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Basic View | Expanded View
 Showing 21-40 of 89 Articles
Invited Commentary 
James A. Tulsky, MD

Shared decision making is often challenging and never entirely rational.1 Even seemingly simple decisions, such as taking antibiotics for an upper respiratory tract infection or repairing a fractured bone, may encompass trade-offs, are influenced by cognitive biases, and can be clouded by emotion. Serious illness amplifies these ...

C. Adrian Austin, MD; Dinushika Mohottige, MD; Rebecca L. Sudore, MD; Alexander K. Smith, MD; Laura C. Hanson, MD, MPH

Importance  Serious illness impairs function and threatens survival. Patients facing serious illness value shared decision making, yet few decision aids address the needs of this population.

Objective  To perform a systematic review of evidence about decision aids and other exportable tools that promote shared decision making ...

Editorial: Addressing Overuse of Medical Services One Decision at a Time; Grace A. Lin, MD, MAS; Rita F. Redberg, MD, MSc
Invited Commentary: Decision Aids in Serious Illness; James A. Tulsky, MD
Joshua M. Sharfstein, MD; Donna Kinzer, BS; John M. Colmers, MPH

This Viewpoint discusses Maryland’s shift away from fee-for-service reimbursement models tied to volume and toward alternate structures that cap payments and reward hospitals and physicians for delivering better health and quality outcomes at lower costs.

Rita F. Redberg, MD, MSc

I recently experienced firsthand the impact of the US Food and Drug Administration’s (FDA) ban on chlorofluorocarbons as described by Jena et al.1 My daughter was home for vacation from college and needed to fill a prescription for an albuterol inhaler (Ventolin). I went to the pharmacy ...

Editor's Note: On Chlorofluorocarbon Bans and Inhaled Albuterol Prices; Joseph S. Ross, MD, MHS; Rita F. Redberg, MD, MSc
Original Investigation  FREE
William M. Sage, MD, JD; Joseph S. Jablonski, JD; Eric J. Thomas, MD, MPH

Importance  Honesty and transparency are essential aspects of health care, including in physicians’ and hospitals’ responses to medical error. Biases and habits associated with medical malpractice litigation, however, may work at cross-purposes with compassion in clinical care and with efforts to improve patient safety.

Objective  To ...

Invited Commentary: Malpractice Settlements; Michelle M. Mello, JD, PhD, MPhil; Jeffrey N. Catalano, Esq
Original Investigation 
J. Bradley Layton, PhD; Christoph R. Meier, PhD, MSc; Julie L. Sharpless, MD; Til Stürmer, MD, PhD; Susan S. Jick, DSc, MPH; M. Alan Brookhart, PhD
Includes: Supplemental Content

Importance  Increases in testosterone use and mixed reports of adverse events have raised concerns about the cardiovascular safety of testosterone. Testosterone is available in several delivery mechanisms with varying pharmacokinetics; injections cause spikes in testosterone levels, and transdermal patches and gels cause more subtle but sustained increases. ...

Invited Commentary: Testosterone Therapy: Too Much, Too Little, Just Right; Margaret E. Wierman, MD
Original Investigation 
Anupam B. Jena, MD, PhD; Oliver Ho, BA; Dana P. Goldman, PhD; Pinar Karaca-Mandic, PhD

Importance  The US Clean Air Act prohibits use of nonessential ozone-depleting substances. In 2005, the US Food and Drug Administration announced the ban of chlorofluorocarbon (CFC) albuterol inhalers by December 31, 2008. The policy resulted in the controversial replacement of generic CFC inhalers by more expensive, branded ...

Editor's Note: On Chlorofluorocarbon Bans and Inhaled Albuterol Prices; Joseph S. Ross, MD, MHS; Rita F. Redberg, MD, MSc
Original Investigation 
Cinta Valls-Pedret, MSc; Aleix Sala-Vila, DPharm, PhD; Mercè Serra-Mir, RD; Dolores Corella, DPharm, PhD; Rafael de la Torre, DPharm, PhD; Miguel Ángel Martínez-González, MD, PhD; Elena H. Martínez-Lapiscina, MD, PhD; Montserrat Fitó, MD, PhD; Ana Pérez-Heras, RD; Jordi Salas-Salvadó, MD, PhD; Ramon Estruch, MD, PhD; Emilio Ros, MD, PhD
Includes: Supplemental Content

Importance  Oxidative stress and vascular impairment are believed to partly mediate age-related cognitive decline, a strong risk factor for development of dementia. Epidemiologic studies suggest that a Mediterranean diet, an antioxidant-rich cardioprotective dietary pattern, delays cognitive decline, but clinical trial evidence is lacking.

