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 Showing 1-20 of 73 Articles
Viewpoint 
James N. Kirkpatrick, MD; Paul J. Hauptman, MD; Sarah J. Goodlin, MD
Modern cardiovascular therapies offer unprecedented opportunities to improve survival and quality of life. Cardiovascular morbidity and mortality have significantly declined, owing in a large part to preventive therapies and technological advances such as coronary revascularization, implantable cardioverter defibrillators (ICDs), and ventricular assist devices (VADs). Newer therapies like transcatheter aortic valve ...
Original Investigation 
Jason F. Okulicz, MD; Tuan D. Le, MD, DrPH; Brian K. Agan, MD; Jose F. Camargo, MD; Michael L. Landrum, MD; Edwina Wright, MD; Matthew J. Dolan, MD; Anuradha Ganesan, MD; Tomas M. Ferguson, MD; Davey M. Smith, MD; Douglas D. Richman, MD; Susan J. Little, MD; Robert A. Clark, MD; Weijing He, MD; Sunil K. Ahuja, MD
Includes: Supplemental Content

Importance  In individuals with human immunodeficiency virus 1 (HIV-1) infection who are receiving antiretroviral therapy (ART), factors that promote full immune recovery are not well characterized.

Objective  To investigate the influence of the timing of ART relative to HIV-1 infection on normalization of CD4+ T-cell ...

Original Investigation 
Prachi Sanghavi, BS; Anupam B. Jena, MD, PhD; Joseph P. Newhouse, PhD; Alan M. Zaslavsky, PhD
Includes: Supplemental Content

Importance  Most out-of-hospital cardiac arrests receiving emergency medical services in the United States are treated by ambulance service providers trained in advanced life support (ALS), but supporting evidence for the use of ALS over basic life support (BLS) is limited.

Objective  To compare the effects of ...

Original Investigation 
Danny R. Hughes, PhD; Miao Jiang, PhD; Richard Duszak Jr, MD
Includes: Supplemental Content

Importance  Little is known about the use of diagnostic testing, such as medical imaging, by advanced practice clinicians (APCs), specifically, nurse practitioners and physician assistants.

Objective  To examine the use of diagnostic imaging ordered by APCs relative to that of primary care physicians (PCPs) following office-based ...

Original Investigation 
James Krieger, MD, MPH; Lin Song, PhD; Miriam Philby, MA
Includes: Supplemental Content

Importance  Asthma is often poorly controlled. Home visitation by community health workers (CHWs) to improve control among adults has not been adequately evaluated.

Objective  To test the hypothesis that CHW home visits for adults with uncontrolled asthma improve outcomes relative to usual care.

Design, Setting, and ...

Invited Commentary 
Timothy W. Schacker, MD
Two critically important issues in human immunodeficiency virus (HIV) therapeutics are when to start antiretroviral therapy and how well these medications restore immunity. In this issue of JAMA Internal Medicine, Okulicz et al1 describe a prospective cohort study of 1119 US military service persons with known seroconversion dates who were ...
Invited Commentary 
Harrison J. Alter, MD, MS
“The medical care system in the United States is being restructured, with the goal of containing rising health care expenditures. Cost-containment strategies…have as their major purpose restraining the use of high-cost medical services. Yet little attention has been paid to how patients’ health and level of functioning in everyday activities ...
A man clutches his chest and collapses on the sidewalk. Call 911. Surely we want the most advanced life support (ALS) available—paramedics capable of intubating, administering intravenous medications, and managing complex arrhythmias, as well as transport to the hospital. Or do we?
Editor's Note 
Mitchell H. Katz, MD
Increased demand for primary care has resulted in the increased use of advanced practice clinicians (nurse practitioners and physician assistants) to supplement the physician workforce. It is natural to ask how the care delivered by these advanced practice clinicians differs from the care provided by physicians.
Challenges in Clinical Electrocardiography 
Rahman Shah, MD; A. Gregory Deam, MD
A man in his late 40s presented to the emergency department with recurrent palpitation and dizziness. He denied having any chest pain or any history of smoking, drug abuse, or alcohol use. His father had died suddenly in his late 30s. While undergoing the workup in the emergency department, he ...
Research Letter 
Kristin M. Corapi, MD, MMSc; Gearoid M. McMahon, MBBCh; Julia B. Wenger, MPH; Julian L. Seifter, MD; Ishir Bhan, MD, MPH
Elevations in parathyroid hormone (PTH) level have been associated with adverse clinical outcomes, including cardiovascular disease and mortality.1,2 Loop diuretics have been linked to increased PTH levels in patients with chronic kidney disease (CKD),3,4 but this association has not been investigated in the general population. We used data from the ...
Viewpoint  FREE
Lisa Aliferis, BA
This Viewpoint reports crowdsourced health care prices in California.
Perspective 
Charlie Wray, DO
Original Investigation 
R. Scott Miller, MD; Lindell K. Weaver, MD; Nazanin Bahraini, PhD; Susan Churchill, APRN-NP; Robert C. Price, MD; Virginia Skiba, MD; James Caviness, MD; Scott Mooney, PhD; Brian Hetzell, MS; Jun Liu, PhD; Kayla Deru, BA; Richard Ricciardi, PhD; Susan Fracisco, MD; Nicole C. Close, PhD; Gerald W. Surrett, MD; Corinna Bartos, MD; Margaret Ryan, MD; Lisa A. Brenner, PhD; for the HOPPS Trial Team
Includes: Supplemental Content

