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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 ...
Michael J. Barry, MD
One of my primary care patients, a generally healthy man in his mid-50s who was a current smoker, developed left scapular pain followed by numbness in the left shoulder and upper arm. Approximately 1 week after the onset of pain, he became unable to raise his left arm with preservation ...
Nathaniel P. Morris, AB
Despite an obesity epidemic and the increasing burden of chronic, diet-related disease in the United States, medical schools have continued to neglect nutrition education over the last several decades. In August 2013, I saw this neglect firsthand. As a second-year medical student, I completed the Introduction to Clinical Nutrition course ...
Editorial  FREE
Mitchell H. Katz, MD
Thanks to the Affordable Care Act (ACA), low-income Americans (those earning less than 139% of the federal poverty level) living in 25 states and the District of Columbia gained eligibility to Medicaid on January 1, 2014.1 The Congressional Budget Office estimates that by 2022 there will be 12 million new ...
Invited Commentary  FREE
Andrew B. Bindman, MD; Janet M. Coffman, PhD
Through coverage expansion, the Patient Protection and Affordable Care Act (ACA) is expected to reduce a major barrier to health care access, the cost of care. However, the law does not ensure that an adequate number of physicians are available and willing to accept a patient’s form of coverage.
Invited Commentary 
June K. Robinson, MD
In 2014, about 76 100 new melanomas will be diagnosed, and an estimated 9710 persons will die (about 6470 men and 3240 women).1 Patients with melanoma in situ, stage 0, have a 5-year survival rate of 99% when treated with excision, whereas those with melanoma limited to the skin and ...
Research Letter 
Sandra L. Decker, PhD; Genevieve M. Kenney, PhD; Sharon K. Long, PhD
When the Supreme Court ruled that under the Patient Protection and Affordable Care Act, states could not be compelled to expand Medicaid,1 it opened an unusual divide for public insurance coverage in the United States. Starting January 1, 2014, adults 19 to 64 years with family income up to 138% ...
Research Letter 
Jonas B. Nielsen, MD; Sandra E. Strandberg, BSc; Adrian Pietersen, MD; Claus Graff, MSc, PhD; Anders G. Holst, MD, PhD; for the Copenhagen ECG Study
Left anterior fascicular block (LAFB) is considered a failure or delay of conduction in the left anterior fascicle.1 Despite the fact that little is known about the long-term prognosis associated with LAFB, it has generally been thought of as a benign electrocardiographic (ECG) finding.2 This view was recently challenged in ...
Original Investigation  FREE
Karin V. Rhodes, MD, MS; Genevieve M. Kenney, PhD; Ari B. Friedman, MS; Brendan Saloner, PhD; Charlotte C. Lawson, BA; David Chearo, MA; Douglas Wissoker, PhD; Daniel Polsky, PhD
Includes: Supplemental Content

Importance  Current measures of access to care have intrinsic limitations and may not accurately reflect the capacity of the primary care system to absorb new patients.

Objective  To assess primary care appointment availability by state and insurance status.

Design, Setting, and Participants  We conducted a ...

Original Investigation 
Renda Soylemez Wiener, MD, MPH; Michael K. Gould, MD, MS; Christopher G. Slatore, MD, MS; Benjamin G. Fincke, MD; Lisa M. Schwartz, MD, MS; Steven Woloshin, MD, MS
Includes: Supplemental Content

Importance  Pulmonary nodules are common, and more will be found with implementation of lung cancer screening. How potentially malignant pulmonary nodules are evaluated may affect patient outcomes, health care costs, and effectiveness of lung cancer screening programs. Guidelines for evaluating pulmonary nodules for cancer exist, but little ...

Original Investigation 
Chima D. Ndumele, PhD; Vincent Mor, PhD; Susan Allen, PhD; James F. Burgess Jr, PhD; Amal N. Trivedi, MD, MPH
Includes: Supplemental Content

Importance  Medicaid enrollees typically report worse access to care than other insured populations. Expansions in Medicaid through less restrictive income eligibility requirements and the resulting influx of new enrollees may further erode access to care for those already enrolled in Medicaid.

Objective  To assess the effect ...

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