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 Showing 1-20 of 88 Articles
Editor's Note 
Joseph S. Ross, MD, MHS
Today, physicians order a wide array of diagnostic laboratory and imaging tests for their patients, including genetic evaluations. To make sense of the growing number of diagnostic testing opportunities, one might expect that physicians, in turn, have grown in their ability to accurately interpret test results. The Research Letter by ...
Invited Commentary 
Trevor Mundel, MD, PhD
There is no question that progress over the last several decades has saved millions of lives and reduced the burden of disease in the world’s poorest countries. Wider distribution of new and existing vaccines and drugs, access to basic health services for women and children, and improvements in water and ...
Topics: catalysis
Invited Commentary 
Kurt Kroenke, MD
That most screening test results will be normal or negative is commonplace, but the reality that abnormal results are frequently false-positive is not always well appreciated, nor is it fully conveyed to patients. How does a patient feel after a false-positive test result? Tosteson and colleagues1 concluded from their longitudinal ...
Invited Commentary 
Paul B. Ginsburg, PhD
There is broad consensus among physicians, hospital and health insurance leaders, and policy makers to reform payment to health care providers so as to reduce the role of fee for service, which encourages high volume, and instead to use systems that reward better patient outcomes, such as bundled payments for ...
Research Letter 
Maria Alma Rodriguez, MD; Alma Yvette DeJesus, RN, MSN; Lee Cheng, PhD
Evidence suggests that minimizing aggressive treatment for patients with terminal cancer may provide a better quality of life during the patients’ final days.1,2 One of the proposed metrics for determining quality of cancer care is whether chemotherapy is administered in the last 14 days of life.3 We assessed the proportion ...
Research Letter 
Arjun K. Manrai, AB; Gaurav Bhatia, MS; Judith Strymish, MD; Isaac S. Kohane, MD, PhD; Sachin H. Jain, MD
In 1978, Casscells et al1 published a small but important study showing that the majority of physicians, house officers, and students overestimated the positive predictive value (PPV) of a laboratory test result using prevalence and false positive rate. Today, interpretation of diagnostic tests is even more critical with the increasing ...
Topics: mathematics
Original Investigation 
Eran Bendavid, MD; Jay Bhattacharya, MD, PhD
Includes: Supplemental Content

Importance  International aid to the health sector is an important component of all health spending in many developing countries. The relationship between health aid and changes in population health among aid recipients remains unknown.

Objective  To quantify the relationship between health aid and changes in life ...

Original Investigation 
Anna N. A. Tosteson, ScD; Dennis G. Fryback, PhD; Cristina S. Hammond, MPH; Lucy G. Hanna, MS; Margaret R. Grove, MS; Mary Brown, MPH; Qianfei Wang, MS; Karen Lindfors, MD, MPH; Etta D. Pisano, MD
Includes: Supplemental Content

Importance  False-positive mammograms, a common occurrence in breast cancer screening programs, represent a potential screening harm that is currently being evaluated by the US Preventive Services Task Force.

Objective  To measure the effect of false-positive mammograms on quality of life by measuring personal anxiety, health utility, ...

Original Investigation 
J. Michael McWilliams, MD, PhD; Michael E. Chernew, PhD; Jesse B. Dalton, MA; Bruce E. Landon, MD, MBA, MSc
Includes: Supplemental Content

Importance  Fostering accountability in the Medicare Accountable Care Organization (ACO) programs may be challenging because traditional Medicare beneficiaries have unrestricted choice of health care providers, are attributed to ACOs based on utilization, and often receive fragmented care.

Objective  To measure 3 related constructs relevant to ACO ...

Viewpoint 
Kevin R. Riggs, MD, MPH; Peter A. Ubel, MD
Increased cost sharing, in the forms of higher co-payments, deductibles, and yearly maximums, has been advocated to encourage patients to become smarter consumers and thus to reduce the overall cost of medical care. High out-of-pocket costs, however, can cause care to be delayed or foregone and can lead to financial ...
Case Report/Case Series 
Emily Kern, MD; Lisa B. VanWagner, MD, MS; Guang-Yu Yang, MD, PhD; Mary E. Rinella, MD

Importance  Use of incretin-based hypoglycemic agents is increasing, but safety data remain limited. We treated a woman with marker-negative autoimmune hepatitis associated with the glucagon-like peptide 1 agonist liraglutide.

