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 Showing 1-20 of 78 Articles
Editorial: Addressing Overuse of Medical Services One Decision at a Time; Grace A. Lin, MD, MAS; Rita F. Redberg, MD, MSc
Invited Commentary: Decision Aids in Serious Illness; James A. Tulsky, MD
Original Investigation 
Max J. Romano, MPH; Jodi B. Segal, MD, MPH; Craig Evan Pollack, MD, MHS
Includes: Supplemental Content

Importance  Both the overuse of unnecessary medical procedures and poor continuity of care are thought to contribute to high health care spending and poor patient outcomes.

Objective  To investigate the association between care continuity and use of potentially unnecessary procedures.

Design, Setting, and Participants  Observational ...

Invited Commentary: Understanding the Value of Continuity in the 21st Century; S. Ryan Greysen, MD, MHS; Allan S. Detsky, MD, PhD
Original Investigation 
Michael B. Rothberg, MD, MPH; Senthil K. Sivalingam, MD; Reva Kleppel, MSW, MPH; Marc Schweiger, MD; Bo Hu, PhD; Karen R. Sepucha, PhD
Includes: Supplemental Content

Importance  Patients with stable coronary disease undergoing percutaneous coronary intervention (PCI) are frequently misinformed about the benefits of PCI. Little is known about the quality of decision making before angiography and possible PCI.

Objective  To assess the quality of informed decision making and its association with ...

Editorial: Addressing Overuse of Medical Services One Decision at a Time; Grace A. Lin, MD, MAS; Rita F. Redberg, MD, MSc
Invited Commentary: Decision Aids in Serious Illness; James A. Tulsky, MD
Original Investigation 
Michael B. Weinstock, MD; Scott Weingart, MD; Frank Orth, DO; Douglas VanFossen, MD; Colin Kaide, MD; Judy Anderson, MS, MAS; David H. Newman, MD

Importance  Patients with potentially ischemic chest pain are commonly admitted to the hospital or observed after a negative evaluation in the emergency department (ED) owing to concern about adverse events. Previous studies have looked at 30-day mortality, but no current large studies have examined the most important ...

Editorial: Addressing Overuse of Medical Services One Decision at a Time; Grace A. Lin, MD, MAS; Rita F. Redberg, MD, MSc
Invited Commentary: Decision Aids in Serious Illness; James A. Tulsky, MD
Original Investigation 
Patricia C. Silveira, MD; Ivan K. Ip, MD; Samuel Z. Goldhaber, MD; Gregory Piazza, MD, MS; Carol B. Benson, MD; Ramin Khorasani, MD, MPH

Importance  The Wells score to determine the pretest probability of deep vein thrombosis (DVT) was validated in outpatient settings, but it is unclear whether it applies to inpatients.

Objective  To evaluate the utility of the Wells score for risk stratification of inpatients with suspected DVT.

Design, ...

Invited Commentary: The Wells Deep Vein Thrombosis Score for Inpatients; Erika Leemann Price, MD, MPH; Tracy Minichiello, MD
Original Investigation 
Ashok Reddy, MD; Craig E. Pollack, MD, MHS; David A. Asch, MD, MBA; Anne Canamucio, MS; Rachel M. Werner, MD, PhD
Includes: Supplemental Content

Importance  Primary care provider (PCP) turnover is common and can disrupt patient continuity of care. Little is known about the effect of PCP turnover on patient care experience and quality of care.

Objective  To measure the effect of PCP turnover on patient experiences of care and ...

Invited Commentary: Understanding the Value of Continuity in the 21st Century; S. Ryan Greysen, MD, MHS; Allan S. Detsky, MD, PhD
Invited Commentary 
S. Ryan Greysen, MD, MHS; Allan S. Detsky, MD, PhD

For most of the 20th century, patients commonly received care from a small number of physicians over a long period of time. Both generalists and specialists followed a large panel of patients in both the ambulatory and hospital setting for many years. In the United States, physicians' first ...

Invited Commentary 
Erika Leemann Price, MD, MPH; Tracy Minichiello, MD

This Invited Commentary discusses the poor utility of the Wells score for deep vein thrombosis in inpatients and suggests alternative approaches to stratify the risk of deep vein thrombosis.

Invited Commentary 
James A. Tulsky, MD

Shared decision making is often challenging and never entirely rational.1 Even seemingly simple decisions, such as taking antibiotics for an upper respiratory tract infection or repairing a fractured bone, may encompass trade-offs, are influenced by cognitive biases, and can be clouded by emotion. Serious illness amplifies these ...

Review 
C. Adrian Austin, MD; Dinushika Mohottige, MD; Rebecca L. Sudore, MD; Alexander K. Smith, MD; Laura C. Hanson, MD, MPH

Importance  Serious illness impairs function and threatens survival. Patients facing serious illness value shared decision making, yet few decision aids address the needs of this population.

Objective  To perform a systematic review of evidence about decision aids and other exportable tools that promote shared decision making ...

