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 Showing 61-79 of 79 Articles
Original Investigation 
Alana E. Sigmund, MD; Elizabeth R. Stevens, MPH; Jeanna D. Blitz, MD; Joseph A. Ladapo, MD, PhD
Includes: Supplemental Content

Importance  The value of routine preoperative testing before most surgical procedures is widely considered to be low. To improve the quality of preoperative care and reduce waste, 2 professional societies released guidance on use of routine preoperative testing in 2002, but researchers and policymakers remain concerned about ...

Invited Commentary: The Conundrum of Unnecessary Preoperative Testing; Gerald W. Smetana, MD
Original Investigation 
Brian L. Strom, MD, MPH; Rita Schinnar, MPA; Jason Karlawish, MD; Sean Hennessy, PharmD, PhD; Valerie Teal, MS; Warren B. Bilker, PhD
Includes: Supplemental Content

Importance  Reports on the association between statins and memory impairment are inconsistent.

Objective  To assess whether statin users show acute decline in memory compared with nonusers and with users of nonstatin lipid-lowering drugs (LLDs).

Design, Setting, and Participants  Using The Health Improvement Network database during ...

Original Investigation 
Kelvin K. F. Tsoi, PhD; Joyce Y. C. Chan, MPH; Hoyee W. Hirai, MSc; Samuel Y. S. Wong, MD; Timothy C. Y. Kwok, MD, PhD
Includes: Supplemental Content

Importance  Dementia is a global public health problem. The Mini-Mental State Examination (MMSE) is a proprietary instrument for detecting dementia, but many other tests are also available.

Objective  To evaluate the diagnostic performance of all cognitive tests for the detection of dementia.

Data Sources  Literature ...

Invited Commentary: Copyright in Cognitive Testing; John C. Newman, MD, PhD
Invited Commentary 
Gerald W. Smetana, MD

Old habits die hard. Physicians continue to order low-value preoperative tests that add unnecessary costs and the potential for subsequent testing that could convey risk to their patients. In 2002, the American Society of Anesthesiologists issued a practice advisory on the preanesthesia evaluation, which stated, “Preoperative tests should ...

Invited Commentary 
Blake Charlton, MD; Rachel J. Stern, MD

As medical trainees, we have come to appreciate that today’s health care systems can be chaotic, fragmented, and filled with menial administrative tasks—in short, often joyless. Recently, Sinsky et al1 argued that such joylessness is one reason why fewer trainees choose primary care and why seasoned primary ...

Research Letter 
Louise Y. Sun, MD, SM, FRCPC; Andrea S. Gershon, MD, MSc, FRCPC; Dennis T. Ko, MD, MSc, FRCPC; Stephan R. Thilen, MD, MS; Lingsong Yun, MSc; W. Scott Beattie, MD, PhD, FRCPC; Duminda N. Wijeysundera, MD, PhD, FRCPC

Preoperative pulmonary function tests (PFTs) assess the severity of known pulmonary disease, diagnose causes of respiratory symptoms, and may help identify patients who are at risk for postoperative pulmonary complications. While useful in selected patients, unnecessary testing is costly.1 Few guidelines for the appropriate use of preoperative ...

Invited Commentary: The Conundrum of Unnecessary Preoperative Testing; Gerald W. Smetana, MD
Research Letter 
Michael T. M. Wang; Mark J. Bolland, MBChB, PhD; Andrew Grey, MD

Observational research is abundant and influences clinical practice, in part via publication in high-impact journals and dissemination by news media. However, it frequently generates unreliable findings.1 Inherent methodologic limitations that generate bias and confounding mean that causal inferences cannot reliably be drawn. Study limitations may be inadequately ...

Original Investigation 
Mark W. Friedberg, MD, MPP; Meredith B. Rosenthal, PhD; Rachel M. Werner, MD, PhD; Kevin G. Volpp, MD, PhD; Eric C. Schneider, MD, MSc
Includes: Supplemental Content

Importance  Published evaluations of medical home interventions have found limited effects on quality and utilization of care.

