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 Showing 1-20 of 68 Articles
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, ...
Invited Commentary 
Yael Schenker, MD, MAS; Alex John London, PhD
Conducting a Google search for a disease is how many people get information about their illness and possible treatments. In a national survey sponsored by the Pew Research Center, 72% of adult Internet users reported looking online for health information in the past 12 months and 43% reported searching for ...
Research Letter 
Lisa-Ann Fraser, MD, MSc; Kuan Liu, MMath; Kyla L. Naylor, MES; Y. Joseph Hwang, MSc; Stephanie N. Dixon, PhD; Salimah Z. Shariff, PhD; Amit X. Garg, MD, PhD
Antipsychotic medications are commonly used in elderly persons to treat dementia and other behavioral disturbances.1 Several articles have linked these medications to an increased risk of fracture.2,3 It is unclear whether this fracture risk is limited to older conventional antipsychotic medications or if the risk extends to newer atypical antipsychotics4 ...
Research Letter 
Shun Yu, MD; Gopi K. Nayak, MD; Jeffrey M. Levsky, MD, PhD; Linda B. Haramati, MD, MS
A substantial proportion of computed tomographic pulmonary angiography (CTPA) results are degraded by patient-related and technical factors, yielding a limited negative interpretation, which qualifies the definitive exclusion of pulmonary embolism. This leads to diagnostic uncertainty and may affect patient management. A multicenter randomized clinical trial of CTPA vs ventilation-perfusion scintigraphy ...
Research Letter 
Mariah L. Kincaid, BS; Lee A. Fleisher, MD; Mark D. Neuman, MD, MSc
Adequate presentation of risks and benefits of medical therapies is essential to informed decision making by patients.1 Transcatheter aortic valve replacement (TAVR) has been recently approved by the US Food and Drug Administration for the treatment of severe aortic stenosis among carefully selected patients; recent randomized clinical trials have identified ...
Katherine Baicker, PhD; Helen Levy, PhD
The second open-enrollment period for coverage through the Health Insurance Marketplace extends from November 15, 2014, to February 15, 2015; millions of people in the United States are once again choosing from a menu of plans. Although federal law dictates some aspects of the plans, shopping for coverage—even on health ...
Jonathan Liu, MD
“The ear has pain, very pain. And pus, lots of pus,” the patient’s daughter said with a grimace, as if she were tasting the cloudy, bacteria-laden fluid while she described it. She recounted, as best as she could, the recent plight of her mother, who was seated on the examination ...
Sandra Zimmerman, RN
My husband had been experiencing tremor in his hands for approximately 2 years. He is 69 years old, had worked for many years for a telecommunications company, and is now retired. The tremors come and go unexpectedly. One night they flared up when he was carving a ham. Sometimes he ...
Original Investigation  FREE
Teresa M. Waters, PhD; Michael J. Daniels, ScD; Gloria J. Bazzoli, PhD; Eli Perencevich, MD; Nancy Dunton, PhD; Vincent S. Staggs, PhD; Catima Potter, MPH; Naleef Fareed, PhD; Minzhao Liu, MS, PhD; Ronald I. Shorr, MD, MS

Importance  In 2008, Medicare implemented the Hospital-Acquired Conditions (HACs) Initiative, a policy denying incremental payment for 8 complications of hospital care, also known as never events. The regulation’s effect on these events has not been well studied.

Objective  To measure the association between Medicare’s nonpayment ...

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