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 Showing 41-60 of 66 Articles
As a physician, I had always assumed that patients were the ones who pressured physicians for an unnecessary antibiotic prescription. I found out that this is not necessarily the case when I recently became ill while attending, ironically enough, an infectious disease conference on antibiotic-resistant bacteria sponsored by the US ...
Kenneth W. Hung, MD; Judith Blaine, MD, PhD; Sarah Faubel, MD
A man in his 60s with lymphoproliferative B-cell disorder, hypertension, and stage 3 chronic kidney disease (CKD) secondary to diabetic nephropathy presented for follow-up of his diabetic nephropathy.
Research Letter 
Krystina B. Lewis, RN, MN, CCN(C); Pablo B. Nery, MD; David H. Birnie, MBChB, MD
There are increasing numbers of patients who are faced with implantable cardioverter-defibrillator (ICD) generators that are low in voltage and require replacement to remain functional. This is an ideal time to reevaluate health care goals and explore personal preferences regarding continuing ICD therapy. We aim herein to assess patient awareness ...
Research Letter 
James W. Smithy, BS; Nicholas S. Downing, AB; Joseph S. Ross, MD, MHS
Pivotal efficacy trials, which are trials that form the basis of the US Food and Drug Administration’s (FDA) decision to approve a novel therapeutic agent,1 have great relevance to clinical practice because when these therapies are first approved for use, few clinical trials have been conducted. However, studies focused on ...
Research Letter 
Nicole R. Fowler, PhD, MHSA; Kim G. Johnson, MD; Jie Li, MS; Charity G. Moore, PhD; Samir Saba, MD; Oscar L. Lopez, MD; Amber E. Barnato, MD, MPH, MS
Older adults with mild cognitive impairment (MCI) and dementia have cardiac comorbidities, making them eligible for device-based therapy for cardiac rhythm abnormalities.1- 3 The risks and benefits of device implantation should be weighed carefully by patients with cognitive impairment, family members, and clinicians given the potential of these devices to ...
Research Letter 
Jonathan M. Wortham, MD; Daniel J. Shapiro, BA; Adam L. Hersh, MD, PhD; Lauri A. Hicks, DO
Community-acquired pneumonia (CAP) is commonly managed in ambulatory settings, yet little is known about trends in ambulatory visit rates or antibiotic prescribing for CAP in adults in the United States. The Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS)1 published guidelines for CAP management in 2007. ...
Original Investigation 
Joseph S. Ross, MD, MHS; Sharon G. Frazee, PhD, MPH; Susan B. Garavaglia, PhD, MBA; Rebecca Levin, MPH; Haik Novshadian, BS; Cynthia A. Jackevicius, PharmD, MSc; Glen Stettin, MD; Harlan M. Krumholz, MD, SM
Includes: Supplemental Content

Importance  Results from the Ezetimibe and Simvastatin in Hypercholesterolemia Enhances Atherosclerosis Regression (ENHANCE) trial, announced in January 2008, demonstrated that ezetimibe use lowered cholesterol levels but did not slow the progression of atherosclerosis.

Objective  To examine the association of this announcement with national patterns of ezetimibe ...

Topics: ezetimibe
Paul B. Bascom, MD
Of the many stories of my mother’s death, this one is the easiest to tell. “My mother had a good death. My mother died shortly after her beloved primary care physician, with tears in his eyes, removed the CPAP machine that kept her alive just long enough for us to ...
Lisa M. Letourneau, MD, MPH
I knew I should have asked. My 82-year-old, “I’m fine” mother had struggled with a worsening upper respiratory tract infection and cough for 5 days. My sister and I finally convinced her to leave her home an hour north of us to spend a few days under our watchful eyes. ...
In the 1920s, when George Papanicolaou began to develop the screening test that now bears his name, the cause of cervical cancer was not known, and the cancer was a common cause of death among women. Since Papanicolaou testing entered clinical practice in the 1950s, however, cervical cancer incidence and ...
Invited Commentary 
Michelle M. Mello, JD, PhD, MPhil; I. Glenn Cohen, JD
In this issue of JAMA Internal Medicine, Kernan et al1 chronicle Yale University’s experience responding to a subpoena for data from an ongoing, double-blind, placebo-controlled trial of pioglitazone. The subpoena arose from litigation brought by Sara J. Kincaid,2 who believed she had been injured by pioglitazone but who was not ...
Original Investigation 
Megan K. Devlin, MD; Natalie K. Kozij, MD; Alex Kiss, PhD; Lisa Richardson, MA, MD; Brian M. Wong, MD
Includes: Supplemental Content

Importance  Handover is the process of transferring pertinent patient information and clinical responsibility between health care practitioners. Few studies have examined morning handover from the overnight trainee to the daytime team.

