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Basic View | Expanded View
 Showing 21-40 of 75 Articles
Invited Commentary 
Michael Bell, MD
Antibiotics are an essential medical resource. The ability to treat infections not only saves lives but provides a safety net for medical advances that now seem routine: trauma surgery, cancer chemotherapy, and stem cell and organ transplantation—each inherently reliant on effective antibiotics in order to deliver their life-saving potential. Antibiotic ...
Invited Commentary 
Lara Goitein, MD
Is there too much focus on measuring and reporting quality rather than on the conditions needed for improving it? The Centers for Medicare & Medicaid Services (CMS) and other organizations require physicians and hospitals to publicly report performance on quality measures, and the CMS and private payers are tying reimbursement ...
Invited Commentary 
Jonathan S. Lee, MD; Michael J. Fine, MD, MSc
Although our understanding of pneumonia dates back thousands of years to when symptoms were recognized by Hippocrates, the first typical bacterial pathogen responsible for causing community-acquired pneumonia (CAP), Streptococcus pneumoniae, was not isolated until the late 19th century. Another half a century passed before 3 atypical bacteria were discovered as ...
Research Letter 
Jeffrey A. Linder, MD, MPH; Jason N. Doctor, PhD; Mark W. Friedberg, MD, MPP; Harry Reyes Nieva, BA; Caroline Birks, MD; Daniella Meeker, PhD; Craig R. Fox, PhD
Clinicians make many patient care decisions each day. The cumulative cognitive demand of these decisions may erode clinicians’ abilities to resist making potentially inappropriate choices. Psychologists, who refer to the erosion of self-control after making repeated decisions as decision fatigue,1,2 have found evidence that it affects nonmedical professionals. For example, ...
Original Investigation 
Nicolas Garin, MD; Daniel Genné, MD; Sebastian Carballo, MD, DPhil; Christian Chuard, MD; Gerhardt Eich, MD; Olivier Hugli, MD, MPH; Olivier Lamy, MD; Mathieu Nendaz, MD, MHPE; Pierre-Auguste Petignat, MD; Thomas Perneger, MD, PhD; Olivier Rutschmann, MD, MPH; Laurent Seravalli, MD; Stephan Harbarth, MD, MS; Arnaud Perrier, MD
Includes: Supplemental Content

Importance  The clinical benefit of adding a macrolide to a β-lactam for empirical treatment of moderately severe community-acquired pneumonia remains controversial.

Objective  To test noninferiority of a β-lactam alone compared with a β-lactam and macrolide combination in moderately severe community-acquired pneumonia.

Design, Setting, and Participants  ...

Original Investigation 
Peter K. Lindenauer, MD, MSc; Tara Lagu, MD, MPH; Joseph S. Ross, MD, MHS; Penelope S. Pekow, PhD; Amy Shatz, MPH; Nicholas Hannon, BS; Michael B. Rothberg, MD, MPH; Evan M. Benjamin, MD
Includes: Supplemental Content

Importance  Public reporting of quality is considered a key strategy for stimulating improvement efforts at US hospitals; however, little is known about the attitudes of hospital leaders toward existing quality measures.

Objectives  To describe US hospital leaders’ attitudes toward hospital quality measures found on the Centers ...

Original Investigation 
Jin Wang, MD; Pan Wang, BPharm; Xinghe Wang, PhD; Yingdong Zheng, PhD; Yonghong Xiao, MD, PhD
Includes: Supplemental Content

Importance  Appropriate antibiotic use is a key strategy to control antibacterial resistance. The first step in achieving this is to identify the major problems in antibiotic prescription in health care facilities, especially in primary health care settings, which is where most patients receive medical care.

Objective  ...

Original Investigation 
Nancy R. Cook, ScD; Paul M Ridker, MD
Includes: Supplemental Content

Importance  While the pooled cohort equations from the recent American College of Cardiology/American Heart Association (ACC/AHA) Guideline on the Assessment of Cardiovascular Risk have overestimated cardiovascular risk in multiple external cohorts, the reasons for the discrepancy are unclear.

Objective  To determine whether increased use of statins ...

