JAMA Internal Medicine - más leídos
Antibiotic Prescribing in US Retail Clinics, Urgent Care Centers, EDs, and Traditional Medical Offices16/7/2018
Palms DL, Hicks LA, Bartoces M, et al.
This cohort study compares antibiotic prescribing in 2014 among retail clinics, urgent care centers, emergency departments, and traditional medical offices in the United States.
Tsugawa Y, Jena AB, Figueroa JF, et al.
This cross-sectional study examines whether patient mortality and readmission rates differ between hospitalized Medicare beneficiaries treated by male or female physicians.
Ivers N, Brown AD, Detsky AS.
This Special Communication explores the strengths, challenges, and lessons learned following the introduction of the Canadian single-payer health care system in the late 1960s, comparing this system with health care approaches in other countries, including the United States.
Spitzer RL, Kroenke K, Williams JW, et al.
BackgroundGeneralized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity.
MethodsA criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use.
ResultsA 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale.
ConclusionThe GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.
Mandrola J, Foy A, Naccarelli G.
The association of atrial fibrillation (AF) with an increased risk of stroke and heart failure makes it a serious health condition. Many people have AF and do not know it, and its prevalence continues to rise in parallel with the growing numbers of people living with obesity and cardiac risk factors.
Roncarati JS, Baggett TP, O’Connell JJ, et al.
This cohort study investigates all-cause and cause-specific mortality and age-stratified incident rate ratios among unsheltered homeless adults in Boston, Massachusetts, 2000-2009, compared with the entire Massachusetts population and also with a cohort of sheltered homeless adults in Boston.
Bolk N, Visser TJ, Nijman J, et al.
BackgroundLevothyroxine sodium is widely prescribed to treat primary hypothyroidism. There is consensus that levothyroxine should be taken in the morning on an empty stomach. A pilot study showed that levothyroxine intake at bedtime significantly decreased thyrotropin levels and increased free thyroxine and total triiodothyronine levels. To date, no large randomized trial investigating the best time of levothyroxine intake, including quality-of-life evaluation, has been performed.
MethodsTo ascertain if levothyroxine intake at bedtime instead of in the morning improves thyroid hormone levels, a randomized double-blind crossover trial was performed between April 1, 2007, and November 30, 2008, among 105 consecutive patients with primary hypothyroidism at Maasstad Hospital Rotterdam in the Netherlands. Patients were instructed during 6 months to take 1 capsule in the morning and 1 capsule at bedtime (one containing levothyroxine and the other a placebo), with a switch after 3 months. Primary outcome measures were thyroid hormone levels; secondary outcome measures were creatinine and lipid levels, body mass index, heart rate, and quality of life.
ResultsNinety patients completed the trial and were available for analysis. Compared with morning intake, direct treatment effects when levothyroxine was taken at bedtime were a decrease in thyrotropin level of 1.25 mIU/L (95% confidence interval [CI], 0.60-1.89 mIU/L; P < .001), an increase in free thyroxine level of 0.07 ng/dL (0.02-0.13 ng/dL; P = .01), and an increase in total triiodothyronine level of 6.5 ng/dL (0.9-12.1 ng/dL; P = .02) (to convert thyrotropin level to micrograms per liter, multiply by 1.0; free thyroxine level to picomoles per liter, multiply by 12.871; and total triiodothyronine level to nanomoles per liter, multiply by 0.0154). Secondary outcomes, including quality-of-life questionnaires (36-Item Short Form Health Survey, Hospital Anxiety and Depression Scale, 20-Item Multidimensional Fatigue Inventory, and a symptoms questionnaire), showed no significant changes between morning vs bedtime intake of levothyroxine.
ConclusionsLevothyroxine taken at bedtime significantly improved thyroid hormone levels. Quality-of-life variables and plasma lipid levels showed no significant changes with bedtime vs morning intake. Clinicians should consider prescribing levothyroxine intake at bedtime.
Trial Registrationisrctn.org Identifier: ISRCTN17436693 (NTR959).
Pottegård A, Pedersen S, Schmidt S, et al.
This case-control study assesses the association of hydrochlorothiazide with risk of malignant melanoma among Danish adults.
Goyal M, Singh S, Sibinga ES, et al.
Goyal et al determine the efficacy of meditation programs in improving stress-related outcomes in diverse adult clinical populations. See the Invited Commentary by [IIC130096].
Incze MA, Redberg RF, Katz MH.
Despite clear guidelines and extensive educational campaigns aimed at reducing overprescribing of antibiotics, the problem remains. At least 30% of antibiotic prescriptions dispensed in the outpatient setting—80 million prescriptions per year in the United States—are given without an appropriate indication. Viral upper respiratory tract infections represent a frequent diagnosis for this low-value care.
New Guidelines for Potassium Replacement in Clinical Practice A Contemporary Review by the National Council on Potassium in Clinical Practice11/9/2000
Cohn JN, Kowey PR, Whelton PK, et al.
This article is the result of a meeting of the National Council on Potassium in Clinical Practice. The Council, a multidisciplinary group comprising specialists in cardiology, hypertension, epidemiology, pharmacy, and compliance, was formed to examine the critical role of potassium in clinical practice. The goal of the Council was to assess the role of potassium in terms of current medical practice and future clinical applications. The primary outcome of the meeting was the development of guidelines for potassium replacement therapy. These guidelines represent a consensus of the Council members and are intended to provide a general approach to the prevention and treatment of hypokalemia.