Editorial: Addressing Overuse of Medical Services One Decision at a Time; Grace A. Lin, MD, MAS; Rita F. Redberg, MD, MSc
Invited Commentary: Decision Aids in Serious Illness; James A. Tulsky, MD
Viewpoint 
Joshua M. Sharfstein, MD; Donna Kinzer, BS; John M. Colmers, MPH

This Viewpoint discusses Maryland’s shift away from fee-for-service reimbursement models tied to volume and toward alternate structures that cap payments and reward hospitals and physicians for delivering better health and quality outcomes at lower costs.

Perspective 
Rita F. Redberg, MD, MSc

I recently experienced firsthand the impact of the US Food and Drug Administration’s (FDA) ban on chlorofluorocarbons as described by Jena et al.1 My daughter was home for vacation from college and needed to fill a prescription for an albuterol inhaler (Ventolin). I went to the pharmacy ...

Editor's Note: On Chlorofluorocarbon Bans and Inhaled Albuterol Prices; Joseph S. Ross, MD, MHS; Rita F. Redberg, MD, MSc
Original Investigation  FREE
William M. Sage, MD, JD; Joseph S. Jablonski, JD; Eric J. Thomas, MD, MPH

Importance  Honesty and transparency are essential aspects of health care, including in physicians’ and hospitals’ responses to medical error. Biases and habits associated with medical malpractice litigation, however, may work at cross-purposes with compassion in clinical care and with efforts to improve patient safety.

Objective  To ...

Invited Commentary: Malpractice Settlements; Michelle M. Mello, JD, PhD, MPhil; Jeffrey N. Catalano, Esq
Original Investigation 
J. Bradley Layton, PhD; Christoph R. Meier, PhD, MSc; Julie L. Sharpless, MD; Til Stürmer, MD, PhD; Susan S. Jick, DSc, MPH; M. Alan Brookhart, PhD
Includes: Supplemental Content

Importance  Increases in testosterone use and mixed reports of adverse events have raised concerns about the cardiovascular safety of testosterone. Testosterone is available in several delivery mechanisms with varying pharmacokinetics; injections cause spikes in testosterone levels, and transdermal patches and gels cause more subtle but sustained increases. ...

Invited Commentary: Testosterone Therapy: Too Much, Too Little, Just Right; Margaret E. Wierman, MD
Original Investigation 
Anupam B. Jena, MD, PhD; Oliver Ho, BA; Dana P. Goldman, PhD; Pinar Karaca-Mandic, PhD

Importance  The US Clean Air Act prohibits use of nonessential ozone-depleting substances. In 2005, the US Food and Drug Administration announced the ban of chlorofluorocarbon (CFC) albuterol inhalers by December 31, 2008. The policy resulted in the controversial replacement of generic CFC inhalers by more expensive, branded ...

Editor's Note: On Chlorofluorocarbon Bans and Inhaled Albuterol Prices; Joseph S. Ross, MD, MHS; Rita F. Redberg, MD, MSc
Original Investigation 
Cinta Valls-Pedret, MSc; Aleix Sala-Vila, DPharm, PhD; Mercè Serra-Mir, RD; Dolores Corella, DPharm, PhD; Rafael de la Torre, DPharm, PhD; Miguel Ángel Martínez-González, MD, PhD; Elena H. Martínez-Lapiscina, MD, PhD; Montserrat Fitó, MD, PhD; Ana Pérez-Heras, RD; Jordi Salas-Salvadó, MD, PhD; Ramon Estruch, MD, PhD; Emilio Ros, MD, PhD
Includes: Supplemental Content

Importance  Oxidative stress and vascular impairment are believed to partly mediate age-related cognitive decline, a strong risk factor for development of dementia. Epidemiologic studies suggest that a Mediterranean diet, an antioxidant-rich cardioprotective dietary pattern, delays cognitive decline, but clinical trial evidence is lacking.

Objective  To investigate ...

Invited Commentary  FREE
Michelle M. Mello, JD, PhD, MPhil; Jeffrey N. Catalano, Esq

In this issue of JAMA Internal Medicine, Sage et al1 report a novel study of nondisclosure provisions among Texas malpractice settlement agreements. Nearly all the settlements contained at least one type of disclosure restriction, and approximately 40% barred claimants from discussing the facts surrounding their injury. ...

Invited Commentary 
Margaret E. Wierman, MD

There is a developing story that the increased use of testosterone therapy without a diagnosis of hypogonadism is associated with an elevated cardiovascular risk for some patients. In this issue of JAMA Internal Medicine, Layton and coauthors1 deepen our knowledge with their analysis of 3 large ...

Invited Commentary 
Scott M. Stevens, MD; Scott C. Woller, MD

Venous thromboembolism, which most commonly manifests as deep venous thrombosis (DVT) of the extremities and pulmonary embolism, affects more than 500 000 Americans annually and is the third most common cause of cardiovascular mortality in the United States. Upper-extremity DVT (UE-DVT) accounts for about 10% of all DVT ...

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