Objective  To measure associations between participation in the Northeastern Pennsylvania Chronic Care Initiative and changes in quality and utilization of care.

Design, Setting, and Participants  The northeast region ...

Invited Commentary: Assessing Effectiveness of the Patient-Centered Medical Home; George L. Jackson, PhD, MHA; John W. Williams Jr, MD, MHS
Original Investigation 
Marie Marklund, PhD, DDS; Bo Carlberg, MD, PhD; Lars Forsgren, MD, PhD; Tommy Olsson, MD, PhD; Hans Stenlund, PhD; Karl A. Franklin, MD, PhD
Includes: Supplemental Content

Importance  Oral appliances that move the mandible forward during sleep are suggested as treatment for mild to moderate obstructive sleep apnea.

Objective  To test whether an adjustable, custom-made oral appliance improves daytime sleepiness and quality of life in patients with daytime sleepiness and snoring or mild ...

Invited Commentary: Mandibular Advancement Therapy for Obstructive Sleep Apnea; Winfried J. Randerath, MD
Original Investigation 
Paula Chatterjee, MD, MPH; Atheendar S. Venkataramani, MD, PhD; Anitha Vijayan, MD; Jason R. Wellen, MD, MBA; Erika G. Martin, PhD, MPH
Includes: Supplemental Content

Importance  Shortages in transplantable solid organs remain a critical public health challenge in the United States. During the past 2 decades, all states have implemented policies to increase organ supply, although their effectiveness is unknown.

Objective  To determine the effects on organ donation and transplantation rates ...

Invited Commentary: Testing Incentives to Increase Organ Donation; Sally Satel, MD; David C. Cronin II, MD, PhD, MHCM
Invited Commentary 
Winfried J. Randerath, MD

Obstructive sleep apnea (OSA) is a major medical challenge: it affects 4% to 13% of the general population, impairs quality of life, and substantially increases the risk of motor vehicle accidents. Obstructive sleep apnea is associated with cardiovascular and metabolic consequences and increased mortality, particularly among the most ...

Invited Commentary 
George L. Jackson, PhD, MHA; John W. Williams Jr, MD, MHS

Much as clinical research has the goal of helping clinicians improve their decision making for individual patients, health services research has the ultimate goal of helping managers and policy makers make better decisions for their organizations and constituents. Many managers of third-party-payer and provider organizations want to know ...

Invited Commentary 
Sally Satel, MD; David C. Cronin II, MD, PhD, MHCM

This Invited Commentary discusses the effectiveness of state policies to encourage organ donation and transplantation in the United States.

Editor's Note 
Rachel J. Stern, MD; Blake Charlton, MD

Today, a small but significant amount of our education as house officers comes from pop-up alerts in the electronic medical record (EMR). Medical school lectures shaped our understanding of venous thromboembolism prophylaxis, antibiotic stewardship, and transfusion of blood products. In residency, EMR-based clinical decision support (CDS) tools cement ...

Special Communication 
Lynne Warner Stevenson, MD

The number of heart transplants performed in the United States was 2177 in 1994 and 2166 in 2014. However, the number of transplant centers has increased, and the criteria for transplants have broadened to include patients 65 years or older, those with a body mass index greater than ...

Research Letter 
Elliot B. Tapper, MD; Neil Sengupta, MD; Michelle Lai, MD, MPH; Gary Horowitz, MD, PhD

This before-and-after comparison study reports that physician ordering patterns of ceruloplasmin tests decreased after a decision pop-up tool was added to the electronic medical record system at Beth Israel Deaconess Medical Center.

Editor's Note: Maximizing EMRs; Rachel J. Stern, MD; Blake Charlton, MD
Comment & Response 
Charlotte Andersson, MD, PhD

To the Editor We have regretfully discovered an error in our program underlying the analyses of the paper “Association of β-Blocker Therapy With Risks of Adverse Cardiovascular Events and Deaths in Patients With Ischemic Heart Disease Undergoing Noncardiac Surgery: A Danish Nationwide Cohort Study” (2014;174[3]:336-344).1

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