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  • Appropriate Use of Imaging for Acute Abdominal Pain

    Abstract Full Text
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    JAMA Intern Med. 2017; doi: 10.1001/jamainternmed.2017.6135

    The case described in this Teachable Moment demonstrates that clinicians should consider the costs and downsides of additional imaging when acute abdominal pain is deemed nonurgent by clinical assessment.

  • Clinician-Level Predictors for Ordering Low-Value Imaging

    Abstract Full Text
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    JAMA Intern Med. 2017; 177(11):1577-1585. doi: 10.1001/jamainternmed.2017.4888

    This study identified characteristics that made clinicians more likely to order low-value imaging tests for patients with low-back pain and headache.

  • Nil per Os Orders for Imaging: A Teachable Moment

    Abstract Full Text
    JAMA Intern Med. 2017; 177(11):1670-1671. doi: 10.1001/jamainternmed.2017.3943

    This Teachable Moment highlights how the use of nil per os orders can lead to complications.

  • JAMA Internal Medicine October 16, 2017

    Figure: Imaging Results of Retrievable IVCF and Associated Depris

    A, Inferior vena cava filter (IVCF) fragments lodged in the pulmonary vasculature (white arrowheads); blue arrowhead indicates the filter fragment that could not be removed. B, The retrievable IVCF with missing struts before removal. C, Arrowhead indicates IVCF fragment lodged in the right atrial musculature.
  • JAMA Internal Medicine October 2, 2017

    Figure 2: Forest Plot for Myocardial Infarction

    Risk ratios (RRs) were determined by the Mantel-Haenszel method with a random-effects model. Square data markers represent RRs; horizontal lines, the 95% CIs with marker size reflecting the statistical weight of the study using random-effects meta-analysis. A diamond data marker represents the overall RR and 95% CI for the outcome of interest. ACRIN/PA indicates American College of Radiology Imaging Network/Pennsylvania Department of Health; CAPP, Cardiac CT for the Assessment of Pain and Plaque; CATCH, Cardiac CT in the Treatment of Acute Chest pain; CCTA, coronary computed tomography angiography; CT-COMPARE, CT Coronary Angiography Compared to Exercise ECG; CT-STAT, Coronary Computed Tomographic Angiography for Systematic Triage of Acute Chest Pain Patient to Treatment; PERFECT, Prospective First Evaluation in Chest Pain; PROMISE, Prospective Multicenter Imaging Study for Evaluation of Chest Pain; PROSPECT, Prospective Randomized Outcome Trial Comparing Radionuclide Stress Myocardial Perfusion Imaging and ECG-Gated Coronary CT Angiography; ROMICAT-II, Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography–II; and SCOT-HEART, Scottish Computed Tomography of the Heart Trial.
  • JAMA Internal Medicine October 2, 2017

    Figure 3: Forest Plot for Revascularization

    Risk ratios (RRs) were determined by the Mantel-Haenszel method with a random-effects model. Square data markers represent RRs; horizontal lines, the 95% CIs with marker size reflecting the statistical weight of the study using random-effects meta-analysis. A diamond data marker represents the overall RR and 95% CI for the outcome of interest. ACRIN/PA indicates American College of Radiology Imaging Network/Pennsylvania Department of Health; CAPP, Cardiac CT for the Assessment of Pain and Plaque; CATCH, Cardiac CT in the Treatment of Acute Chest pain; CCTA, coronary computed tomography angiography; CT-COMPARE, CT Coronary Angiography Compared to Exercise ECG; CT-STAT, Coronary Computed Tomographic Angiography for Systematic Triage of Acute Chest Pain Patient to Treatment; PERFECT, Prospective First Evaluation in Chest Pain; PROMISE, Prospective Multicenter Imaging Study for Evaluation of Chest Pain; PROSPECT, Prospective Randomized Outcome Trial Comparing Radionuclide Stress Myocardial Perfusion Imaging and ECG-Gated Coronary CT Angiography; ROMICAT-II, Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography–II; and SCOT-HEART, Scottish Computed Tomography of the Heart Trial.
  • Unnecessary Staging Imaging in Early-Stage Breast Cancer: A Teachable Moment

    Abstract Full Text
    JAMA Intern Med. 2017; 177(10):1516-1517. doi: 10.1001/jamainternmed.2017.2785

    This Teachable Moment uses the details of a case report to evaluate the risks and benefits of staging imaging in early-stage breast cancer.

  • Quality of Cancer Surveillance Clinical Practice Guidelines: Specificity and Consistency of Recommendations

    Abstract Full Text
    JAMA Intern Med. 2017; 177(5):701-709. doi: 10.1001/jamainternmed.2017.0079

    This retrospective cross-sectional analysis examines the specificity and consistency of recommendations for surveillance after active treatment across cancer guidelines.