Observations  A young woman with type 2 diabetes mellitus and vitiligo presented with a 10-day history of ...

Editor's Note 
Rita F. Redberg, MD, MSc
This vignette illustrates an all-too-common problem—the incidentaloma—and one guaranteed to become more frequent because the US Preventive Services Task Force has just endorsed chest computed tomography for lung cancer screening, even beyond the population and frequency studied in the National Lung Screening Trial. It is critical to consider the price ...
Invited Commentary 
Karina W. Davidson, PhD; Ian M. Kronish, MD, MPH; Jonathan A. Shaffer, PhD
“Lumpers” and “splitters” were terms originally used to describe scientists who applied centripetal or centrifugal forces, respectively, to the evolving species taxonomy and other nosology debates in the 1800s. The first use of these 2 terms is attributed to Charles Darwin: “Those who make many species are the ‘splitters,’ and ...
Invited Commentary 
Marion Nestle, PhD, MPH; Robert B. Baron, MD, MS
Conditions related to nutrition are commonly seen in clinical practice, yet few physicians have the knowledge, experience, or time to discuss how patients’ diets affect their health. Over the last half century, many individuals and groups have called for more and better nutrition instruction during medical education. The most recent ...
Invited Commentary 
Lisa M. Kern, MD, MPH; Rainu Kaushal, MD, MPH
Through the Health Information Technology Economic and Clinical Health Act (HITECH) of 2009, the federal government is investing nearly $30 billion in incentives for hospitals and health care providers to adopt and meaningfully use electronic health records (EHRs). The federal government’s goal is to be transformative—to enable new and improved ...
Research Letter 
Lipika Samal, MD, MPH; Adam Wright, PhD; Michael J. Healey, MD; Jeffrey A. Linder, MD, MPH; David W. Bates, MD, MSc
Includes: Supplemental Content
The American Recovery and Reinvestment Act of 2009 included $30 billion for implementation of the Electronic Health Record (EHR) Meaningful Use (MU) incentive program with a goal of increasing EHR adoption and improving quality of care. Stage 1 of the EHR MU incentive program specified required core objectives, menu objectives, ...
Original Investigation 
Jeff C. Huffman, MD; Carol A. Mastromauro, LICSW; Scott R. Beach, MD; Christopher M. Celano, MD; Christina M. DuBois, BA; Brian C. Healy, PhD; Laura Suarez, MD; Bruce L. Rollman, MD; James L. Januzzi, MD
Includes: Supplemental Content

Importance  Depression and anxiety are associated with adverse cardiovascular outcomes in patients with recent acute cardiac events. There has been minimal study of collaborative care (CC) management models for mental health disorders in high-risk cardiac inpatients, and no prior CC intervention has simultaneously managed depression and anxiety ...

Original Investigation 
Bruce L. Davidson, MD, MPH; Sara Verheijen, BS; Anthonie W. A. Lensing, MD, PhD; Martin Gebel, PhD; Timothy A. Brighton, MBBS; Roger M. Lyons, MD; Jeffrey Rehm, MD; Martin H. Prins, MD, PhD

Importance  Combined anticoagulant and aspirin therapy is associated with increased bleeding risk in patients with atrial fibrillation, but the bleeding risk of combined use of anticoagulant and nonsteroidal anti-inflammatory drugs (NSAIDs) is poorly documented.

Objective  To estimate the bleeding risk of combined anticoagulant (rivaroxaban or enoxaparin–vitamin ...

Original Investigation  FREE
Cara Tannenbaum, MD, MSc; Philippe Martin, BSc; Robyn Tamblyn, PhD; Andrea Benedetti, PhD; Sara Ahmed, PhD
Includes: Supplemental Content

Importance  The American Board of Internal Medicine Foundation Choosing Wisely Campaign recommends against the use of benzodiazepine drugs for adults 65 years and older. The effect of direct patient education to catalyze collaborative care for reducing inappropriate prescriptions remains unknown.

Objective  To compare the effect of ...

Perspective  FREE
Marilyn Ursu Bauriedel
Twenty years ago I made the decision that I wanted to avoid unnecessary radiation in medical procedures. Recently, when I was scheduled to have cataract surgery, I followed my physician’s preoperation orders to have an electrocardiogram (ECG). Who would have thought this test would leave me, 5 days after successful ...

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