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Ayers JW, Althouse BM, Leas EC, et al.
This quasiexperimental examination of internet search results determines that the Netflix series 13 Reasons Why has both increased suicide awareness while unintentionally increasing suicidal ideation.
Alvin MD, Jaffe AS, Ziegelstein RC, et al.
This Special Communication discusses the benefits of eliminating creatine kinase–myocardial band testing in suspected acute coronary syndrome.
Juraschek SP, Daya N, Rawlings AM, et al.
This cohort study compares early vs later orthostatic hypotension measurements and their association with history of dizziness and long-term adverse outcomes.
Bachhuber MA, Saloner B, Cunningham CO, et al.
Bachhuber et al determine the association between the presence of state medical cannabis laws and opioid analgesic overdose mortality in a time series analysis. See also the Invited Commentary by Hayes and Brown.
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).
O'Brien K, Knight JR, Jr, Harris SK.
The national suicide rate has risen steadily in recent decades, making suicide now the second leading cause of death among young people, accounting for more than 1 in 6 deaths. Adolescent reports of suicide ideation and attempts are on the rise. According to national high school Youth Risk Behavior Survey, the percentage of high school respondents who reported that they seriously considered attempting suicide during the 12 months preceding the survey rose from 13.8% in 2009 to 17.7% in 2015; during this same interval, the percentage of high school students making a plan for how they would attempt suicide increased (10.9% to 14.6%), as did the percentage who actually attempted suicide (6.3% to 8.6%).
Ash AS, Mick EO, Ellis RP, et al.
This modeling analysis adds social determinants of health variables to a diagnosis-based payment formula that allocates funds to managed care plans and physician networks.
Should adults older than 75 years receive statin therapy for the indication of primary prevention of cardiovascular disease? Last year, the US Preventive Services Task Force concluded that the evidence was insufficient to draw a conclusion about the balance of benefits and harms for the primary prevention of cardiovascular events and mortality in this age group. Even so, statins are commonly prescribed to patients over the age of 75 years, and the prevalence of use is increasing. The Medical Expenditure Panel Survey reported that statin use for primary prevention in adults older than 79 years increased more than 3-fold, from 8.8% in 1999-2000 to 34.1% in 2011-2012.
Maskrey N, Gordon A.
This Viewpoint addresses the need for clinicians to hone and practice good communication skills to enable shared decision making with patients.
Brush JE, Jr, Brophy JM.
This Viewpoint discusses how expert clinicians zero in on the most probable diagnosis and how this process can be communicated to patients.
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.
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.
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].
Singer W, Low PA.
Orthostatic hypotension (OH) is an important but often neglected clinical sign that can result from heterogeneous underlying pathophysiology. During the first few minutes following orthostasis, the 2 main variables governing blood pressure (BP) maintenance are the neurally mediated arterial baroreceptor control of sympathetic vasomotor tone of resistance and splanchnic capacitance vessels and the magnitude of central blood volume. Activation of the renin-angiotensin-aldosterone system and other endocrine systems mostly applies to prolonged orthostasis beyond the first few minutes.
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.
Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population8/10/2012
Shanafelt TD, Boone S, Tan L, et al.
Shanafelt and colleagues evaluated rates of burnout among US physicians, differences by specialty, and comparisons of physicians with US workers in other fields. Burnout was measured using validated instruments, and satisfaction with work-life balance was explored. See the editorial by O’Malley.
Yang Q, Zhang Z, Gregg EW, et al.
Yang et al examine time trends of added sugar consumption as percentage of daily calories in the United States and investigate the association of this consumption with cardiovascular disease mortality. See the Invited Commentary by [IIC130095].
Brach JS, Perera S, Gilmore S, et al.
This cluster-randomized trial compares the effectiveness of a group exercise program that focuses on the timing and coordination of movement with a seated strength, endurance, and flexibility program (usual care) on function, disability, and walking ability of older adults.
Lazarus B, Chen Y, Wilson FP, et al.
This population-based cohort study quantifies the association between proton pump inhibitor use and incident chronic kidney disease among participants in the Atherosclerosis Risk in Communities study.
Joynt Maddox KE.
A growing proportion of state and federal health care dollars are spent via managed care, in which government pays private companies to administer insurance coverage on its behalf. Recent reports suggest that as many as 77% of Medicaid beneficiaries are enrolled in some type of managed care plan, and Medicare Advantage, which is Medicare’s managed care option, now enrolls nearly a third of Medicare beneficiaries.
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