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 Showing 1-20 of 43 Articles
Teachable Moment 
Joseph W. Howells, DO; Patricia A. Short, MD

This case report describes a patient whose medical history, clinical presentation, and other known factors should have prompted greater suspicion of false-positive serum ammonia elevation.

Original Investigation  FREE
Myreen E. Tomas, MD; Sirisha Kundrapu, MD; Priyaleela Thota, MD; Venkata C. K. Sunkesula, MD; Jennifer L. Cadnum, BS; Thriveen Sankar Chittoor Mana, MS; Annette Jencson, BS, CIC; Marguerite O’Donnell, RN; Trina F. Zabarsky, RN; Michelle T. Hecker, MD; Amy J. Ray, MD; Brigid M. Wilson, PhD; Curtis J. Donskey, MD
Includes: Supplemental Content

Importance  Contamination of the skin and clothing of health care personnel during removal of personal protective equipment (PPE) contributes to dissemination of pathogens and places personnel at risk for infection.

Objectives  To determine the frequency and sites of contamination on the skin and clothing of personnel ...

Invited Commentary: Health Care Worker Self-contamination; Michelle Doll, MD; Gonzalo M. Bearman, MD, MPH
Original Investigation 
Alan Rosenberg, MD; Abiy Agiro, PhD; Marc Gottlieb, MPA; John Barron, PharmD; Peter Brady, MBA; Ying Liu, MS; Cindy Li, MSc; Andrea DeVries, PhD
Includes: Supplemental Content

Importance  The Choosing Wisely campaign consists of more than 70 lists produced by specialty societies of medical practices or procedures of minimal clinical benefit to patients in most situations, with recommendations regarding judicious use.

Objective  To quantify the frequency and trends of some of the earliest ...

Invited Commentary: Changing Clinician Behavior When Less Is More; Ralph Gonzales, MD, MSPH; Adithya Cattamanchi, MD, MAS
Invited Commentary  FREE
Michelle Doll, MD; Gonzalo M. Bearman, MD, MPH

The vulnerability of health care workers to acquisition and propagation of infectious agents has received global attention because of recent outbreaks of highly communicable and fatal diseases, including Ebola virus disease and severe acute respiratory syndrome. The emergence of these high-profile pathogens has prompted calls for better personal ...

Invited Commentary 
Ralph Gonzales, MD, MSPH; Adithya Cattamanchi, MD, MAS

The American Board of Internal Medicine Foundation intended for the Choosing Wisely campaign to support conversations between clinicians and their patients about what care is necessary.1 The campaign sought to do so by involving professional societies in creating lists of unnecessary tests and procedures and disseminating the ...

Special Communication 
Aaron S. Kesselheim, MD, JD, MPH; Michael S. Sinha, MD, JD, MPH; Steven Joffe, MD, MPH

Although insider trading is illegal, recent high-profile cases have involved physicians and scientists who are part of corporate governance or who have access to information about clinical trials of investigational products. Insider trading occurs when a person in possession of information that might affect the share price of ...

Original Investigation 
Mads E. Jørgensen, MB; Mark A. Hlatky, MD; Lars Køber, MD, DSc; Robert D. Sanders, MD, PhD, FRCA; Christian Torp-Pedersen, MD, DSc; Gunnar H. Gislason, MD, PhD; Per Føge Jensen, MD, PhD; Charlotte Andersson, MD, PhD
Includes: Supplemental Content

Importance  Perioperative β-blocker strategies are important to reduce risks of adverse events. Effectiveness and safety may differ according to patients’ baseline risk.

Objective  To determine the risk of major adverse cardiovascular events (MACEs) associated with long-term β-blocker therapy in patients with uncomplicated hypertension undergoing noncardiac surgery....

Original Investigation 
Chien-Chang Lee, MD, ScD; Meng-tse Gabriel Lee, PhD; Yueh-Sheng Chen, MD; Shih-Hao Lee, MA; Yih-Sharng Chen, MD, PhD; Shyr-Chyr Chen, MD, MBA; Shan-Chwen Chang, MD, PhD
Includes: Supplemental Content

Importance  Fluoroquinolones have been associated with collagen degradation, raising safety concerns related to more serious collagen disorders with use of these antibiotics, including aortic aneurysm and dissection.

Objective  To examine the relationship between fluoroquinolone therapy and the risk of developing aortic aneurysm and dissection.

Design, Setting, ...

Editor's Note: Global Drug Safety Insights From Taiwan; Joseph S. Ross, MD, MHS
Editor's Note 
Joseph S. Ross, MD, MHS; Mitchell H. Katz, MD

When a patient is made to wait a long time to receive care from a physician or other health care professional, the implicit message is clear: the patient’s time is less important than the clinician’s. Although patients are understanding of waits due to professional emergencies (eg, when an ...

