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Original Investigation 
Guilherme Del Fiol, MD, PhD; T. Elizabeth Workman, PhD, MLIS; Paul N. Gorman, MD
Includes: Supplemental Content

Importance  In making decisions about patient care, clinicians raise questions and are unable to pursue or find answers to most of them. Unanswered questions may lead to suboptimal patient care decisions.

Objective  To systematically review studies that examined the questions clinicians raise in the context of ...

Perspective  FREE
Leslie Sheu, MD; Emily Welsh Gottenborg, MD
A man in his late 20s with a history of posttraumatic stress disorder (PTSD) and depression presented to his primary care clinician (PCP) with chronic diarrhea for years accompanied by intermittent hematochezia.
Editor's Note 
Mitchell H. Katz, MD
It is not news that neuroimaging is overordered for patients with headache. In fact, as the authors have alluded to, the American College of Radiology, as part of the Choose Wisely campaign (ABIM [American Board of Internal Medicine] Foundation), has placed “Don’t do imaging for uncomplicated headache” on its top ...
Invited Commentary 
Evangelos C. Rizos, MD, PhD; Evangelia E. Ntzani, MD, PhD
Invited Commentary 
Greg Maynard, MD, MSc, SFHM
Lamontagne et al1 present findings in this issue of JAMA Internal Medicine from a study focused on the epidemiology, management patterns, and clinical consequences of nonleg venous thrombosis. This prospective cohort study is nested in a large international trial (Prophylaxis for Thromboembolism in Critical Care Trial, aka, PROTECT) randomizing medical-surgical ...
Invited Commentary 
Lena M. Chen, MD, MS; John Z. Ayanian, MD, MPP
Improving care coordination has emerged as a key strategy of many payers and policymakers for enhancing the quality and lowering the costs of health care in the United States. Accountable care organizations and bundled payments aim to bridge the provider-based silos that fragment care. Patient-centered medical homes (PCMHs) seek to ...
Research Letter 
Brian C. Callaghan, MD, MS; Kevin A. Kerber, MD, MS; Robert J. Pace, MD; Lesli E. Skolarus, MD, MS; James F. Burke, MD, MS
While most headaches are attributable to benign conditions, patients and physicians are often concerned about intracranial pathologic conditions. However, the yield of significant abnormalities on neuroimaging in patients with chronic headaches is 1% to 3%.1- 3 Given the comparable yield in patients without headaches, multiple guidelines have recommended against routine ...
Research Letter 
J. Eric Oliver, PhD; Thomas Wood, MA
Over the past 50 years, numerous conspiracy theories have materialized around public health matters such as water fluoridation, vaccines, cell phones, and alternative medicine. What remains unclear is whether the American public supports these conspiracy theories or whether they correlate with actual health behaviors.
Original Investigation 
Francois Lamontagne, MD, MSc; Lauralyn McIntyre, MD, MSc; Peter Dodek, MD, MHSc; Diane Heels-Ansdell, MS; Maureen Meade, MD, MSc; Julia Pemberton, MSc; Yoanna Skrobik, MD; Ian Seppelt, MBBS; Nicholas E. Vlahakis, MBBS; John Muscedere, MD; Graham Reece, MD; Marlies Ostermann, MBBS; Soundrie Padayachee, PhD, CSci; Jamal Alhashemi, MBBS, MSc; Michael Walsh, MD, PhD; Bradley Lewis, MD; David Schiff, MD; Alan Moody, MBBS; Nicole Zytaruk, RN; Martine LeBlanc, MD; Deborah J. Cook, MD, MSc; for the PROTECT (Prophylaxis for Thromboembolism in Critical Care Trial) Investigators, on behalf of the Canadian Critical Care Trials Group and the Australian and New Zealand Intensive Care Society Clinical Trials Group

Importance  Critically ill patients are at risk of venous thrombosis, and therefore guidelines recommend daily thromboprophylaxis. Deep vein thrombosis (DVT) commonly occurs in the lower extremities but can occur in other sites including the head and neck, trunk, and upper extremities. The risk of nonleg deep venous ...

Original Investigation 
Peter S. Hussey, PhD; Eric C. Schneider, MD; Robert S. Rudin, PhD; D. Steven Fox, MD; Julie Lai, MPH; Craig Evan Pollack, MD
Includes: Supplemental Content

Importance  Better continuity of care is expected to improve patient outcomes and reduce health care costs, but patterns of use, costs, and clinical complications associated with the current patterns of care continuity have not been quantified.