Katherine T. Hamilton, MD; Benjamin J. Lee, MD
Editor's Note 
Mitchell H. Katz, MD
Despite the emphasis on delivering patient-centered medicine, patients are rarely asked directly what they want or think. That is why I liked this study by Howard-Anderson et al.1 In the context of major national policy initiatives and hospital quality initiatives focused on preventing readmission, the authors asked patients who were ...
Invited Commentary 
Elisabeth M. Dietrich, MPH; Joshua M. Sharfstein, MD
The past 5 years have ushered in major, much-needed changes in the oversight of medical devices in the United States. Although several efforts remain works in progress, the US Food and Drug Administration (FDA) is taking important steps to improve premarket device review and postmarket device surveillance.
Research Letter 
Muhammad Rizwan Sardar, MD; Marwan Badri, MBChB, MRCP; Catherine T. Prince, DO, PhD, MPH; Jonathan Seltzer, MD, MBA, MA; Peter R. Kowey, MD
The American College of Cardiology/American Heart Association (ACC/AHA) guidelines are frequently used to guide cardiovascular care. Randomized controlled trials (RCTs) are considered to be the highest level of evidence and are cited in these guidelines whenever available. However, RCTs can have limited external validity. To examine their generalizability, we examined ...
Research Letter 
Jessica Howard-Anderson, MD; Sarah Lonowski, MBA; Sitaram Vangala, MS; Chi-hong Tseng, PhD; Ashley Busuttil, MD; Nasim Afsar-manesh, MD
The patient perspective on readmissions is lacking in the literature despite evidence that improved patient satisfaction is associated with decreased 30-day readmission rates1 and that patient-centered communication may improve health outcomes and reduce expenditures.2,3 In the emerging era of patient engagement in which patients increasingly desire to participate in their ...
Original Investigation 
Diana Zuckerman, PhD; Paul Brown, BS; Aditi Das, PhD
Includes: Supplemental Content

Importance  Under the 510(k) process, the US Food and Drug Administration (FDA) clears about 400 implanted medical devices that are considered moderate to high risk for market each year without requiring clinical testing. Instead, the FDA requires the applicant to provide scientific evidence that the new device ...

Original Investigation 
Ian S. Reynolds, MPH; Joshua P. Rising, MD; Allan J. Coukell, BScPharm; Kirsten H. Paulson, MS; Rita F. Redberg, MD, MSc
Includes: Supplemental Content

Importance  Postmarketing surveillance is critical to evaluating the safety and effectiveness of medical devices. The US Food and Drug Administration (FDA) may order the manufacturer of a high-risk device to conduct postmarketing surveillance studies, known as postapproval studies (PASs), at the time of approval.

Objectives  To ...

Original Investigation 
Samir Bipin Pancholy, MD; Ghanshyam Palamaner Subash Shantha, MD, MPH; Toralben Patel, MD, MPH; Lawrence J. Cheskin, MD
Includes: Supplemental Content

Importance  Although outcomes in patients with ST-segment elevation myocardial infarction (STEMI) have improved in the past 2 decades, a sex disparity exists in survival, with women having higher mortality than men.

Objective  To conduct a meta-analysis of observational studies that examined differences in mortality by sex ...

Special Communication 
Allan S. Brett, MD; Joshua D. Levine, MD

Carotid ultrasonography is performed frequently to identify carotid stenosis in patients with no history of carotid-territory cerebrovascular ischemia. The premises of such testing are that the potential benefit of endarterectomy or stenting exceeds the potential harm in patients with asymptomatic stenosis and that discovery of asymptomatic stenosis may ...

This Viewpoint describes the Food and Drug Administration’s unique device identification system for medical devices and recommends that federal agencies, specialty societies, and health care organizations collaborate to ensure that the system’s potential is fulfilled.
Patricia J. Zettler, JD; Henry T. Greely, JD
State “right-to-try” laws that purport to allow patients to be treated with unapproved drugs or devices seem likely to be futile.
Invited Commentary 
Amy E. Doran, MD; Neeral L. Shah, MD
Hepatic encephalopathy is a well-known neuropsychiatric complication of cirrhosis with symptoms ranging from mild confusion and sleep disturbance to obtundation. It is highly associated with increased mortality and health care costs.1 As the population of patients with cirrhosis grows, so do these burdens on the health care system. Lactulose treatment ...

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