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 Showing 1-20 of 63 Articles
Invited Commentary 
Michelle M. Mello, JD, PhD, MPhil; I. Glenn Cohen, JD
In this issue of JAMA Internal Medicine, Kernan et al1 chronicle Yale University’s experience responding to a subpoena for data from an ongoing, double-blind, placebo-controlled trial of pioglitazone. The subpoena arose from litigation brought by Sara J. Kincaid,2 who believed she had been injured by pioglitazone but who was not ...
Original Investigation 
Megan K. Devlin, MD; Natalie K. Kozij, MD; Alex Kiss, PhD; Lisa Richardson, MA, MD; Brian M. Wong, MD
Includes: Supplemental Content

Importance  Handover is the process of transferring pertinent patient information and clinical responsibility between health care practitioners. Few studies have examined morning handover from the overnight trainee to the daytime team.

Objective  To characterize current morning handover practices in 2 academic medical centers by assessing the ...

Original Investigation 
Riyaz Bashir, MD; Chad J. Zack, MD; Huaqing Zhao, PhD; Anthony J. Comerota, MD; Alfred A. Bove, MD
Includes: Supplemental Content

Importance  The role of catheter-directed thrombolysis (CDT) in the treatment of acute proximal deep vein thrombosis (DVT) is controversial, and the nationwide safety outcomes are unknown.

Objectives  The primary objective was to compare in-hospital outcomes of CDT plus anticoagulation with those of anticoagulation alone. The secondary ...

Mitchell H. Katz, MD
As an internal medicine resident in the 1980s, I essentially lived in the hospital. On ward months, we were on an every-third-night rotation such that we woke up and went to sleep at home only 1 of every 3 days. On our on-call day we admitted patients all day and ...
Special Communication 
Walter N. Kernan, MD; Catherine M. Viscoli, PhD; Mathew C. Varughese, JD

Researchers conducting randomized clinical trials may find themselves subject to legal subpoenas for interim data. When a subpoena demands premature disclosure of unblinded data, there is potential for damage to the scientific integrity and reputation of the on-going trial. We describe herein general issues raised by subpoenas for ...

Paul R. Massey, MD; Jeffrey H. Anderson, MD
Inpatient clinical clerkships in the third year of medical school are the touchstones of traditional medical education in the United States and have remained so since they were originally suggested by Abraham Flexner in 1910.1 Historically, the third year is when a physician is forged from a student and when ...
In the late 1970s, investigators learned that androgen-deprivation therapy (ADT) decreased serum testosterone levels and, more importantly, reduced bone pain among men with prostate cancer. Whereas ADT demonstrated benefit in patients with metastatic disease and as an adjunct to radiation therapy in patients with locally advanced disease, its use at ...
Original Investigation 
Karen E. Hoffman, MD, MHSc, MPH; Jiangong Niu, PhD; Yu Shen, PhD; Jing Jiang, PhD; John W. Davis, MD; Jeri Kim, MD; Deborah A. Kuban, MD; George H. Perkins, MD; Jay B. Shah, MD; Grace L. Smith, MD, PhD, MPH; Robert J. Volk, PhD; Thomas A. Buchholz, MD; Sharon H. Giordano, MD, MPH; Benjamin D. Smith, MD
Includes: Supplemental Content

Importance  Up-front treatment of older men with low-risk prostate cancer can cause morbidity without clear survival benefit; however, most such patients receive treatment instead of observation. The impact of physicians on the management approach is uncertain.

Objective  To determine the impact of physicians on the management ...

Original Investigation 
Grace L. Lu-Yao, MPH, PhD; Peter C. Albertsen, MD; Dirk F. Moore, PhD; Weichung Shih, PhD; Yong Lin, PhD; Robert S. DiPaola, MD; Siu-Long Yao, MD
Includes: Supplemental Content

Importance  One in 6 American men will be diagnosed as having prostate cancer during their lifetime. Although there are no data to support the use of primary androgen-deprivation therapy (ADT) for early-stage prostate cancer, primary ADT has been widely used for localized prostate cancer, especially among older ...