  • Clinicians’ Expectations of the Benefits and Harms of Treatments, Screening, and Tests: A Systematic Review

    Abstract Full Text
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    JAMA Intern Med. 2017; 177(3):407-419. doi: 10.1001/jamainternmed.2016.8254

    This systematic review describes the findings of studies evaluating clinicians’ estimations of the benefits and harms associated with testing and treatment.

  • Clinicians’ Perceptions of Barriers to Avoiding Inappropriate Imaging for Low Back Pain—Knowing Is Not Enough

    Abstract Full Text
    JAMA Intern Med. 2016; 176(12):1866-1868. doi: 10.1001/jamainternmed.2016.6364

    This study uses survey data to examine why clinicians still order low-value imaging for nonspecific low back pain contrary to the Choosing Wisely campaign recommendations against it.

  • The Quality of Outpatient Care Delivered to Adults in the United States, 2002 to 2013

    Abstract Full Text
    JAMA Intern Med. 2016; 176(12):1778-1790. doi: 10.1001/jamainternmed.2016.6217

    This cross-sectional survey study measures changes in outpatient quality and patient experience in the United States from 2002 to 2013 to determine whether efforts to improve outpatient quality have been successful.

  • JAMA Internal Medicine December 1, 2016

    Figure: Trends in Care and Patient Experience, 2002 to 2013

    A, Recommended clinical care composites. Comparison of 2002 and 2013: recommended cancer screening (P < .01), recommended diagnostic and preventive testing (P = .05), recommended diabetes care (P = .21), recommended counseling (P < .01), and recommended medical treatment (P < .01). B, Avoidance of inappropriate clinical care composites. Comparison of 2002 and 2013: inappropriate medical treatment avoidance (P < .01), inappropriate imaging avoidance (P = .64), inappropriate cancer screening avoidance (P = .02), and inappropriate antibiotic avoidance (P < .01). C, Patient experience measures were dichotomized as follows: response of 4 on a Likert scale of 1 to 4 (physician communication and access) or responses of 8, 9, or 10 on a Likert scale of 0 to 10 (global care) were counted as positive. Comparison of 2002 and 2013: global care (P < .01), physician communication (P < .01), and access (P < .01). Error bars indicate 95% CIs. See the eFigure in the Supplement for linear representation on a 0 to 10 scale.
  • 2016 Update on Medical Overuse: A Systematic Review

    Abstract Full Text
    JAMA Intern Med. 2016; 176(11):1687-1692. doi: 10.1001/jamainternmed.2016.5381

    This structured review identifies and highlights the 10 original research articles most likely to reduce overuse of medical care.

  • Physician-Driven Variation in Nonrecommended Services Among Older Adults Diagnosed With Cancer

    Abstract Full Text
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    JAMA Intern Med. 2016; 176(10):1541-1548. doi: 10.1001/jamainternmed.2016.4426

    This study uses Medicare data to characterize physician ordering of low-value breast cancer services including imaging for staging low-risk disease and IMRT after breast-conservation surgery.

  • Physician Practice Style Variation—Implications for Policy

    Abstract Full Text
    JAMA Intern Med. 2016; 176(10):1549-1550. doi: 10.1001/jamainternmed.2016.4433
  • Cancer Screening After Unprovoked Venous Thromboembolism: A Teachable Moment

    Abstract Full Text
    JAMA Intern Med. 2016; 176(6):739-740. doi: 10.1001/jamainternmed.2016.1783

    This Teachable Moment discusses how aggressive physicians should be in screening for an occult cancer in patients with unprovoked venous thromboembolism.

  • Common Reasons That Asymptomatic Patients Who Are 65 Years and Older Receive Carotid Imaging

    Abstract Full Text
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    JAMA Intern Med. 2016; 176(5):626-633. doi: 10.1001/jamainternmed.2016.0678

    This study examines why asymptomatic patients who are 65 years and older and undergo revascularization receive initial carotid imaging.

  • Osteoporosis Overtreatment in a Regional Health Care System

    Abstract Full Text
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    JAMA Intern Med. 2016; 176(3):391-393. doi: 10.1001/jamainternmed.2015.6020

    This cohort study estimates the incidence of osteoporosis overtreatment of women in a health system where DXA reports include T scores for anatomic sites that guidelines recommend against using as a basis for treatment.

  • Variability in DXA Reporting and Other Challenges in Osteoporosis Evaluation

    Abstract Full Text
    JAMA Intern Med. 2016; 176(3):393-395. doi: 10.1001/jamainternmed.2015.7550
  • Promoting Patient-Centered Counseling to Reduce Use of Low-Value Diagnostic Tests: A Randomized Clinical Trial

    Abstract Full Text
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    JAMA Intern Med. 2016; 176(2):191-197. doi: 10.1001/jamainternmed.2015.6840

    This randomized clinical trial evaluates the effectiveness of a standardized patient–based intervention designed to enhance primary care physician patient-centeredness and skill in handling patient requests for low-value diagnostic tests.