Importance  Improvement has been anecdotally observed in patients with persistent postconcussion symptoms (PCS) after mild traumatic brain injury following treatment with hyperbaric oxygen (HBO). The effectiveness of HBO as an adjunctive treatment for PCS is unknown to date.

Objectives  To compare the safety of and to ...

Original Investigation 
Anil N. Makam, MD, MAS; Oanh K. Nguyen, MD, MAS

Importance  Cardiac biomarker testing is not routinely indicated in the emergency department (ED) because of low utility and potential downstream harms from false-positive results. However, current rates of testing are unknown.

Objective  To determine the use of cardiac biomarker testing overall, as well as stratified by ...

Original Investigation 
Meera Viswanathan, PhD; Leila C. Kahwati, MD, MPH; Carol E. Golin, MD; Susan J. Blalock, MPH, PhD; Emmanuel Coker-Schwimmer, MPH; Rachael Posey, MSLS; Kathleen N. Lohr, PhD, MPhil, MA
Includes: Supplemental Content

Importance  Medication therapy management (MTM) services (also called clinical pharmacy services) aim to reduce medication-related problems and their downstream outcomes.

Objective  To assess the effect of MTM interventions among outpatients with chronic illnesses.

Data Sources  MEDLINE, Cochrane Library, and International Pharmaceutical Abstracts through January ...

Invited Commentary 
Charles W. Hoge, MD; Wayne B. Jonas, MD
During the past decade, unprecedented clinical and research resources have been directed toward addressing 2 conditions considered “silent” and “signature injuries” of the Iraq and Afghanistan wars, namely, posttraumatic stress disorder (PTSD) and concussion (mild traumatic brain injury). This investment is increasingly paying dividends in knowledge and interventions that are ...
Editor's Note 
Rita F. Redberg, MD, MSc
The assumption that market principles apply to the choices consumers (that is, patients) make about their medical care is an important part of health care policy and regulations in the United States. This assumption, however, belies the facts that health care is mostly not paid for out of pocket, that ...
Research Letter 
Michael D. Miedema, MD, MPH; Faye L. Lopez, MS, MPH; Michael J. Blaha, MD, MPH; Salim S. Virani, MD, PhD; Josef Coresh, MD, PhD; Christie M. Ballantyne, MD; Aaron R. Folsom, MD, MPH
The 2013 guidelines of the American College of Cardiology and American Heart Association (ACC/AHA) for treatment of cholesterol levels recommend statin therapy for individuals at an elevated absolute risk for cardiovascular disease (CVD).1 This risk-based approach is a paradigm shift from prior Adult Treatment Panel (ATP) III guidelines2 that were ...
This Viewpoint describe the case of the commercial withdrawal of tositumomab as a cautionary tale of the weaknesses in our current drug-approval system.

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