Editor's Note 
Joseph S. Ross, MD, MHS

The investments made by the government of Taiwan to create the Taiwan National Health Insurance Research Database continue to realize global population health benefits. The database has been used to conduct numerous studies of drug safety and efficacy, diagnostic test utility, disease progression, and risk factor prognosis, generating ...

Challenges in Clinical Electrocardiography 
Philip S. Hall, MD; Babak Nazer, MD; Randall J. Lee, MD, PhD

A woman in her 50s with a history of intravenous drug use and hepatitis C was admitted with a diagnosis of community-acquired pneumonia. Physical examination demonstrated violaceous plaques on her ears, fingertips, hands, elbows, and ankles. She reported recent injection use of cocaine, 2 days prior to admission. ...

Research Letter 
Kristin N. Ray, MD, MS; Amalavoyal V. Chari, PhD; John Engberg, PhD; Marnie Bertolet, PhD; Ateev Mehrotra, MD, MPH

This Research Letter examined data from the American Time Use Survey and found that time waiting for or obtaining medical care was significantly longer for racial/ethnic minorities, individuals with less education, and individuals who are unemployed.

Editor's Note: No Time to Wait; Joseph S. Ross, MD, MHS; Mitchell H. Katz, MD
Research Letter 
Nynne Nyboe Andersen, MD; Björn Pasternak, MD, PhD; Mikael Andersson, MSc; Nete Munk Nielsen, MD, PhD; Tine Jess, MD, DMSc

This population-based cohort study suggests a possible 2-fold increased relative risk but a low absolute risk of central demyelinating diseases associated with anti-TNF exposure in patients with irritable bowel syndrome.

Teachable Moment 
Claire K. Larson, MD; Helen Kao, MD

This Teachable Moment highlights the risk of polypharmacy in the treatment of neuropsychiatric symptoms, the complexity of prognostication in dementia, and the importance of a multifaceted approach to neuropsychiatric symptoms.

Original Investigation 
Annie LeBlanc, PhD; Jeph Herrin, PhD; Mark D. Williams, MD; Jonathan W. Inselman; Megan E. Branda, MSc; Nilay D. Shah, PhD; Emma M. Heim; Sara R. Dick, MSc; Mark Linzer, MD; Deborah H. Boehm, MPH; Kristen M. Dall-Winther, MD; Marc R. Matthews, MD; Kathleen J. Yost, PhD; Kathryn K. Shepel; Victor M. Montori, MD
Includes: Supplemental Content

Importance  For antidepressants, the translation of evidence of comparative effectiveness into practice is suboptimal. This deficit directly affects outcomes and quality of care for patients with depression. To overcome this problem, we developed the Depression Medication Choice (DMC) encounter decision aid, designed to help patients and clinicians ...

Invited Commentary: The Role of Decision Aids in Depression Care; Kurt Kroenke, MD
Original Investigation 
Kenneth E. Freedland, PhD; Robert M. Carney, PhD; Michael W. Rich, MD; Brian C. Steinmeyer, MS; Eugene H. Rubin, MD, PhD
Includes: Supplemental Content

Importance  Depression and inadequate self-care are common and interrelated problems that increase the risks of hospitalization and mortality in patients with heart failure (HF).

Objective  To determine the efficacy of an integrative cognitive behavior therapy (CBT) intervention for depression and HF self-care.

Design, Setting, and Participants...

Editor's Note: Reframing Depression Treatment in Heart Failure; Patrick G. O’Malley, MD, MPH
Original Investigation 
Constance D. Lehman, MD, PhD; Robert D. Wellman, MS; Diana S. M. Buist, PhD; Karla Kerlikowske, MD; Anna N. A. Tosteson, ScD; Diana L. Miglioretti, PhD; For the Breast Cancer Surveillance Consortium

Importance  After the US Food and Drug Administration (FDA) approved computer-aided detection (CAD) for mammography in 1998, and the Centers for Medicare and Medicaid Services (CMS) provided increased payment in 2002, CAD technology disseminated rapidly. Despite sparse evidence that CAD improves accuracy of mammographic interpretations and costs ...

Invited Commentary: Time to Stop Paying for Computer-Aided Mammography; Joshua J. Fenton, MD, MPH
Invited Commentary 
Kurt Kroenke, MD

Clarion calls about enhancing detection and management of depression in primary care have reiterated several truisms: Depression is as prevalent as many common medical disorders, treatable yet frequently undertreated, responsible for enormous occupational and social impairment as well as adverse effects on the costs, treatment outcomes, and mortality ...

Invited Commentary 
Joshua J. Fenton, MD, MPH

Computer-aided detection (CAD) is a technology designed to address the problem of screening mammography’s imperfect sensitivity. Now used on over 90% of US mammograms, CAD essentially acts like an automated second reader by marking potentially suspicious spots for radiologists to review before making final recommendations. Early studies suggested ...

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