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 Showing 21-40 of 62 Articles
Editor's Note 
Rita F. Redberg, MD, MSc
Dabigatran was approved by the Food and Drug Administration (FDA) in 2010 via the accelerated pathway after a 6-month review. The haste to approve novel drugs places an increasing importance on postapproval data to help better understand risks and benefits. Thus, the postapproval data on the use of dabigatran in ...
Special Communication 
Daniel J. Morgan, MD, MS; Scott M. Wright, MD; Sanket Dhruva, MD
Includes: Supplemental Content

Importance  Overuse of medical care, consisting primarily of overdiagnosis and overtreatment, is a common clinical problem.

Objective  To identify and highlight the most significant clinical articles published in 2013 related to medical overuse.

Evidence Review  A systematic review of English-language articles published in 2013 that ...

Research Letter 
Christina Nelson, MD, MPH; Sarah Elmendorf, MD; Paul Mead, MD, MPH
Clinical features of Lyme disease include erythema migrans rash, facial palsy, arthritis, and peripheral neuropathy. In endemic areas, patients with erythema migrans can be diagnosed clinically. Otherwise, diagnosis is based on the history of possible exposure, compatible clinical features, and positive 2-tier serologic testing.1
They say that the most dangerous kind of ignorance is not knowing what you don’t know. It took me a long time to realize I had statin-related cognitive impairment because I had no idea what it was.
Original Investigation 
Seth A. Berkowitz, MD, MPH; Alexis A. Krumme, MS; Jerry Avorn, MD; Troyen Brennan, MD, MPH, JD; Olga S. Matlin, PhD; Claire M. Spettell, PhD; Edmund J. Pezalla, MD, MPH; Gregory Brill, MS; William H. Shrank, MD, MSHS; Niteesh K. Choudhry, MD, PhD
Includes: Supplemental Content

Importance  Although many classes of oral glucose-lowering medications have been approved for use, little comparative effectiveness evidence exists to guide initial selection of therapy for diabetes mellitus.

Objective  To determine the effect of initial oral glucose-lowering agent class on subsequent need for treatment intensification and 4 ...

Original Investigation 
Judith I. Tsui, MD, MPH; Jennifer L. Evans, MS; Paula J. Lum, MD, MPH; Judith A. Hahn, PhD; Kimberly Page, PhD, MPH

Importance  Injection drug use is the primary mode of transmission for hepatitis C virus (HCV) infection. Prior studies suggest opioid agonist therapy may reduce the incidence of HCV infection among injection drug users; however, little is known about the effects of this therapy in younger users.


Original Investigation 
Peter K. Lindenauer, MD, MSc; Mihaela S. Stefan, MD; Meng-Shiou Shieh, PhD; Penelope S. Pekow, PhD; Michael B. Rothberg, MD, MPH; Nicholas S. Hill, MD
Includes: Supplemental Content

Importance  Small clinical trials have shown that noninvasive ventilation (NIV) is efficacious in reducing the need for intubation and improving short-term survival among patients with severe exacerbations of chronic obstructive pulmonary disease (COPD). Little is known, however, about the effectiveness of NIV in routine clinical practice.


Invited Commentary 
Jodi B. Segal, MD, MPH; Nisa M. Maruthur, MD, MHS
Berkowitz and colleagues1 assert that there is little comparative effectiveness evidence to guide initial selection of therapy for diabetes mellitus. They therefore conducted this rigorous study to determine effects attributable to initial oral glucose-lowering agents. With a retrospective cohort design using 4 years of recent claims data from a large ...
Challenges in Clinical Electrocardiography 
P. Elliott Miller, MD; Eric L. Scholten, MD; Chintan S. Desai, MD; Ryan J. Tedford, MD
A woman in her 70s presented to our hospital with progressive shortness of breath, fatigue, and lower extremity edema. Her history included nonischemic cardiomyopathy with a left ventricular ejection fraction of 25%, New York Heart Association functional class IIIb to IV heart failure, cardiac resynchronization therapy for a left bundle ...
Research Letter 
Joshua J. Fenton, MD, MPH; Christoph I. Lee, MD, MSHS; Guibo Xing, PhD; Laura-Mae Baldwin, MD, MPH; Joann G. Elmore, MD, MPH
Since 2001, Medicare has reimbursed computer-aided detection (CAD) during screening mammography. The CAD software tool is used by radiologists to identify lesions suggestive of malignant disease. Research suggests that CAD use increases the rate of false-positive findings of screening mammography and the detection of ductal carcinoma in situ (DCIS).1 Increased ...
Research Letter 
Michael A. Yokell, ScB; M. Kit Delgado, MD, MS; Nickolas D. Zaller, PhD; N. Ewen Wang, MD; Samuel K. McGowan, AB; Traci Craig Green, PhD, MSc
Opioid overdose is a leading cause of injury-related mortality in the United States.1,2 However, little is known nationally regarding the characteristics of opioid overdose presentations to emergency departments (EDs).
Jason H. Maley, MD; Erin C. Kiskis, BA
Original Investigation 
Thomas J. Moore, AB; Joseph Glenmullen, MD; Donald R. Mattison, MD, MS

