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 Showing 21-40 of 88 Articles
Original Investigation 
Lona Mody, MD; Sarah L. Krein, PhD; Sanjay K. Saint, MD; Lillian C. Min, MD; Ana Montoya, MD; Bonnie Lansing, LPN; Sara E. McNamara, MPH; Kathleen Symons, BA; Jay Fisch, BS; Evonne Koo, MPH; Ruth Anne Rye, BS; Andrzej Galecki, MD, PhD; Mohammed U. Kabeto, MS; James T. Fitzgerald, PhD; Russell N. Olmsted, MPH; Carol A. Kauffman, MD; Suzanne F. Bradley, MD
Includes: Supplemental Content

Importance  Indwelling devices (eg, urinary catheters and feeding tubes) are often used in nursing homes (NHs). Inadequate care of residents with these devices contributes to high rates of multidrug-resistant organisms (MDROs) and device-related infections in NHs.

Objective  To test whether a multimodal targeted infection program (TIP) ...

Invited Commentary: Reducing Antimicrobial Resistance in Nursing Homes; Nimalie D. Stone, MD, MS
Original Investigation 
Daniel J. Niven, MD, MSc; Gordon D. Rubenfeld, MD, MSc; Andrew A. Kramer, PhD; Henry T. Stelfox, MD, PhD
Includes: Supplemental Content

Importance  Little is known about the deadoption of ineffective or harmful clinical practices. A large clinical trial (the Normoglycemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation [NICE-SUGAR] trial) demonstrated that strict blood glucose control (tight glycemic control) in patients admitted to adult intensive care ...

Invited Commentary: On the Undiffusion of Established Practices; Frank Davidoff, MD, MACP
Original Investigation 
Louise A. Beveridge, MB, ChB; Allan D. Struthers, MD; Faisel Khan, PhD; Rolf Jorde, PhD; Robert Scragg, MBBS, PhD; Helen M. Macdonald, PhD; Jessica A. Alvarez, PhD, RD; Rebecca S. Boxer, MD, MS; Andrea Dalbeni, MD; Adam D. Gepner, MD; Nicole M. Isbel, MBBS, PhD; Thomas Larsen, MD, PhD; Jitender Nagpal, MBBS, MD; William G. Petchey, BM, PhD; Hans Stricker, MD; Franziska Strobel, MD; Vin Tangpricha, MD, PhD; Laura Toxqui, PhD; M. Pilar Vaquero, PhD; Louise Wamberg, MD, PhD; Armin Zittermann, PhD; Miles D. Witham, BM, BCh, PhD; for the D-PRESSURE Collaboration
Includes: Supplemental Content

Importance  Low levels of vitamin D are associated with elevated blood pressure (BP) and future cardiovascular events. Whether vitamin D supplementation reduces BP and which patient characteristics predict a response remain unclear.

Objective  To systematically review whether supplementation with vitamin D or its analogues reduce BP....

Invited Commentary 
Nimalie D. Stone, MD, MS
The need to address transmission of multidrug-resistant organisms (MDROs) has never been more critical for nursing homes. Nursing home care is increasing in complexity as growing proportions of residents are entering homes directly from acute care hospitals. The post–acute care population experiences health care exposures such as invasive medical devices, ...
Invited Commentary 
Frank Davidoff, MD, MACP
Everett Rogers’ classic monograph on the diffusion of innovations represents the process by which we adopt new ideas and practices as a smooth S-shaped curve. In this curve, the percentage of adoption increases incrementally over time, then shoots up exponentially and begins to level off as it approaches 90%.1 The ...
Editor's Note 
Mitchell H. Katz, MD
This Editorial Note discusses the effect of health policy on aggressive treatment of illness in end-of-life care.
Special Communication 
Kim A. Eagle, MD; Prashant Vaishnava, MD; James B. Froehlich, MD

The field of perioperative medicine has garnered legitimacy during the past 3 decades. Adverse cardiovascular events in the perioperative period account for significant morbidity and mortality. Although testing patients preoperatively to detect ischemia and identify those who may benefit from modifications in care is a tempting strategy, risk ...