Brendan R. Jackson, MD, MPH
It was midway through internal medicine residency when a fellow resident turned to me and said, “I’m done with this medical torture.” I knew exactly how he felt. We had been working furiously to care for very sick, elderly patients in the intensive care unit, performing invasive procedures, carefully selecting ...
Topics: grandmother
James S. Floyd, MD, MS; Bruce M. Psaty, MD, PhD
Each year, about 23 000 people in the United States die from antibiotic-resistant infections. For many of these infections, safe and effective treatments are lacking. To address this problem, the US Food and Drug Administration (FDA) has updated several expedited approval programs for new antibacterial therapies, some of which alter ...
In June 2014, the US Supreme Court ruled that some employers can decide for themselves whether the contraceptive mandate in the Affordable Care Act (ACA) is a substantial burden on the exercise of religious freedom (Box)2 and sue for an exemption on that basis. What are the broader implications of ...
Research Letter 
Christina C. Melon, BA, MSc; Panteha Eshtiaghi; Warren J. Luksun, MD, FRCPC; Duminda N. Wijeysundera, MD, PhD, FRCPC
Assessment of exercise capacity is critical to preoperative evaluation. Practice guidelines recommend that patients proceed to noncardiac surgery without further testing if their exercise capacity exceeds 4 metabolic equivalent tasks (METs).1 This assumption that good exercise capacity indicates low perioperative risk is largely extrapolated from studies involving objective exercise testing. ...
Research Letter 
German Morís, MD; Juan Carlos Garcia-Monco, MD
Cases of drug-induced aseptic meningitis (DIAM) are likely underreported, and only a few reviews of the literature have been performed. We have updated (to February 2014) a previous review (1999)1 to identify newer agents associated with DIAM, as well as distinctive new features.
Research Letter 
Analía R. Stormo, BS; Mona Saraiya, MD, MPH; Esther Hing, MPH; Jillian T. Henderson, PhD; George F. Sawaya, MD
A well-woman preventive care visit is a core service supported by the Human Resources and Services Administration,1 yet it is unclear which preventive services are provided by primary care physicians (PCPs) and which are provided by obstetrician/gynecologists (OB/GYNs).2,3 We examined patterns of selected age-appropriate preventive care visits across a woman’s ...
Maura Calsyn, JD; Ezekiel J. Emanuel, MD, PhD
Medicare’s Acute Care Episode (ACE) demonstration bundled hospital and physician payments for 37 inpatient cardiac and orthopedic procedures. This payment structure improved coordination between physicians and hospitals and motivated hospitals to negotiate lower prices with device manufacturers, in most instances saving money without evidence of stinting on care. The program ...
Topics: medicare; acute care
Invited Commentary 
Margot Kushel, MD
In the United States, an estimated 2 million people are addicted to heroin or opioid analgesics, 80% of whom are not in treatment.1 Rates of addiction have increased during the past 20 years, following increased misuse of prescription opioid analgesics, resulting in large increases in opioid-related emergency department visits, hospitalizations, ...
Invited Commentary 
Wayne B. Jonas, MD, LTC (Ret); Eric B. Schoomaker, MD, PhD, LTG (Ret)
In the documentary movie Escape Fire,1 a battle-weary and combat-wounded soldier falls out of his bunk during a medical evacuation flight from Afghanistan to Washington, DC. Disoriented from an overdose of opioid and psychoactive medications previously prescribed for his wounds, pain, and loss, he later embarks on a journey of ...
Research Letter 
Robin L. Toblin, PhD, MPH; Phillip J. Quartana, PhD; Lyndon A. Riviere, PhD; Kristina Clarke Walper, MPH; Charles W. Hoge, MD
Chronic pain affects a quarter of people seeking primary health care.1,2 Opioid medications are prescribed for chronic pain, but recently, rates of opioid use and misuse have ballooned, leading to significant numbers of overdose-related hospitalizations and deaths.3 The prevalence of chronic pain and opioid use associated with deployment is not ...
Research Letter 
Nareg H. Roubinian, MD, MPHTM; Gabriel J. Escobar, MD; Vincent Liu, MD; Marla N. Gardner, BS; Jeffrey L. Carson, MD; Steven H. Kleinman, MD; Edward L. Murphy, MD; for the NHLBI Recipient Epidemiology and Donor Evaluation Study (REDS-III)
Blood conservation strategies effectively decrease red blood cell (RBC) use in specific patient groups.1- 3 However, the impact of RBC transfusion reduction on mortality in a diverse inpatient population remains poorly described. We detail the impact of declining RBC use on 30-day mortality within Kaiser Permanente Northern California (KPNC), an ...

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