Loftfield E, Cornelis MC, Caporaso N, et al.
This population-based study of UK Biobank data assesses the association between coffee intake and mortality according to genetic caffeine metabolism scores.
Sandhu AT, Parizo J, Moradi-Ragheb N, et al.
This study examines the use of a limited transthoracic echocardiogram (TTE) that evaluates only the left ventricle and its association with overall use of TTE.
Trepanowski JF, Kroeger CM, Barnosky A, et al.
This randomized clinical trial compares the effects of alternate-day fasting vs daily calorie restriction on weight loss, weight maintenance, and risk indicators for cardiovascular disease.
Song M, Fung TT, Hu FB, et al.
This cohort study assesses the associations of animal and plant protein intake with the risk for mortality in 2 populations of US adults.
Simonsen L, Reichert TA, Viboud C, et al.
BackgroundObservational studies report that influenza vaccination reduces winter mortality risk from any cause by 50% among the elderly. Influenza vaccination coverage among elderly persons (≥65 years) in the United States increased from between 15% and 20% before 1980 to 65% in 2001. Unexpectedly, estimates of influenza-related mortality in this age group also increased during this period. We tried to reconcile these conflicting findings by adjusting excess mortality estimates for aging and increased circulation of influenza A(H3N2) viruses.
MethodsWe used a cyclical regression model to generate seasonal estimates of national influenza-related mortality (excess mortality) among the elderly in both pneumonia and influenza and all-cause deaths for the 33 seasons from 1968 to 2001. We stratified the data by 5-year age group and separated seasons dominated by A(H3N2) viruses from other seasons.
ResultsFor people aged 65 to 74 years, excess mortality rates in A(H3N2)-dominated seasons fell between 1968 and the early 1980s but remained approximately constant thereafter. For persons 85 years or older, the mortality rate remained flat throughout. Excess mortality in A(H1N1) and B seasons did not change. All-cause excess mortality for persons 65 years or older never exceeded 10% of all winter deaths.
ConclusionsWe attribute the decline in influenza-related mortality among people aged 65 to 74 years in the decade after the 1968 pandemic to the acquisition of immunity to the emerging A(H3N2) virus. We could not correlate increasing vaccination coverage after 1980 with declining mortality rates in any age group. Because fewer than 10% of all winter deaths were attributable to influenza in any season, we conclude that observational studies substantially overestimate vaccination benefit.
Gray SL, Anderson ML, Dublin S, et al.
This prospective population-based cohort study reports an increased risk for dementia with increased total standard daily doses of anticholinergics. See the Invited Commentary by Campbell and Boustani.
In this issue of JAMA Internal Medicine, Ivers et al discuss the course of Canada’s “single-payer” (or “Medicare for all”) health insurance system over the last 50 years. The article summarizes the reasons why the Canadian system can seem superior to the insurance system in the United States. Awareness of those differences is one reason why Canadians are especially wary of change; it takes little imagination for them to envision the universal coverage and other features that they could lose. The article also highlights the ways in which the Canadian system is by no means ideal—especially public concerns about constrained access to some medical care and the lack of universal coverage for pharmaceuticals. In the mid-1990s, worries about delayed access to care increased substantially in Canada and were accompanied by decreasing public satisfaction with the system.
Brenner AT, Malo TL, Margolis M, et al.
This analysis assesses the quality of shared decision making between clinicians and patients eligible for lung cancer screening regarding the initiation of lung cancer screening in clinical practice.
The Cost of Satisfaction A National Study of Patient Satisfaction, Health Care Utilization, Expenditures, and Mortality12/3/2012
Fenton JJ, Jerant AF, Bertakis KD, et al.
BackgroundPatient satisfaction is a widely used health care quality metric. However, the relationship between patient satisfaction and health care utilization, expenditures, and outcomes remains ill defined.
MethodsWe conducted a prospective cohort study of adult respondents (N = 51 946) to the 2000 through 2007 national Medical Expenditure Panel Survey, including 2 years of panel data for each patient and mortality follow-up data through December 31, 2006, for the 2000 through 2005 subsample (n = 36 428). Year 1 patient satisfaction was assessed using 5 items from the Consumer Assessment of Health Plans Survey. We estimated the adjusted associations between year 1 patient satisfaction and year 2 health care utilization (any emergency department visits and any inpatient admissions), year 2 health care expenditures (total and for prescription drugs), and mortality during a mean follow-up duration of 3.9 years.
ResultsAdjusting for sociodemographics, insurance status, availability of a usual source of care, chronic disease burden, health status, and year 1 utilization and expenditures, respondents in the highest patient satisfaction quartile (relative to the lowest patient satisfaction quartile) had lower odds of any emergency department visit (adjusted odds ratio [aOR], 0.92; 95% CI, 0.84-1.00), higher odds of any inpatient admission (aOR, 1.12; 95% CI, 1.02-1.23), 8.8% (95% CI, 1.6%-16.6%) greater total expenditures, 9.1% (95% CI, 2.3%-16.4%) greater prescription drug expenditures, and higher mortality (adjusted hazard ratio, 1.26; 95% CI, 1.05-1.53).
ConclusionIn a nationally representative sample, higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality.
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