JAMA Internal Medicine - más leídos
Hooton TM, Vecchio M, Iroz A, et al.
This randomized clinical trial assesses the efficacy of increased daily water intake vs usual fluid intake on the frequency of recurrent cystitis in premenopausal women experiencing recurrent cystitis who drink low volumes of total fluid daily.
This Viewpoint examines the risks and benefits of consuming probiotic products and current labelling practices in the United States.
Thurston RC, Chang Y, Matthews KA, et al.
This cohort study of community-recruited women aged 40 to 60 years evaluates the association of a history of sexual harassment and sexual assault with mental and physical health indices.
Mishra P, Kiang JC, Grant RW.
This crossover study of primary care physicians evaluates whether the use of medical scribes in primary care improves physician productivity and patient satisfaction.
Li F, Harmer P, Fitzgerald K, et al.
This randomized clinical trial compares the effectiveness of a tai ji quan intervention with multimodal exercise and stretching exercise in reducing falls in older adults who had fallen in the past year.
Haire-Joshu D, Hill-Briggs F.
Today 39.6% of adults in the United States are obese, placing them at high risk for chronic disease-related morbidity and mortality. Behavioral weight management is a proven treatment for obesity, with significant benefits associated with a weight loss of 5% to 7%. The US Preventive Services Task Force (USPSTF) recommendation for “Behavioral Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults,” supported by an evidence report and systematic review, provides evidence for effective programs to reverse obesity and reduce risk for negative health outcomes. The current USPSTF statement “recommends that clinicians offer or refer adults with a body mass index (BMI) of 30 or higher…to intensive, multicomponent behavioral interventions (B recommendation).” These interventions “can lead to clinically significant improvements in weight status and reduce the incidence of type 2 diabetes among adults with obesity and elevated plasma glucose levels.” This statement updates the 2012 USPSTF recommendation by further articulating core program elements and structure needed for effective counseling and impact. However, a recent study by Fitzpatrick and Stevens reported that obesity management in primary care settings remains suboptimal, with underdiagnoses of obesity and declines in weight management counseling from 33% in the 2008-2009 period to 21% in the 2012-2013 period. Despite evidence that intensive behavioral interventions work, most patients will not receive care that complies with that evidence. A critical priority then is how to promote the implementation and dissemination of evidence-based obesity interventions.
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.
Vargas-Santos A, Peloquin CE, Zhang Y, et al.
This cohort study uses data from the UK Health Improvement Network to examine the association of allopurinol use in patients with gout with the risk of developing chronic kidney disease stage 3 or higher.
Incze MA, Redberg RF, Gupta A.
This Patient Page provides information on insomnia—how to recognize it and how it is best treated.
Moore TJ, Zhang H, Anderson G, et al.
This study estimates the costs of pivotal clinical trials for all new therapeutic agents approved by the US Food and Drug Administration from 2015 to 2016 and examines how key features of the pivotal trials were associated with these costs.
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].
Tjia J, Hunnicutt JN, Herndon L, et al.
This quasi-experimental longitudinal study quantifies the influence of a large-scale communication training program on nursing home antipsychotic use.
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.
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).
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.
For decades, it has been said that increasing fluid intake could help prevent or cure urinary tract infections. In this issue of JAMA Internal Medicine, a randomized clinical trial confirms that folk wisdom. Hooton and colleagues randomized women with 3 or more episodes of cystitis in the prior year to consume 1.5 L of water per day (three 0.5-L bottles) in addition to their usual intake, or to consume no additional water. The women who consumed additional water had an approximately 50% reduction in number of cystitis episodes in the year after randomization and were prescribed fewer antibiotics. We realize that this trial was not blinded, the primary outcome was self-reported, and it was sponsored by Danone Research, which sells the bottled water used in this study. However, the research question is important and the intervention was safe, easy, and effective (and it would be impossible to blind a trial in which drinking water is the intervention). As the authors note, the reduction in episodes of cystitis is likely due to increased urine volume and voids that reduce bacterial load in the bladder. Given this, it seems clear that any safe-to-drink water will do, including your local tap water, which will also spare the environmental impact of bottled water and improve the cost-effectiveness of the intervention.
Leigh J, Tancredi D, Jerant A, et al.
Debate surrounds the relative pay of physicians in various specialties. Several studies have addressed income differences. Few, by comparison, have addressed work hours, and we are not aware of any that consider annual work hours. Yet, work hours—independent of income—figure prominently in discussions of physician lifestyles, student choices, and patient safety.
Jenner S, Djermester P, Prügl J, et al.
This cross-sectional internet-based survey study analyzes sexual harassment among physicians in an academic tertiary referral center in Germany.
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.
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.
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