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 Showing 1-20 of 71 Articles
Perspective 
Erik Rifkin, PhD; Andy Lazris, MD, CMD

As an environmental scientist and expert on evaluating risk, I’ve become something of a therapeutic nihilist. I rarely see my physician (Andy Lazris, MD, my coauthor, encouraged me to share and helped write my story)—and want no screening tests when I do. But when I had a heart ...

Teachable Moment 
Patrick D. Tyler, MD; Marc R. Larochelle, MD, MPH; John N. Mafi, MD, MPH

This Teachable Moment discusses the how the Centers for Disease Control and Prevention guidelines for opioid prescribing can play a major role in limiting the impact of this epidemic.

Original Investigation 
Michael Klompas, MD, MPH; Lingling Li, PhD; Ken Kleinman, ScD; Paul M. Szumita, PharmD; Anthony F. Massaro, MD
Includes: Supplemental Content

Importance  Ventilator bundles, including head-of-bed elevation, sedative infusion interruptions, spontaneous breathing trials, thromboprophylaxis, stress ulcer prophylaxis, and oral care with chlorhexidine gluconate, are ubiquitous, but the absolute and relative value of each bundle component is unclear.

Objective  To evaluate associations between individual and collective ventilator bundle ...

Invited Commentary: Care Bundles; Andrew Auerbach, MD, MPH; Peter Lindenauer, MD, MSc
Original Investigation  FREE
Sara G. Rasmussen, MHS; Elizabeth L. Ogburn, PhD; Meredith McCormack, MD; Joan A. Casey, PhD; Karen Bandeen-Roche, PhD; Dione G. Mercer, BS; Brian S. Schwartz, MD, MS
Includes: Supplemental Content

Importance  Asthma is common and can be exacerbated by air pollution and stress. Unconventional natural gas development (UNGD) has community and environmental impacts. In Pennsylvania, UNGD began in 2005, and by 2012, 6253 wells had been drilled. There are no prior studies of UNGD and objective respiratory ...

Original Investigation 
Frank Bloos, MD, PhD; Evelyn Trips, MSc; Axel Nierhaus, MD, EIDEC; Josef Briegel, MD; Daren K. Heyland, MD; Ulrich Jaschinski, MD; Onnen Moerer, MD; Andreas Weyland, MD; Gernot Marx, MD; Matthias Gründling, MD; Stefan Kluge, MD; Ines Kaufmann, MD; Klaus Ott, MD; Michael Quintel, MD; Florian Jelschen, MD; Patrick Meybohm, MD; Sibylle Rademacher, MD; Andreas Meier-Hellmann, MD; Stefan Utzolino, MD; Udo X. Kaisers, MD; Christian Putensen, MD; Gunnar Elke, MD; Maximilian Ragaller, MD; Herwig Gerlach, MD, PhD, MBA; Katrin Ludewig, MD; Michael Kiehntopf, MD; Holger Bogatsch, MD; Christoph Engel, MD; Frank M. Brunkhorst, MD; Markus Loeffler, MD; Konrad Reinhart, MD; for SepNet Critical Care Trials Group
Includes: Supplemental Content

Importance  High-dose intravenous administration of sodium selenite has been proposed to improve outcome in sepsis by attenuating oxidative stress. Procalcitonin-guided antimicrobial therapy may hasten the diagnosis of sepsis, but effect on outcome is unclear.

Objective  To determine whether high-dose intravenous sodium selenite treatment and procalcitonin-guided anti-infectious ...

Invited Commentary 
Andrew Auerbach, MD, MPH; Peter Lindenauer, MD, MSc

The concept of a bundle as a way to implement multiple best practices together to support quality improvement and better patient outcomes has great appeal.1,2 However, little is known about how bundles work and whether the individual components or the group are most important to ...

Challenges in Clinical Electrocardiography 
Joshua R. Shak, MD, PhD; Amanda K. Johnson, MD, MBA; Nora Goldschlager, MD

A man in his 20s presented to the emergency department with 1 day of chest pressure. He reported no medical history. Four days prior to presentation he had experienced subjective fevers, rhinorrhea, a dry cough, and sinus congestion. The day prior to presentation he had experienced 3 hours ...

Research Letter 
Ravi Gupta, BS, BA; Aaron S. Kesselheim, MD, JD, MPH; Nicholas Downing, MD; Jeremy Greene, MD, PhD; Joseph S. Ross, MD, MHS

This study uses US Food and Drug Administration data to identify approved generic drugs manufactured between September 30, 1984, and January 11, 2016 and compares the effects of number of generic drugs associated with brand-name drugs.

Research Letter 
Alan B. Zonderman, PhD; Nicolle A. Mode, MS; Ngozi Ejiogu, MD; Michele K. Evans, MD

This study uses data from the Healthy Aging in Neighborhoods of Diversity across the Life Span study to examine the contributions of sex, race, and socioeconomic differences to overall mortality in middle-aged adults.

