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JAMA Internal Medicine - más leídos

Cost of Developing a Single Cancer Drug
11/9/2017
Prasad V, Mailankody S.
ver resumen
This analysis of US Securities and Exchange Commission filings provides a contemporary estimate of research and development spending to develop 10 new cancer drugs.

Distribution of Medical Education Debt by Specialty, 2010-2016
1/10/2017
Grischkan J, George BP, Chaiyachati K, et al.
ver resumen
This survey study analyzes the trends in the distribution of medical education debt by focusing on the increase in graduates without such debt.

Coronary Computed Tomography Angiography vs Functional Stress Testing for Patients With Suspected CAD
2/10/2017
Foy AJ, Dhruva SS, Peterson B, et al.
ver resumen
This systematic review and meta-analysis compares the clinical effectiveness of coronary computed tomography angiography with that of functional stress testing for patients with suspected coronary artery disease.

Clinician-Level Predictors for Ordering Low-Value Imaging
25/9/2017
Hong AS, Ross-Degnan D, Zhang F, et al.
ver resumen
This study identified characteristics that made clinicians more likely to order low-value imaging tests for patients with low-back pain and headache.

Strong Anticholinergics and Incident Dementia
1/3/2015
Gray SL, Anderson ML, Dublin S, et al.
ver resumen
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.

A Brief Measure for Assessing Generalized Anxiety Disorder The GAD-7
22/5/2006
Spitzer RL, Kroenke K, Williams JW, et al.
ver resumen
Background
Generalized 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.
Methods
A 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.
Results
A 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.
Conclusion
The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.

Meditation for Psychological Stress and Well-being
1/3/2014
Goyal M, Singh S, Sibinga ES, et al.
ver resumen
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].

Medical Cannabis Laws and Opioid Mortality
1/10/2014
Bachhuber MA, Saloner B, Cunningham CO, et al.
ver resumen
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.

Much-Needed Corrective on Drug Development Costs
11/9/2017
Goozner M.
ver resumen
Contemporary pharmaceutical industry pricing practices are threatening to undermine the health care industry’s and policymakers’ efforts at cost control. Egregious as the price hikes are, the hedge fund managers who gained notoriety for exorbitant price increases on some generics are the least of the problem. The 2 biggest drivers of high drug costs in recent years have been the steady increase in prices for existing on-patent drugs, which account for more than 70% of all drug spending, and the 6-figure retail prices set for the latest generation of specialty and cancer therapeutics.

Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population
8/10/2012
Shanafelt TD, Boone S, Tan L, et al.
ver resumen
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.

Effects of Evening vs Morning Levothyroxine Intake A Randomized Double-blind Crossover Trial
13/12/2010
Bolk N, Visser TJ, Nijman J, et al.
ver resumen
Background
Levothyroxine 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.
Methods
To 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.
Results
Ninety 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.
Conclusions
Levothyroxine 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 Registration
isrctn.org Identifier: ISRCTN17436693 (NTR959).

Sugar Intake and Cardiovascular Diseases Mortality
1/4/2014
Yang Q, Zhang Z, Gregg EW, et al.
ver resumen
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].

Proton Pump Inhibitor Use and the Risk of Chronic Kidney Disease
1/2/2016
Lazarus B, Chen Y, Wilson FP, et al.
ver resumen
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.

Depression Is a Risk Factor for Noncompliance With Medical Treatment Meta-analysis of the Effects of Anxiety and Depression on Patient Adherence
24/7/2000
DiMatteo M, Lepper HS, Croghan TW.
ver resumen
Background
Depression and anxiety are common in medical patients and are associated with diminished health status and increased health care utilization. This article presents a quantitative review and synthesis of studies correlating medical patients' treatment noncompliance with their anxiety and depression.
Methods
Research on patient adherence catalogued on MEDLINE and PsychLit from January 1, 1968, through March 31, 1998, was examined, and studies were included in this review if they measured patient compliance and depression or anxiety (with n>10); involved a medical regimen recommended by a nonpsychiatrist physician to a patient not being treated for anxiety, depression, or a psychiatric illness; and measured the relationship between patient compliance and patient anxiety and/or depression (or provided data to calculate it).
Results
Twelve articles about depression and 13 about anxiety met the inclusion criteria. The associations between anxiety and noncompliance were variable, and their averages were small and nonsignificant. The relationship between depression and noncompliance, however, was substantial and significant, with an odds ratio of 3.03 (95% confidence interval, 1.96-4.89).
Conclusions
Compared with nondepressed patients, the odds are 3 times greater that depressed patients will be noncompliant with medical treatment recommendations. Recommendations for future research include attention to causal inferences and exploration of mechanisms to explain the effects. Evidence of strong covariation of depression and medical noncompliance suggests the importance of recognizing depression as a risk factor for poor outcomes among patients who might not be adhering to medical advice.

Lung Cancer Mortality and Smoking Exposure in US Patients With HIV
18/9/2017
Reddy KP, Kong C, Hyle EP, et al.
ver resumen
This validated microsimulation model evaluates the risk of lung cancer death by smoking exposure for persons living with human immunodeficiency virus.

New Guidelines for Potassium Replacement in Clinical Practice A Contemporary Review by the National Council on Potassium in Clinical Practice
11/9/2000
Cohn JN, Kowey PR, Whelton PK, et al.
ver resumen
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.

Acupuncture for Chronic Pain Individual Patient Data Meta-analysis
22/10/2012
Vickers AJ, Cronin AM, Maschino AC, et al.
ver resumen
Vickers and coauthors conducted a systematic review to identify RCTs of acupuncture for chronic pain in which allocation concealment was determined unambiguously to be adequate. Individual patient data meta-analyses were conducted using data from 29 of 31 eligible RCTs, with a total of 17 922 patients evaluated. Please also see the Invited Commentary.

The Cost of Satisfaction A National Study of Patient Satisfaction, Health Care Utilization, Expenditures, and Mortality
12/3/2012
Fenton JJ, Jerant AF, Bertakis KD, et al.
ver resumen
Background
Patient 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.
Methods
We 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.
Results
Adjusting 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).
Conclusion
In 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.

Blood Pressure Lowering and Risk of Mortality in Chronic Kidney Disease
1/10/2017
Malhotra R, Nguyen H, Benavente O, et al.
ver resumen
This systematic review and meta-analysis of randomized clinical trials investigates if more intensive compared with less intensive blood pressure control is associated with reduced mortality risk in persons with chronic kidney disease stages 3 to 5.

Eliminating Creatine Kinase–Myocardial Band Testing in Suspected ACS
1/10/2017
Alvin MD, Jaffe AS, Ziegelstein RC, et al.
ver resumen
This Special Communication discusses the benefits of eliminating creatine kinase–myocardial band testing in suspected acute coronary syndrome.







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