Importance  Severe impulse control disorders involving pathological gambling, hypersexuality, and compulsive shopping have been reported in association with the use of dopamine receptor agonist drugs in case series and retrospective patient surveys. These agents are used to treat Parkinson disease, restless leg syndrome, and hyperprolactinemia.

Objectives  ...

Original Investigation 
David A. Fiellin, MD; Richard S. Schottenfeld, MD; Christopher J. Cutter, PhD; Brent A. Moore, PhD; Declan T. Barry, PhD; Patrick G. O’Connor, MD, MPH

Importance  Prescription opioid dependence is increasing and creates a significant public health burden, but primary care physicians lack evidence-based guidelines to decide between tapering doses followed by discontinuation of buprenorphine hydrochloride and naloxone hydrochloride therapy (hereinafter referred to as buprenorphine therapy) or ongoing maintenance therapy.

Objective  ...

Invited Commentary 
Katherine Baicker, PhD; Meredith Rosenthal, PhD
In an era in which the term patient-centered is ubiquitous in health care, the payment and delivery systems remain stubbornly anything but. Although many proposed reforms aim to align the financial incentives faced by all of the people and institutions in the health care system with the delivery of high-value ...
Invited Commentary 
Joshua J. Gagne, PharmD, ScD
Apophenia is the perception of meaningful patterns and causal connections among random data. Are case reports of severe impulsive behaviors associated with the use of dopamine receptor agonist drugs examples of apophenia or of a causal connection between the drugs and impulse control disorders?
Invited Commentary 
Howard D. Weiss, MD; Gregory M. Pontone, MD
The discovery of striatal dopamine deficiency and the introduction of levodopa in the 1960s as treatment for the motor symptoms of Parkinson disease revolutionized neurology and neurotherapeutics. For the first time, patients with an apparently hopeless chronic degenerative brain disorder were able to regain function and return to the mainstream ...
Special Communication 
Rachelle E. Bernacki, MD, MS; Susan D. Block, MD; for the American College of Physicians High Value Care Task Force
Includes: Supplemental Content

An understanding of patients’ care goals in the context of a serious illness is an essential element of high-quality care, allowing clinicians to align the care provided with what is most important to the patient. Early discussions about goals of care are associated with better quality of life, ...

Special Communication 
Harald Schmidt, PhD; Ezekiel J. Emanuel, MD, PhD

Current approaches to controlling health care costs have strengths and weaknesses. We propose an alternative, “inclusive shared savings,” that aims to lower medical costs through savings that are shared by physicians and patients. Inclusive shared savings may be particularly attractive in situations in which treatments, such as those ...

Research Letter 
Alexis A. Krumme, MS; Niteesh K. Choudhry, MD, PhD; William H. Shrank, MD, MSHS; Troyen A. Brennan, MD, JD, MPH; Olga S. Matlin, PhD; Gregory Brill, MS; Joshua J. Gagne, PharmD, ScD
Cigarette smoking can make managing chronic diseases more difficult. For instance, in patients with certain respiratory conditions, smoking increases the risk of acute exacerbation, can worsen disease control, and may limit the effectiveness of inhaled corticosteroids.1 Similarly, by raising blood pressure, smoking can make it challenging to effectively control hypertension ...

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