Objective  To investigate ...

Invited Commentary  FREE
Michelle M. Mello, JD, PhD, MPhil; Jeffrey N. Catalano, Esq

In this issue of JAMA Internal Medicine, Sage et al1 report a novel study of nondisclosure provisions among Texas malpractice settlement agreements. Nearly all the settlements contained at least one type of disclosure restriction, and approximately 40% barred claimants from discussing the facts surrounding their injury. ...

Invited Commentary 
Margaret E. Wierman, MD

There is a developing story that the increased use of testosterone therapy without a diagnosis of hypogonadism is associated with an elevated cardiovascular risk for some patients. In this issue of JAMA Internal Medicine, Layton and coauthors1 deepen our knowledge with their analysis of 3 large ...

Invited Commentary 
Scott M. Stevens, MD; Scott C. Woller, MD

Venous thromboembolism, which most commonly manifests as deep venous thrombosis (DVT) of the extremities and pulmonary embolism, affects more than 500 000 Americans annually and is the third most common cause of cardiovascular mortality in the United States. Upper-extremity DVT (UE-DVT) accounts for about 10% of all DVT ...

Editor's Note 
Joseph S. Ross, MD, MHS; Rita F. Redberg, MD, MSc

The competing concerns and interests of both individuals and society must be considered when establishing regulatory policy. In 2008, the US Food and Drug Administration (FDA) banned albuterol inhalers containing chlorofluorocarbons. This decision was questioned at the time because the chlorofluorocarbons emitted from inhalers have an insignificant effect ...

Research Letter 
Michelangelo Sartori, MD, PhD; Ludovica Migliaccio, BSc; Elisabetta Favaretto, MD; Carlotta Brusi, MD; Eleonora Conti, MD; Giuseppina Rodorigo, MD; Benilde Cosmi, MD, PhD

Upper-extremity deep venous thrombosis (UE-DVT) accounts for approximately 14% of all cases of DVT.1 Because UE-DVT may provoke pulmonary embolism (PE), prompt diagnosis is necessary to select the patients who require anticoagulation. This study aimed to evaluate the failure rate of ultrasonographic screening for UE-DVT.

Invited Commentary: Whole-Arm Ultrasound for Upper-Extremity Deep Venous Thrombosis; Scott M. Stevens, MD; Scott C. Woller, MD
Katherine Baicker, PhD; Amitabh Chandra, PhD

This Viewpoint explains how cost sharing in employer-sponsored health insurance plans affects low- and high-wage workers differently and advocates regulatory changes that would both improve health and control costs.

Teachable Moment 
Spyridoula Maraka, MD; Derek T. O’Keeffe, MBBChBAO; Victor M. Montori, MD
Teachable Moment 
Linh T. Nguyen, BS; Christopher T. Sullivan, BA; Anil N. Makam, MD, MAS
Original Investigation 
Saurav Chatterjee, MD; Howard C. Herrmann, MD; Robert L. Wilensky, MD; John Hirshfeld, MD; Daniel McCormick, DO; David S. Frankel, MD; Robert W. Yeh, MD, MSc; Ehrin J. Armstrong, MD; Dharam J. Kumbhani, MD, SM, MRCP; Jay Giri, MD, MPH

Importance  The Lariat device has received US Food and Drug Administration (FDA) 510(k) clearance for soft-tissue approximation and is being widely used off-label for left atrial appendage (LAA) exclusion. A comprehensive analysis of safety and effectiveness has not been reported.

Objectives  To perform a systematic review ...

Invited Commentary: Lariat—Small Step or Giant Leap?; Paul D. Varosy, MD
Invited Commentary 
Paul D. Varosy, MD
Editor's Note 
Deborah Grady, MD, MPH

This Editorial Note discusses an intervention to reduce inappropriate use of central venous catheters in hospitalized patients.

Challenges in Clinical Electrocardiography 
Kevin K. Manocha, MD; David Snipelisky, MD; Nandan S. Anavekar, MD

A woman in her 70s with a medical history significant for atrial fibrillation and cardioembolic stroke who was receiving long-term anticoagulation therapy with warfarin (international normalized ratio, 2.3) presented to an outside facility with sudden onset of nausea and vertigo. Her mental status declined and she was unable ...

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