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 Showing 1-20 of 76 Articles
Teachable Moment 
Eric C. T. Geijteman, MD; Teun van Gelder, MD, PhD; Lia van Zuylen, MD, PhD
Original Investigation 
Mona Siddiqui, MD, MPH; Eric T. Roberts, MA; Craig E. Pollack, MD, MHS
Includes: Supplemental Content

Importance  High unemployment during the 2007-2009 Great Recession and eligibility expansions have increased the size and cost of Medicaid. To provide states with flexibility in administering the program while containing costs, the Deficit Reduction Act of 2005 (DRA) gave states the authority to impose cost-sharing strategies, including ...

Original Investigation 
Andrew J. Foy, MD; Guodong Liu, PhD; William R. Davidson Jr, MD; Christopher Sciamanna, MD; Douglas L. Leslie, PhD

Importance  Patients presenting to the emergency department (ED) with chest pain whose evaluation for ischemia demonstrates no abnormalities receive further functional or anatomical studies for coronary artery disease; however, comparative evidence for the various strategies is lacking and multiple testing options exist.

Objective  To compare chest ...

Original Investigation 
Shelly L. Gray, PharmD, MS; Melissa L. Anderson, MS; Sascha Dublin, MD, PhD; Joseph T. Hanlon, PharmD, MS; Rebecca Hubbard, PhD; Rod Walker, MS; Onchee Yu, MS; Paul K. Crane, MD, MPH; Eric B. Larson, MD, MPH
Includes: Supplemental Content

Importance  Many medications have anticholinergic effects. In general, anticholinergic-induced cognitive impairment is considered reversible on discontinuation of anticholinergic therapy. However, a few studies suggest that anticholinergics may be associated with an increased risk for dementia.

Objective  To examine whether cumulative anticholinergic use is associated with a ...

Invited Commentary 
Katherine Baicker, PhD; Helen Levy, PhD
Economists like to say that there is no free lunch, but reducing wasteful health care spending in public programs may be as close as we will ever get. The challenge is that reducing such spending, or even identifying it, is hard. Some of the policy options focus on the health ...
Invited Commentary 
Noll L. Campbell, PharmD; Malaz A. Boustani, MD, MPH
In this issue of JAMA Internal Medicine, Gray and colleagues1 present findings from an observational analysis that show a higher risk for dementia with the increasing dose and duration of exposure to medications with strong anticholinergic activity. The risk for dementia was consistent when comparing participants with recent and past ...
Editor's Note 
Rita F. Redberg, MD, MSc
Chest pain is one of the most challenging symptoms for emergency medicine physicians to evaluate. They must identify patients with cardiac ischemia without subjecting all patients, the overwhelming majority of whom do not have ischemia, to unnecessary testing. Most patients evaluated in the emergency department (ED) for chest pain who ...
Challenges in Clinical Electrocardiography 
Jonathan W. Waks, MD; Adam S. Fein, MD; Saumya Das, MD, PhD
An active 62-year-old man with no medical problems began to experience frequent, sudden episodes of exertional near-syncope and syncope. The episodes were not associated with any prodromal symptoms. A neurologic evaluation was unrevealing. A transthoracic echocardiogram demonstrated a structurally normal heart, and the patient’s resting electrocardiogram (ECG) was normal. On ...
Perspective 
Sunita Sah, MD, MBA, PhD
“All new patients have an x-ray before seeing the doctor.” As a physician, I found this sentence baffling—I had been taught that the physician’s role is to first see a patient, take a detailed history, perform an examination, and consider the differential diagnoses. Only then could I consider the investigations ...
Original Investigation 
Andreas P. Kalogeropoulos, MD, MPH, PhD; Vasiliki V. Georgiopoulou, MD; Rachel A. Murphy, PhD; Anne B. Newman, MD, MPH; Douglas C. Bauer, MD; Tamara B. Harris, MD, MS; Zhou Yang, MPH, PhD; William B. Applegate, MD, MPH; Stephen B. Kritchevsky, PhD

Importance  Additional information is needed about the role of dietary sodium on health outcomes in older adults.

Objective  To examine the association between dietary sodium intake and mortality, incident cardiovascular disease (CVD), and incident heart failure (HF) in older adults.

Design, Setting, and Participants  We ...

Original Investigation 
Wayne A. Ray, PhD; Cecilia P. Chung, MD, MPH; Katherine T. Murray, MD; William O. Cooper, MD, MPH; Kathi Hall, BS; C. Michael Stein, MB, ChB
Includes: Supplemental Content

Importance  Growing methadone use in pain management has raised concerns regarding its safety relative to other long-acting opioids. Methadone hydrochloride may increase the risk for lethal respiratory depression related to accidental overdose and life-threatening ventricular arrhythmias.