Invited Commentary: On the Undiffusion of Established Practices; Frank Davidoff, MD, MACP
Research Letter 
Mihaela S. Stefan, MD; Randa Jaber, MD; Peter K. Lindenauer, MD, MSc; Jane L. Garb, MS; Janet Fitzgerald, RN, MS; Michael B. Rothberg, MD, MPH
The Affordable Care Act established the Value-Based Purchasing Program, launched in 2013, which uses risk-standardized mortality rates as a benchmark to penalize or reward hospitals.1 The risk-standardized mortality rate is calculated using administrative data and includes patients with life-threatening illnesses for whom pneumonia may be the last insult in the ...
Research Letter 
Michael T. M. Wang; Greg Gamble, MSc; Andrew Grey, MD
Medical reversal—when a current practice is found to be no better than, or inferior to, a prior standard—is common1 and inconsistently translated into practice.2 Continuing use of ineffective treatments wastes resources and harms patients.3 There may be multiple reasons for persistence of reversed practices. Commercial entities may resist evidence of ...
Invited Commentary: On the Undiffusion of Established Practices; Frank Davidoff, MD, MACP
Teachable Moment 
Stephanie Chen, MD; Sammy Zakaria, MD, MPH
Ami Schattner, MD
I was going through my usual weekly early-afternoon clinic when I suddenly noticed that my manner with the patients was anything but usual.
Original Investigation 
Michael J. Orlich, MD, PhD; Pramil N. Singh, DrPH; Joan Sabaté, MD, DrPH; Jing Fan, MS; Lars Sveen; Hannelore Bennett, MS; Synnove F. Knutsen, MD, PhD; W. Lawrence Beeson, DrPH; Karen Jaceldo-Siegl, DrPH, MS; Terry L. Butler, DrPH; R. Patti Herring, PhD; Gary E. Fraser, PhD, MD

Importance  Colorectal cancers are a leading cause of cancer mortality, and their primary prevention by diet is highly desirable. The relationship of vegetarian dietary patterns to colorectal cancer risk is not well established.

Objective  To evaluate the association between vegetarian dietary patterns and incident colorectal cancers....

Original Investigation 
Elyn H. Wang, BA; Cary P. Gross, MD; Jon C. Tilburt, MD, MPH; James B. Yu, MD, MHS; Paul L. Nguyen, MD; Marc C. Smaldone, MD, MSHP; Nilay D. Shah, PhD; Robert Abouassally, MD; Maxine Sun, PhD; Simon P. Kim, MD, MPH
Includes: Supplemental Content

Importance  The current attitudes of prostate cancer specialists toward decision aids and their use in clinical practice to facilitate shared decision making are poorly understood.

Objective  To assess attitudes toward decision aids and their dissemination in clinical practice.

Design, Setting, and Participants  A survey was ...

Invited Commentary: Decision Aid Paradox; Michael J. Barry, MD
Original Investigation  FREE
Matthew J. Bair, MD, MS; Dennis Ang, MD; Jingwei Wu, MS; Samantha D. Outcalt, PhD; Christy Sargent, BS; Carol Kempf, RN; Amanda Froman, BS; Arlene A. Schmid, PhD, OTR; Teresa M. Damush, PhD; Zhangsheng Yu, PhD; Louanne W. Davis, PsyD; Kurt Kroenke, MD
Includes: Supplemental Content

Importance  Despite the prevalence and the functional, psychological, and economic impact of chronic pain, few intervention studies of treatment of chronic pain in veterans have been performed.

Objective  To determine whether a stepped-care intervention is more effective than usual care, as hypothesized, in reducing pain-related disability, ...

Invited Commentary 
Michael J. Barry, MD
For most medical treatment decisions, there is more than one reasonable choice. Although bacterial meningitis needs antibiotics, decisions about treatments for conditions such as clinically localized prostate cancer have many options, including observation, radiation therapy, and surgery. In turn, each of these broad treatment categories has variants: watchful waiting, active ...
Editor's Note 
Joseph S. Ross, MD, MHS
Musculoskeletal pain is one of the most common reasons adults visit their primary care physician, an office encounter that typically starts with a discussion of the patient’s symptoms and physical function, continues with advice from the physician to lose weight and engage in rehabilitation exercises, and concludes with a prescription, ...
Challenges in Clinical Electrocardiography 
Arjun Sinha, MD, MS; Jasmine Rassiwala, MD, MPH; Nora Goldschlager, MD
A woman in her 60s with hypertension and hyperlipidemia presented with chest pain for 3 days. She denied any cardiac history but reported intermittent substernal chest pain for the past few months that had worsened in the past week. She denied associated symptoms. Her vital signs and cardiopulmonary examination results ...
Challenges in Clinical Electrocardiography 
Zaid Aziz, MD; Peter Mikolajczak, MD; Paul J. Hauptman, MD
A man in his 90s with a history of hypertension, hypercholesterolemia, sinus node dysfunction, and prior dual-chamber pacemaker implantation presented with 1 month of abdominal pain radiating to his back. The initial chest radiograph demonstrated a dual-chamber permanent pacemaker with an atrial lead in the right atrial appendage and ventricular ...
Research Letter 
Jonathan Michael Pell, MD; Mary Mancuso, MA; Shelly Limon, BSN, MS, CNRN; Kathy Oman, RN, PhD; Chen-Tan Lin, MD
In 2001, the Institute of Medicine1 recommended improving patient engagement by providing continuous care, allowing patients to be the source of control and fostering transparency with patients and families. Electronic health records (EHRs) facilitate these objectives via the use of patient portals.2 Giving outpatients direct access to their health information ...
Paul Rousseau, MD
The attending physician was trailed by 5 trainees: 2 medical students, 1 intern, a resident, and a fellow. As they stopped at the door to the patient's room, the attending physician spoke.

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