentary on a recently published article from the JAMA Network places in context findings on risks of malfunction in cardiovascular implantable electronic devices during radiation therapy for cancer.

Challenges in Clinical Electrocardiography 
Ali Pourdjabbar, MD; Martin S. Green, MD; Pablo B. Nery, MD

The 12-lead electrocardiogram (ECG) is a diagnostic tool in cardiology and similar to other diagnostic tests is also susceptible to misinterpretation. Understanding the principles of ECG acquisition is essential to accurate interpretation. The reported cases highlight the importance of applying these principles to challenging scenarios in which the ...

Research Letter 
Rabeea F. Khan, MD; Shelli Feder, MSN; Nathan E. Goldstein, MD; Sarwat I. Chaudhry, MD

This study evaluated the spectrum of symptoms, improvement in symptoms after discharge, and perceptions of palliative care among patients who were hospitalized for heart failure.

Research Letter 
Penny Yin, MD; Alex Kiss, PhD; Jerome A. Leis, MD, MSc

This cohort study of appropriate orders for urinalysis determines whether overuse of urinalysis contributes to misdiagnosis and excessive use of antibiotics among elderly patients admitted to the emergency department of a tertiary care center.

Original Investigation  FREE
Marianne C. Snijdewind, MA; Dick L. Willems, MD, PhD; Luc Deliens, PhD; Bregje D. Onwuteaka-Philipsen, PhD; Kenneth Chambaere, PhD

Importance  Right to Die NL, an organization in the Netherlands that advocates for the option of euthanasia, founded the End-of-Life Clinic in 2012 to provide euthanasia or physician-assisted suicide for patients who meet all legal requirements but whose regular physicians rejected their request. Many patients whose requests ...

Invited Commentary: Euthanasia in Belgium and the Netherlands; Barron H. Lerner, MD, PhD; Arthur L. Caplan, PhD
Invited Commentary 
Muriel R. Gillick, MD

Facing death is rarely easy. As dying becomes an imminent reality rather than a remote inevitability, patients often have difficulty choosing among treatment alternatives, even if they are cognitively intact. Health care proxies, when confronting options ranging from burdensome, invasive treatment to exclusively palliative care, frequently are uncertain ...

Invited Commentary  FREE
Barron H. Lerner, MD, PhD; Arthur L. Caplan, PhD

The slippery slope is an argument frequently invoked in the world of bioethics. It connotes the notion that a particular course of action will lead inevitably to undesirable and unintended consequences. Saying no to the original action, even if that act is moral in itself, may, in light ...

Special Communication 
Andrew B. Cohen, MD, DPhil; Megan S. Wright, PhD; Leo Cooney Jr, MD; Terri Fried, MD
Includes: Supplemental Content

As the population ages, more adults will develop impaired decision-making capacity and have no family members or friends available to make medical decisions on their behalf. In such situations, a professional guardian is often appointed by the court. This official has no preexisting relationship with the impaired individual ...

Invited Commentary: Guidance in Shared Decision Making; Muriel R. Gillick, MD
Research Letter 
Sigrid Dierickx, MSc; Luc Deliens, PhD; Joachim Cohen, PhD; Kenneth Chambaere, PhD

This study examined the shifts in the expression and granting of euthanasia requests between 2007 and 2013 and the reasons that physicians granted or denied these requests.

Invited Commentary: Euthanasia in Belgium and the Netherlands; Barron H. Lerner, MD, PhD; Arthur L. Caplan, PhD
Research Letter 
Erika H. Newton, MD, MPH; Erin A. Zazzera, RN, MPH; Guillaume Van Moorsel, MPH, MLIS; Brenda E. Sirovich, MD, MS

This data analysis identified outpatient and emergency department process measures to determine to what extent the measures preferentially target underuse vs overuse.

Teachable Moment 
Anne-Laure Sennesael, MSc; Jean-Michel Dogné, PhD; Anne Spinewine, PhD

While direct oral anticoagulants (DOACs) hold some advantages over vitamin K antagonists, DOAC adverse effects, including bleeding, present a clinical challenge in frail older patients.

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