Objective  To measure the association between care continuity, costs, and ...

Importance  Dietary supplements have been proposed as a mechanism to improve health and prevent disease.

Objective  To determine if supplementing diet with long-chain ω-3 polyunsaturated fatty acids or with macular xanthophylls results in a reduced rate of cardiovascular disease (CVD).

Design, Setting, and Participants  The ...

Perspective 
Claudia Finkelstein, MDCM
My daughter met her cadaver yesterday. She has begun her own journey of “things that you need to know to be a physician.” Many are taught explicitly, and so many more are implicit. I am in the high desert writing, walking, breathing, recovering from some of these same lessons.
Editorial 
Mark J. Pletcher, MD, MPH; Bernard Lo, MD; Deborah Grady, MD
The widespread implementation of electronic medical records (EMRs), stimulated by the Patient Protection and Affordable Care Act, provides a major opportunity to conduct inexpensive pragmatic randomized trials1,2 that are embedded into the clinical practice of health care delivery. Electronic medical records allow health systems to identify particular types of patients, ...
Editor's Note 
Kenneth E. Covinsky, MD
Many guidelines and performance measures for chronic conditions, such as hypertension, seem to assume that patients come neatly packaged with only 1 problem. But patients’ conditions are often more complicated, and many patients have more than 1 condition. We know little about the impact that this multimorbidity has on care ...
Invited Commentary 
Sei J. Lee, MD, MAS
Hypoglycemia is the most common and serious adverse event caused by insulin treatment. Besides the well-known potential for hypoglycemia to cause immediate injury, coma, or even death, there is evidence that hypoglycemia may increase the risk of dementia many years later.1 Despite its importance, remarkably little is known about the ...
Research Letter 
Brian Rostron, PhD
Vozoris1 recently reported that menthol cigarette use was associated with increased stroke risk compared with nonmenthol cigarette use among US smokers (odds ratio, 2.25; 95% CI, 1.33-2.78). These results, however, were not consistent across all demographic groups. For example, no increased risk was observed among African American smokers, a group ...
Research Letter 
Anil N. Makam, MD, MAS; Andrew D. Auerbach, MD, MPH; Michael A. Steinman, MD
Includes: Supplemental Content
Routine blood cultures for all patients hospitalized with community-acquired pneumonia have limited utility, and false-positive results lead to inappropriate antimicrobial use and longer hospital stays.1 As a result, performance measures and practice guidelines that promoted obtaining blood cultures in all such patients were modified from 2005 through 2007 to recommend ...
Research Letter 
Nathalie Moise, MD; Karina W. Davidson, PhD; William Chaplin, PhD; Steven Shea, MD, MS; Ian Kronish, MD, MPH
Depression is a known risk factor for poor prognosis among patients with cardiovascular disease.1 Numerous biological and behavioral mechanisms have been proposed.2 However, few studies have investigated the association between depression and “clinical inertia,” or lack of treatment intensification in individuals not at evidence-based goals for care.3 To address this ...
Original Investigation 
Andrew I. Geller, MD; Nadine Shehab, PharmD, MPH; Maribeth C. Lovegrove, MPH; Scott R. Kegler, PhD; Kelly N. Weidenbach, DrPH; Gina J. Ryan, PharmD, CDE; Daniel S. Budnitz, MD, MPH
Includes: Supplemental Content

Importance  Detailed, nationally representative data describing high-risk populations and circumstances involved in insulin-related hypoglycemia and errors (IHEs) can inform approaches to individualizing glycemic targets.

Objective  To describe the US burden, rates, and characteristics of emergency department (ED) visits and emergency hospitalizations for IHEs.

Design, Setting, and ...

Original Investigation 
Steven S. Fu, MD, MSCE; Michelle van Ryn, PhD, MPH; Scott E. Sherman, MD, MPH; Diana J. Burgess, PhD; Siamak Noorbaloochi, PhD; Barbara Clothier, MS; Brent C. Taylor, PhD; Carolyn M. Schlede, MD; Randy S. Burke, PhD; Anne M. Joseph, MD, MPH

Importance  Current tobacco use treatment approaches require smokers to request treatment or depend on the provider to initiate smoking cessation care and are therefore reactive. Most smokers do not receive evidence-based treatments for tobacco use that include both behavioral counseling and pharmacotherapy.

Objective  To assess the ...

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