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 Showing 1-20 of 62 Articles
I hope that the article by Tjia and colleagues1 in this issue of JAMA Internal Medicine is read not just by clinicians who care for patients with advanced dementia and nursing home residents. The article contributes to the literature and practice in 2 important ways. First, the study’s strengths advance ...
Research Letter 
Michael E. Johansen, MD, MS; Timothy R. Huerta, PhD, MS; Caroline R. Richardson, MD, MS
Proton pump inhibitors (PPIs) are a class of therapeutically equivalent medications when used at equivalent doses.1,2 Despite this, high-cost PPIs continue to be used when low-cost equivalents are available. We sought to estimate the national loss associated with the use of high-cost PPIs over their lower-cost alternatives. Furthermore, we investigated ...
Research Letter 
Sean B. Smith, MD; Gregory W. Ruhnke, MD, MS, MPH; Curtis H. Weiss, MD, MS; Grant W. Waterer, MBBS, MS, MBA; Richard G. Wunderink, MD
The Nationwide Inpatient Sample aggregated data from approximately 20% of US hospital admissions from 1993 to 2011. Prior literature found that pneumonia admissions decreased following the introduction of the pneumococcal vaccine in 2000.1 The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), codes provide information regarding pneumonia pathogens, but ...
Research Letter 
Clement J. McDonald, MD; Fiona M. Callaghan, PhD; Arlene Weissman, PhD; Rebecca M. Goodwin, JD; Mallika Mundkur, MD; Thomson Kuhn, MS
Physicians complain about the time costs and other effects of electronic medical records (EMRs).1- 3 In a small survey,4 family practice physicians reported an EMR-associated loss of 48 minutes of free time per clinic day (P < .05). We collaborated with the American College of Physicians (ACP) to revise the ...
Original Investigation 
Hayley B. Gershengorn, MD; Hannah Wunsch, MD, MSc; Damon C. Scales, MD, PhD; Ryan Zarychanski, MD, MSc; Gordon Rubenfeld, MD, MSc; Allan Garland, MD, MA
Includes: Supplemental Content

Importance  Arterial catheters are used frequently in intensive care units (ICUs). Clinical effectiveness and adverse events associated with the use of the catheters have not been formally evaluated in clinical studies.

Objective  To determine whether an association exists between arterial catheter use and hospital mortality in ...

Original Investigation 
Hamita Sachar, MD; Keta Vaidya, MD; Loren Laine, MD
Includes: Supplemental Content

Importance  Current guidelines recommend an intravenous bolus dose of a proton pump inhibitor (PPI) followed by continuous PPI infusion after endoscopic therapy in patients with high-risk bleeding ulcers. Substitution of intermittent PPI therapy, if similarly effective as bolus plus continuous-infusion PPI therapy, would decrease the PPI dose, ...

Original Investigation  FREE
Jennifer Tjia, MD, MSCE; Becky A. Briesacher, PhD; Daniel Peterson, MA; Qin Liu, MD, PhD; Susan E. Andrade, ScD; Susan L. Mitchell, MD, MPH

Importance  Advanced dementia is characterized by severe cognitive impairment and complete functional dependence. Patients’ goals of care should guide the prescribing of medication during such terminal illness. Medications that do not promote the primary goal of care should be minimized.

Objectives  To estimate the prevalence of ...

Original Investigation 
Jonathan S. Lee, MD; Wato Nsa, MD, PhD; Leslie R. M. Hausmann, PhD; Amal N. Trivedi, MD, MPH; Dale W. Bratzler, DO, MPH; Dana Auden, MS; Maria K. Mor, PhD; Kristie Baus, RN, MS; Fiona M. Larbi, RN, BSN, CPAN; Michael J. Fine, MD, MSc
Includes: Supplemental Content

Importance  Nearly every US acute care hospital reports publicly on adherence to recommended processes of care for patients hospitalized with pneumonia. However, it remains uncertain how much performance of these process measures has improved over time or whether performance is associated with superior patient outcomes.

Objectives  ...

