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  • 2017 Update on Medical Overuse: A Systematic Review

    Abstract Full Text
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    JAMA Intern Med. 2017; doi: 10.1001/jamainternmed.2017.4361

    This review identifies and highlights original research articles published in 2016 that are most relevant to understanding medical overuse or strategies to reduce it.

  • JAMA Internal Medicine August 1, 2017

    Figure: Trends in Care by Nurse Practitioners (NPs) and Physician Assistants (PAs) to Specialist Physician Patients, 2001-2013

    A, Unadjusted trends from 2001 to 2013 in visits with NPs and PAs as a percentage of all outpatient visits to medical and surgical specialist physicians.B, The same trends as a percentage of all “new” and “return” patient visits, respectively. C, The same trends by reason for visit. The P value for linear growth by bivariate survey-weighted logistic regression is .001 or less for all subcategories except the “preventive” visit reason, where P = .01. Error bars indicate 95% CIs incorporating survey weights and clustering from the multistage sampling design of National Ambulatory Medical Care Survey (NAMCS).
  • The Value of Using Registries to Evaluate Randomized Clinical Trial Study Populations

    Abstract Full Text
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    JAMA Intern Med. 2017; 177(6):889-889. doi: 10.1001/jamainternmed.2017.0761
  • Perioperative Statin Use in Noncardiac Surgery: Who and When?

    Abstract Full Text
    JAMA Intern Med. 2017; 177(2):242-243. doi: 10.1001/jamainternmed.2016.8037
  • JAMA Internal Medicine January 1, 2017

    Figure 4: Patient Age Distributions at Time of Surgery

    Patient age is stratified by valve series. The boxes represent quartiles; whiskers represent most extreme data points which are no more than 1.5 times the interquartile range from the box. For the purpose of this study, Vascutek series also includes Koehler Medical and AorTech valves.
  • JAMA Internal Medicine December 1, 2016

    Figure 3: Abdominal Aortic Aneurysm (AAA)–Related Events in Men Aged 64 to 83 Years With Aortic Diameters Smaller Than 30 mm at Baseline

    There were no cases of surgery with survival for ruptured AAAs.
  • JAMA Internal Medicine November 1, 2016

    Figure 2: Mean DOT per 1000 Patient-days by US Census Division Between January 1, 2006, and December 31, 2012

    Across all hospitals, the mean DOT per 1000 patient-days by census division were estimated by generalized estimating equation models controlling for year, case mix index, average patient age, bed size category, teaching status, urban or rural facility location, proportion of surgical discharges, average comorbidity score, facility geographic location, critical care setting, and proportion of inpatient-days in which the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code was related to an infection. DOT indicates days of therapy.
  • JAMA Internal Medicine November 1, 2016

    Figure 1: Mean DOT per 1000 Patient-days for All Antibiotics

    Across all hospitals, the change in mean DOT per 1000 patient-days were estimated by generalized estimating equation models controlling for case mix index, average patient age, bed size category, teaching status, urban or rural facility location, proportion of surgical discharges, average comorbidity score, facility geographic location, critical care setting, and proportion of inpatient-days in which the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code was related to an infection. Data points represent mean DOT per 1000 patient-days for each antibiotic class, and the whiskers represent 95% CIs. DOT indicates days of therapy.
  • JAMA Internal Medicine November 1, 2016

    Figure 2: Odds of Reintubation and Mortality Associated With Overnight Extubation for Propensity-Matched Pairs Stratified by Patient Subgroup

    Tests for interaction between overnight extubation and subgroups depicted for each outcome were assessed using the primary propensity-matched cohorts (all patients with mechanical ventilation [MV] duration <12 h and, separately, all patients with MV duration ≥12 h). No significant interaction (P < .05) was found between overnight extubation and any subgroup examined for any outcome. A, The full cohort included 4518 of 4522 patients undergoing overnight extubations (99.9%); 1796 of 1800 patients with medical admission undergoing overnight extubations (99.8%); 1429 of 1645 patients undergoing elective surgery and overnight extubations (86.9%); 1064 of 1077 patients undergoing emergent surgery and overnight extubations (98.8%); 256 of 263 patients in the medical ICU undergoing overnight extubations (97.3%); 1971 of 1990 patients in the surgical intensive care unit (ICU) undergoing overnight extubations (99.0%); 2189 of 2191 patients in the medical-surgical ICU undergoing overnight extubations (99.0%); 1807 of 1843 patients with an intensivist on-site undergoing overnight extubations (98.0%); and 2526 of 2532 patients without an intensivist on-site undergoing overnight extubations (99.8%). B, The full cohort included 5761 of 5763 patients undergoing overnight extubations (99.9%); 3482 of 3485 patients with medical admissions undergoing overnight extubations (99.9%); 907 of 910 patients undergoing elective surgery and overnight extubations (99.7%); 1365 of 1368 patients undergoing emergent surgery and overnight extubations (99.8%); 573 of 573 patients in the medical ICU undergoing overnight extubations (100%); 1883 of 1883 patients in the surgical ICU undergoing overnight extubations (100%); 3116 of 3118 patients in the medical-surgical ICU undergoing overnight extubations (99.9%); 2316 of 2318 patients with an intensivist on-site undergoing overnight extubations (99.9%); and 3125 of 3125 patients without an intensivist on-site undergoing overnight extubations (100%). OR indicates odds ratio.
  • JAMA Internal Medicine September 1, 2016