Objective  To compare the risk of out-of-hospital death in patients ...

Original Investigation 
Sarah E. Jackson, PhD; Andrew Steptoe, DSc; Jane Wardle, PhD
Includes: Supplemental Content

Importance  Couples are highly concordant for unhealthy behaviors, and a change in one partner’s health behavior is often associated with a change in the other partner’s behavior. However, no studies have explicitly compared the influence of having a partner who takes up healthy behavior (eg, quits smoking) ...

Editor's Note 
Deborah Grady, MD
Practice varies around the United States and across each institution, but I would bet that every reader could give multiple examples of situations in which tests are ordered automatically before talking to or examining a patient. There are situations in which ordering tests before examining a patient is reasonable and ...
Research Letter 
Daniel E. Freedberg, MD, MS; Hojjat Salmasian, MD, MPH; Julian A. Abrams, MD, MS; Robert A. Green, MD, MPH
Proton pump inhibitors (PPIs) are highly effective in treating gastric acid–related disorders but are often overused.1 Intravenous (IV) PPIs are expensive compared with oral PPIs and have few absolute indications; more than half of hospitalized patients prescribed IV PPIs could instead receive oral PPIs.2 Health information technologies have the potential ...
Research Letter 
Alvaro Alonso, MD, PhD; Richard F. MacLehose, PhD; Pamela L. Lutsey, PhD; Suma Konety, MD; Lin Y. Chen, MD, MS
Amiodarone hydrochloride is an antiarrhythmic drug frequently used in the treatment of atrial fibrillation (AF). Isolated reports1- 3 have suggested that use of amiodarone may cause acute pancreatitis. To our knowledge, this potential adverse effect of amiodarone has not been explored in large studies. We assessed whether use of amiodarone ...
Research Letter 
Christine T. Cigolle, MD, MPH; Jinkyung Ha, PhD; Lillian C. Min, MD, MSHS; Pearl G. Lee, MD, MS; Tanya R. Gure, MD; Neil B. Alexander, MD, MS; Caroline S. Blaum, MD, MS
Falling is the most frequent cause of injury in older adults in the United States, leading to substantial disability and mortality. A variety of studies have found that approximately one-third of older adults fall each year, but there have been no nationally representative longitudinal studies that examine falling across the ...
Teachable Moment 
Jennifer Weiskopf, MD; Serena Scott, MD
Original Investigation  FREE
Kasia J. Lipska, MD, MHS; Joseph S. Ross, MD; Yinghui Miao, MPH; Nilay D. Shah, PhD; Sei J. Lee, MD, MAS; Michael A. Steinman, MD
Includes: Supplemental Content

Importance  In older adults with multiple serious comorbidities and functional limitations, the harms of intensive glycemic control likely exceed the benefits.

Objectives  To examine glycemic control levels among older adults with diabetes mellitus by health status and to estimate the prevalence of potential overtreatment of diabetes....

Original Investigation 
Jason Phua, FRCP; Gavin M. Joynt, FRCP; Masaji Nishimura, MD; Yiyun Deng, MD; Sheila Nainan Myatra, MD; Yiong Huak Chan, PhD; Nguyen Gia Binh, MD; Cheng Cheng Tan, MBBS; Mohammad Omar Faruq, MD; Yaseen M. Arabi, MD; Bambang Wahjuprajitno, MD; Shih-Feng Liu, MD; Seyed Mohammad Reza Hashemian, MD; Waqar Kashif, MD; Dusit Staworn, MD; Jose Emmanuel Palo, MD; Younsuck Koh, MD; for the ACME Study Investigators and the Asian Critical Care Clinical Trials Group
Includes: Supplemental Content

Importance  Little data exist on end-of-life care practices in intensive care units (ICUs) in Asia.

Objective  To describe physicians’ attitudes toward withholding and withdrawal of life-sustaining treatments in end-of-life care and to evaluate factors associated with observed attitudes.

Design, Setting, and Participants  Self-administered structured and ...

Invited Commentary 
Mervyn Koh, MBBS, MRCP, FAMS; Poi Choo Hwee, MBBS, MRCP
The decision to withhold and withdraw life-sustaining treatment in an intensive care unit (ICU) remains a challenge given the presence of technological advances that make it possible to prolong life even when there is minimum chance of meaningful recovery. These decisions are often difficult to make, with strong social, legal, ...
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