Joseph R. Roberts, MD, PGY-2; Kiran Bambha, MD, MSc
Patrick G. O’Connor, MD, MPH; Robert J. Sokol, MD; Gail D’Onofrio, MD, MS
Substance use is highly prevalent, a substantial cause of morbidity and mortality and accounts for over $500 billion in economic costs in the United States annually. The 2012 National Survey on Drug Use and Health (NSDUH),1 which surveyed Americans 12 years or older, reported that 32% binge drink and nearly ...
Challenges in Clinical Electrocardiography 
David Snipelisky, MD; Maegan Roberts, MS; Joseph Blackshear, MD
Invited Commentary 
Takehiro Sugiyama, MD, PhD; Martin F. Shapiro, MD, PhD
Disparity in dietary quality is a public health concern in the United States. Excess caloric intake induces obesity and diabetes mellitus, which in turn cause cardiovascular diseases. Similarly, poorer dietary quality has been shown to affect health outcomes, whether directly or via intermediate chronic conditions such as hypertension and dyslipidemia. ...
Invited Commentary 
Kasia J. Lipska, MD, MHS
Older adults experience adverse drug events (ADEs) far more often than younger persons. The reasons for this include age-related decline in kidney and liver function, comorbidities, and the use of multiple medications. Oral glucose-lowering agents and insulin are implicated in one-quarter of emergency hospitalizations for ADEs among older US adults.1 ...
Invited Commentary 
Deborah Korenstein, MD; Cynthia D. Smith, MD
As the US health care system strives to improve value, there is near universal agreement that medical trainees must learn to reduce waste. The Accreditation Council for Graduate Medical Education has included skills in cost consciousness in the 2013 internal medicine reporting milestones,1 the Medicare Payment Advisory Commission has recommended ...
Invited Commentary 
Vinay Prasad, MD
Prostate-specific antigen (PSA) screening has been a disappointing public health strategy. The history of the PSA test will one day serve as a reminder that, although all of us in health care want to do everything possible to reduce the mortality of cancer, the early adoption of screening techniques on ...
Research Letter 
Aner Tal, PhD; Scott Zuckerman, MD; Brian Wansink, PhD
Television (TV) has generally been blamed for helping make Americans overweight1 owing to both its distracting influence and its encouragement of a sedentary lifestyle.2- 4 Indeed, a recent correlational analysis5 of dinner patterns illustrated that the frequency of TV viewing during dinner was 1 of the 2 largest correlates of ...
Topics: television; eating
Research Letter 
Jesse D. Sammon, DO; Daniel Pucheril, MD, MBA; Mireya Diaz, PhD; Adam S. Kibel, MD; Philip W. Kantoff, MD; Mani Menon, MD; Quoc-Dien Trinh, MD
Includes: Supplemental Content
Routine screening for prostate cancer using prostate-specific antigen (PSA) is a widely contested practice, and recommendations have recently changed dramatically. In October 2011, the US Preventative Services Task Force recommended against screening in any age group,1 yet current nationwide patterns of PSA screening are largely unknown. We sought to elucidate ...
Original Investigation 
Trisha M. Parekh, DO; Mukaila Raji, MD, MS; Yu-Li Lin, MS; Alai Tan, MD, PhD; Yong-Fang Kuo, PhD; James S. Goodwin, MD
Includes: Supplemental Content

Importance  Certain antimicrobial drugs interact with sulfonylureas to increase the risk of hypoglycemia.

Objective  To determine the risk of hypoglycemia and associated costs in older patients prescribed glipizide or glyburide who fill a prescription for an antimicrobial drug.

Design, Setting, and Participants  This was a ...

Original Investigation 
Brenda E. Sirovich, MD, MS; Rebecca S. Lipner, PhD; Mary Johnston, MS; Eric S. Holmboe, MD
Includes: Supplemental Content

Importance  Growing concern about rising costs and potential harms of medical care has stimulated interest in assessing physicians’ ability to minimize the provision of unnecessary care.

Objective  To assess whether graduates of residency programs characterized by low-intensity practice patterns are more capable of managing patients’ care ...

Original Investigation 
Dong D. Wang, MD, MSc; Cindy W. Leung, ScD; Yanping Li, PhD; Eric L. Ding, ScD; Stephanie E. Chiuve, ScD; Frank B. Hu, MD, PhD; Walter C. Willett, MD, DrPH
Includes: Supplemental Content

Importance  Many changes in the economy, policies related to nutrition, and food processing have occurred within the United States since 2000, and the net effect on dietary quality is not clear. These changes may have affected various socioeconomic groups differentially.

Objective  To investigate trends in dietary ...

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