    Figure 1: Incidence of Chronic Opioid Use Among Opioid-Naive Surgical and Nonsurgical Patients

    Illustrated is the incidence of chronic opioid use within 1 year after surgery for surgical patients and the annual incidence of chronic opioid use among nonsurgical patients. Error bars indicate 95% CIs, which were calculated using robust standard errors.
  • JAMA Internal Medicine September 1, 2016

    Figure 2: Risk of Chronic Opioid Use Following Surgery

    Illustrated are the adjusted odds ratios for chronic opioid use within 1 year after surgery for each study surgical procedure. Error bars indicate 95% CIs, which were calculated using robust standard errors. Our regression model included controls for age, sex, year of surgery, and overall health care utilization. In addition, the model also included controls for preoperative use of benzodiazepines, antidepressants, and antipsychotics, and controls for the medical comorbidities listed in Table 1.
  • Characteristics of Patients Undergoing Cardiac Catheterization Before Noncardiac Surgery: A Report From the National Cardiovascular Data Registry CathPCI Registry

    Abstract Full Text
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    JAMA Intern Med. 2016; 176(5):611-618. doi: 10.1001/jamainternmed.2016.0259

    This study describes the characteristics, angiographic findings, and treatment patterns of patients with stable angina symptoms undergoing cardiac catheterization and/or percutaneous coronary intervention before noncardiac surgery in a large national registry.

  • JAMA Internal Medicine March 1, 2016

    Figure 1: Telemetry Strip From Surgery Center

  • JAMA Internal Medicine February 1, 2016

    Figure: Trends in Use of Mesh in Pelvic Organ Prolapse Repair Surgery Between 2011 and 2013 in New York State

    Percentages (with 95% CIs) of procedures using mesh for repair of pelvic organ prolapse repair and by hospital procedure volume and teaching status.
  • Surgical Intervention in Terminal Illness—Doing Everything: A Teachable Moment

    Abstract Full Text
    JAMA Intern Med. 2016; 176(1):18-19. doi: 10.1001/jamainternmed.2015.6335

    This Teachable Moment describes the case of a man with metastatic masses in his brain who underwent surgery and died shortly thereafter and calls for more careful consideration of treatment options.

  • JAMA Internal Medicine January 1, 2016

    Figure: Change in Proportions of Patients Discharged to Postacute Care Facilities

    Patients are grouped by surgical procedure. Q indicates quarter.
  • JAMA Internal Medicine December 1, 2015

    Figure 3: β-Blocker–Associated Risks by Subgroup, Numbers Need to Harm (NNH), and Test for Interaction

    Risks of 30-day major adverse cardiovascular events were estimated. Patients not treated with β-blockers served as reference in all analyses. Analyses should not be directly compared between subgroups because the reference group differed. The NNH was adjusted for sex, age, body mass index, calendar year, surgery risk, comorbidities, and pharmacotherapy. The effects associated with β-blocker use were comparable when stratifying by subgroup where P for interaction >.05. Stratification by date is based on a change in Danish guidelines for antihypertensive treatments (see Methods section). Alcohol consumption and smoking had missing values (see Methods section). OR indicates odds ratio.
  • Hospital Acquisition of Physician Groups: On the Road to Value-Based or Higher-Priced Care?

    Abstract Full Text
    JAMA Intern Med. 2015; 175(12):1939-1941. doi: 10.1001/jamainternmed.2015.6183
  • Update on Medical Practices That Should Be Questioned in 2015

    Abstract Full Text
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    JAMA Intern Med. 2015; 175(12):1960-1964. doi: 10.1001/jamainternmed.2015.5614

    This Special Communication identifies and highlights articles published in 2014 that are most likely to influence medical overuse, organized into the categories of overdiagnosis, overtreatment, and methods to avoid overuse.

  • β-Blocker–Associated Risks in Patients With Uncomplicated Hypertension Undergoing Noncardiac Surgery

    Abstract Full Text
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    JAMA Intern Med. 2015; 175(12):1923-1931. doi: 10.1001/jamainternmed.2015.5346

    This study of a Danish natonwide cohort of patients with uncomplicated hypertension reports that antihypertensive treatment with a β-blocker may be associated with increased risks of perioperative major adverse cardiovascular events and all-cause mortality.