Objective  To characterize current morning handover practices in 2 academic medical centers by assessing the ...

Original Investigation 
Riyaz Bashir, MD; Chad J. Zack, MD; Huaqing Zhao, PhD; Anthony J. Comerota, MD; Alfred A. Bove, MD
Includes: Supplemental Content

Importance  The role of catheter-directed thrombolysis (CDT) in the treatment of acute proximal deep vein thrombosis (DVT) is controversial, and the nationwide safety outcomes are unknown.

Objectives  The primary objective was to compare in-hospital outcomes of CDT plus anticoagulation with those of anticoagulation alone. The secondary ...

Mitchell H. Katz, MD
As an internal medicine resident in the 1980s, I essentially lived in the hospital. On ward months, we were on an every-third-night rotation such that we woke up and went to sleep at home only 1 of every 3 days. On our on-call day we admitted patients all day and ...
Special Communication 
Walter N. Kernan, MD; Catherine M. Viscoli, PhD; Mathew C. Varughese, JD

Researchers conducting randomized clinical trials may find themselves subject to legal subpoenas for interim data. When a subpoena demands premature disclosure of unblinded data, there is potential for damage to the scientific integrity and reputation of the on-going trial. We describe herein general issues raised by subpoenas for ...

Paul R. Massey, MD; Jeffrey H. Anderson, MD
Inpatient clinical clerkships in the third year of medical school are the touchstones of traditional medical education in the United States and have remained so since they were originally suggested by Abraham Flexner in 1910.1 Historically, the third year is when a physician is forged from a student and when ...
In the late 1970s, investigators learned that androgen-deprivation therapy (ADT) decreased serum testosterone levels and, more importantly, reduced bone pain among men with prostate cancer. Whereas ADT demonstrated benefit in patients with metastatic disease and as an adjunct to radiation therapy in patients with locally advanced disease, its use at ...
Original Investigation 
Karen E. Hoffman, MD, MHSc, MPH; Jiangong Niu, PhD; Yu Shen, PhD; Jing Jiang, PhD; John W. Davis, MD; Jeri Kim, MD; Deborah A. Kuban, MD; George H. Perkins, MD; Jay B. Shah, MD; Grace L. Smith, MD, PhD, MPH; Robert J. Volk, PhD; Thomas A. Buchholz, MD; Sharon H. Giordano, MD, MPH; Benjamin D. Smith, MD
Includes: Supplemental Content

Importance  Up-front treatment of older men with low-risk prostate cancer can cause morbidity without clear survival benefit; however, most such patients receive treatment instead of observation. The impact of physicians on the management approach is uncertain.

Objective  To determine the impact of physicians on the management ...

Original Investigation 
Grace L. Lu-Yao, MPH, PhD; Peter C. Albertsen, MD; Dirk F. Moore, PhD; Weichung Shih, PhD; Yong Lin, PhD; Robert S. DiPaola, MD; Siu-Long Yao, MD
Includes: Supplemental Content

Importance  One in 6 American men will be diagnosed as having prostate cancer during their lifetime. Although there are no data to support the use of primary androgen-deprivation therapy (ADT) for early-stage prostate cancer, primary ADT has been widely used for localized prostate cancer, especially among older ...

Brendan R. Jackson, MD, MPH
It was midway through internal medicine residency when a fellow resident turned to me and said, “I’m done with this medical torture.” I knew exactly how he felt. We had been working furiously to care for very sick, elderly patients in the intensive care unit, performing invasive procedures, carefully selecting ...
Topics: grandmother

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