Viewpoint 
Lydia A. Flier, MD; Christopher R. Henderson, MD, MPhil; Carolyn L. Treasure, MD

This Invited Commentary examines arguments in favor of discontinuing the Step 2 Clinical Skills Examination.

Perspective 
Neil Skolnik, MD

I am leaving a room where I had a discussion with a son and daughter who strongly desired that their 94-year-old mother with severe dementia, chronic obstructive pulmonary disease, a history of heart disease with triple-bypass surgery, and 2 repaired hip fractures continue her statin and all her ...

Teachable Moment 
Ploa Desforges, MD; Todd C. Lee, MD, MPH; Emily G. McDonald, MD, MSc

This Teachable Moment discusses nonpharmacologic interventions prior to prescribing quetiapine, benzodiazepines, or sedative hypnotic drugs for the short-term treatment of insomnia in older adult patients.

Editorial 
Lisa M. Schwartz, MD, MS; Steven Woloshin, MD, MS
Includes: Supplemental Content

Cancer centers advertise to reach patients and their families in a very competitive market. Patients often have dangerous cancers and face toxic treatments and the advertisements offer hope. But the hope can—and often does—morph into hype. After all, this is advertising. Medicine has long been ambivalent about advertising ...

Original Investigation 
Anupam B. Jena, MD, PhD; Andrew R. Olenski, BS; Daniel M. Blumenthal, MD, MBA
Includes: Supplemental Content

Importance  Limited evidence exists on salary differences between male and female academic physicians, largely owing to difficulty obtaining data on salary and factors influencing salary. Existing studies have been limited by reliance on survey-based approaches to measuring sex differences in earnings, lack of contemporary data, small sample ...

Invited Commentary: Equal Pay for Equal Work for Physicians; Vineet M. Arora, MD, MAPP
Original Investigation 
Eric C. Sun, MD, PhD; Beth Darnall, PhD; Laurence C. Baker, PhD; Sean Mackey, MD, PhD
Includes: Supplemental Content

Importance  Chronic opioid use imposes a substantial burden in terms of morbidity and economic costs. Whether opioid-naive patients undergoing surgery are at increased risk for chronic opioid use is unknown, as are the potential risk factors for chronic opioid use following surgery.

Objective  To characterize the ...

Original Investigation 
Michaël Chassé, MD, PhD, FRCPC; Alan Tinmouth, MD, MSc, FRCPC; Shane W. English, MD, MSc, FRCPC; Jason P. Acker, MBA, PhD; Kumanan Wilson, MD, FRCPC; Greg Knoll, MD, MSc, FRCPC; Nadine Shehata, MD, MSc, FRCPC; Carl van Walraven, MD, MSc, FRCPC; Alan J. Forster, MD, MSc, FRCPC; Timothy Ramsay, PhD; Lauralyn A. McIntyre, MD, MSc, FRCPC; Dean A. Fergusson, MHA, PhD
Includes: Supplemental Content

Importance  While red blood cells (RBCs) are administered to improve oxygen delivery and patient outcomes, they also have been associated with potential harm. Unlike solid organ transplantation, the clinical consequences of donor characteristics on recipients have not been evaluated in transfusion medicine.

Objective  To analyze the ...

Invited Commentary: Blood Donor Demographics and Transfusion Recipient Survival; Harvey G. Klein, MD
Invited Commentary 
Vineet M. Arora, MD, MAPP
Invited Commentary 
Harvey G. Klein, MD

Blood for transfusion is a drug or, more specifically, a biological medicine.1 The US Food and Drug Administration regulates blood for purity, potency, and safety under the Food, Drug, and Cosmetic Act of 1938. Regulatory authorities in most developed countries prescribe blood collection, storage, testing, labeling, and ...

Review 
Joshua R. Lakin, MD; Susan D. Block, MD; J. Andrew Billings, MD; Luca A. Koritsanszky, MPH; Rebecca Cunningham, MD; Lisa Wichmann, RN, MS, ACM, NC-BC; Doreen Harvey, BSN, RN, CCM, NC-BC; Jan Lamey, MS; Rachelle E. Bernacki, MD, MS
Includes: Supplemental Content

Importance  The Institute of Medicine recently called for systematic improvements in clinician-led conversations about goals, values, and care preferences for patients with serious and life-threatening illnesses. Studies suggest that these conversations are associated with improved outcomes for patients and their families, enhanced clinician satisfaction, and lower health ...

Challenges in Clinical Electrocardiography 
Matthew Jackson, MBChB; Muhammad Muzaffar Mahmood, MBBS, MRCP

A woman in her 70s presented with sudden-onset central chest pain. She was known to have hypertension, which was well controlled with amlodipine maleate therapy. She sought medical help within 2 hours of the onset of pain and an electrocardiogram (ECG) was performed (Figure 1). No ...

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