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 Showing 1-20 of 73 Articles
Challenges in Clinical Electrocardiography 
Lindee Strizich Tull, MD, MS; Zachary D. Goldberger, MD, MS
A man in his 30s with a medical history of remote pulmonary embolus (PE) and antiphosholipid antibody (APLA) syndrome presented to the emergency department with progressive dyspnea on exertion of 3 months’ duration. He also reported subacute, occasional, dull, substernal and right-sided exertional chest pain and a 10-pound unintentional weight ...
Invited Commentary 
Alex D. Federman, MD, MPH; Theresa Soriano, MD, MPH
A 75-year-old man lives alone and struggles to manage his heart failure, diabetes mellitus, hyperlipidemia, and chronic arthritis. He is prescribed 12 medications, including some he must take or inject 3 times a day. He cannot walk more than 30 feet without discomfort and rarely leaves home. Undertreated depression compounds ...
Invited Commentary 
Jeremiah D. Schuur, MD, MHS
Despite devoting immense resources to emergency preparedness since the September 11, 2001, terrorist attacks, many US emergency departments (EDs) remain crowded, with patients in the waiting room awaiting a complete physician evaluation and acutely ill “boarding”—being held in the ED for a bed to open up on the hospital wards. ...
Invited Commentary 
David M. Safley, MD; Adnan K. Chhatriwalla, MD
The pathophysiologic mechanisms of renovascular hypertension are well described: Hemodynamically significant renal artery stenosis results in reduced renal perfusion pressure, which in turn leads to activation of the renin-angiotensin system and increased levels of angiotensin II, resulting in systemic vasoconstriction, aldosterone release, sodium retention, and expansion of extracellular fluid volume ...
Topics: geese; kidney
The relationship between increasing emergency department (ED) crowding and worse outcomes for patients has been well documented.1,2 This evidence has created growing recognition among federal policy makers that the quality of emergency care should be measured. In July 2013, the Centers for Medicare & Medicaid Services3 made several quality measures ...
Research Letter 
Emily Carrier, MD, MSCI; Joneigh Khaldun, MD, MPH; Renee Y. Hsia, MD, MSc
In the United States, quality measures have recently been developed to evaluate emergency department (ED) length of stay (LOS). As of 2012, hospitals are expected to report their median ED LOS to the Centers for Medicare and Medicaid Services, which reports these data to the public on their Hospital Compare ...
Research Letter 
Anthony A. Bavry, MD, MPH; Samir R. Kapadia, MD; Deepak L. Bhatt, MD, MPH; Dharam J. Kumbhani, MD, SM, MRCP
Arguments for renal artery revascularization include blood pressure control, stabilization of renal function, and reduction in adverse cardiovascular events. We previously reported on the randomized clinical trial data to 2009 regarding renal artery revascularization compared with medical therapy.1 That report concluded that renal artery revascularization was associated with marginal improvement ...
Research Letter 
Michael B. Rothberg, MD, MPH; Joshua Class, BS; Tara F. Bishop, MD, MPH; Jennifer Friderici, MS; Reva Kleppel, MPH, MSW; Peter K. Lindenauer, MD, MSc
The overuse of tests and procedures because of fear of malpractice litigation, known as defensive medicine,1 is estimated to cost $46 billion annually in the United States,2 but these costs have been measured only indirectly. We estimated the cost of defensive medicine on 3 hospital medicine services in a health ...
Original Investigation 
Dongyi (Tony) Du, MD, PhD; Stephen McKean, PhD; Jeffrey A. Kelman, MD; John Laschinger, MD; Chris Johnson, MS; Rob Warnock, BA; Chris M. Worrall, BS; Art Sedrakyan, MD, PhD; William Encinosa, PhD; Thomas E. MaCurdy, PhD; Hector S. Izurieta, MD, MPH
Includes: Supplemental Content

Importance  Early mortality for patients who undergo aortic valve replacement (AVR) may differ between mechanical and biological prosthetic (hereinafter referred to as bioprosthetic) valves. Clinical trials may have difficulty addressing this issue owing to limited sample sizes and low mortality rates.

Objective  To compare early mortality ...

Original Investigation 
Samuel T. Edwards, MD; Julia C. Prentice, PhD; Steven R. Simon, MD, MPH; Steven D. Pizer, PhD
Includes: Supplemental Content

Importance  Primary care services based at home have the potential to reduce the likelihood of hospitalization among older adults with multiple chronic diseases.

Objective  To characterize the association between enrollment in Home-Based Primary Care (HBPC), a national home care program operated by the US Department of ...

Original Investigation 
Gijs W. D. Landman, MD, PhD; Kornelis J. J. van Hateren, MD, PhD; Peter R. van Dijk, MD, PhD; Susan J. J. Logtenberg, MD, PhD; Sebastiaan T. Houweling, MD, PhD; Klaas H. Groenier, PhD; Henk J. G. Bilo, MD, PhD, FRCP; Nanne Kleefstra, MD, PhD
Includes: Supplemental Content

Importance  Device-guided breathing (DGB) is recommended by the American Heart Association for its blood pressure–lowering effects. Most previous studies that showed beneficial effects on blood pressure had low methodological quality and only investigated short-term blood pressure effects.

Objective  To assess the efficacy of DGB on blood ...

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 
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

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