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 Showing 41-49 of 49 Articles
Research Letter 
Eve A. Kerr, MD, MPH; Jersey Chen, MD; Jeremy B. Sussman, MD, MS; Mandi L. Klamerus, MPH; Brahmajee K. Nallamothu, MD, MPH
The Choosing Wisely (CW) campaign, which commenced in 2011, focuses on reducing medical services that are of questionable value or may be harmful.1 In 1996 and 2002, guidelines from the American College of Cardiology and the American Heart Association implied that routine stress testing before low-risk surgeries should be avoided; ...
Research Letter 
Bo Wang, PharmD; Jun Liu, MPH; Aaron S. Kesselheim, MD, JD, MPH
In the United States, effective market exclusivity for a prescription drug is the time between US Food and Drug Administration (FDA) approval and the availability of the first generic version. Market exclusivity incorporates the minimum regulatory exclusivity periods granted to all FDA-approved drugs (eg, 5 years for new small-molecule drugs ...
Invited Commentary: Market Exclusivity for Top-Selling Pharmaceuticals; Nicholas S. Downing, MD
Say Salomon, MD; James Fausto, MD
We met an elderly patient who had a history of hypertension and diabetes. He was admitted with complaints of dizziness and a “feeling of slow heart beat” for the past 2 weeks. He also had 1 episode of a presyncopal event and an electrocardiogram indicating third-degree atrioventricular block. This seemed ...
Original Investigation 
John J. You, MD, MSc; James Downar, MDCM, MHSc; Robert A. Fowler, MDCM, MS, Epi; François Lamontagne, MD, MSc; Irene W. Y. Ma, MD, MSc; Dev Jayaraman, MD, MPH; Jennifer Kryworuchko, RN, PhD; Patricia H. Strachan, RN, PhD; Roy Ilan, MD, MSc; Aman P. Nijjar, MD, MPH; John Neary, MD; John Shik, MD, MSc; Kevin Brazil, PhD; Amen Patel, MB; Kim Wiebe, MD, MPH; Martin Albert, MD; Anita Palepu, MD, MPH; Elysée Nouvet, PhD; Amanda Roze des Ordons, MD, MMEd; Nishan Sharma, MSc, EdD; Amane Abdul-Razzak, MD, MSc; Xuran Jiang, MSc; Andrew Day, MSc; Daren K. Heyland, MD, MSc; for the Canadian Researchers at the End of Life Network (CARENET)
Includes: Supplemental Content

Importance  Seriously ill hospitalized patients have identified communication and decision making about goals of care as high priorities for quality improvement in end-of-life care. Interventions to improve care are more likely to succeed if tailored to existing barriers.

Objective  To determine, from the perspective of hospital-based ...

Invited Commentary: Goals of Care Discussion; James N. Kirkpatrick, MD
Original Investigation 
S. Ryan Greysen, MD, MHS, MA; Irena Stijacic Cenzer, MA; Andrew D. Auerbach, MD, MPH; Kenneth E. Covinsky, MD, MPH

Importance  Medicare currently penalizes hospitals for high readmission rates for seniors but does not account for common age-related syndromes, such as functional impairment.

Objective  To assess the effects of functional impairment on Medicare hospital readmissions given the high prevalence of functional impairments in community-dwelling seniors.

Design, ...

Invited Commentary: Functional Status and Hospital Readmissions; Laura G. Burke, MD, MPH; Ashish K. Jha, MD, MPH
Original Investigation 
Tammy T. Hshieh, MD; Jirong Yue, MD; Esther Oh, MD; Margaret Puelle; Sarah Dowal, MSW, MPH; Thomas Travison, PhD; Sharon K. Inouye, MD, MPH
Includes: Supplemental Content

Importance  Delirium, an acute disorder with high morbidity and mortality, is often preventable through multicomponent nonpharmacological strategies. The efficacy of these strategies for preventing subsequent adverse outcomes has been limited to small studies to date.

Objective  To evaluate available evidence on multicomponent nonpharmacological delirium interventions in ...

Invited Commentary: Delirium and the “Know-Do” Gap in Elder Acute Care; S. Ryan Greysen, MD, MHS, MA
Invited Commentary 
James N. Kirkpatrick, MD
Mechanical ventilation. Internal cardioverter defibrillators. Hemodialysis. Extracorporeal membrane oxygenation. Cardiopulmonary resuscitation. Percutaneous gastrostomy feeding tubes. Multidrug chemotherapy. Dying used to be less complicated when unaccompanied by decisions about high-tech interventions. We forestall mortality but at the cost of increasing end-of-life complexity. Clinicians help patients manage this complexity with open communication ...
Invited Commentary 
Laura G. Burke, MD, MPH; Ashish K. Jha, MD, MPH
In this issue, a study by Greysen et al1 provides new insight into the consequences of functional impairment for Medicare beneficiaries after a hospital admission. Linking data from the Health and Retirement Study (a nationally representative cohort of seniors living in communities) and Medicare claims, the authors find that as ...
Invited Commentary 
S. Ryan Greysen, MD, MHS, MA
Approximately 40% of all adult hospital admissions and 50% of all costs for acute care are attributed to patients 65 years and older.1 Unfortunately, complications from hospitalization are fairly common for this population. Delirium is a powerful case in point: as many as 50% of older adults will experience an ...

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