JAMA Internal Medicine - más leídos
May P, Normand C, Cassel J, et al.
This meta-analysis estimates the association of palliative care consultation with direct hospital costs for adults with serious illness.
Hadland SE, Cerdá M, Li Y, et al.
This database analysis examines the extent to which pharmaceutical industry marketing of opioid products to physicians during 2014 was associated with opioid prescribing during 2015.
In abandoning its 2012 objection to prostate-specific antigen (PSA)–based screening for prostate cancer (D recommendation), the US Preventive Services Task Force (USPSTF) now supports individualized decision making for men aged 55 to 69 years (C recommendation). The new Task Force recommendation, supported by an evidence report and systematic review, now aligns the USPSTF with the American Cancer Society and the American Urological Association. The USPSTF recommendations, which have consistently been evidence based, appear to have a large influence on practice patterns. Following the 2008 recommendation against screening men older than 75 years, prostate cancer screening and cancer incidence rates markedly declined for older men. In the year following the 2011 release of a draft recommendation against any screening (D recommendation; final version published in May 2012), the number of men diagnosed with prostate cancer decreased by over 33 000. Prostate cancer screening rates also subsequently decreased among all age groups by 2013. The new C recommendation may well be associated with a resurgence in prostate cancer screening and increased numbers of prostate cancer cases diagnosed, especially if the new guidelines are misunderstood to be endorsing screening rather than offering a more nuanced message about decision making.
Niknejad B, Bolier R, Henderson CR, Jr, et al.
This systematic review and meta-analysis evaluates the use of psychological interventions for older adults with chronic pain.
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].
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.
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.
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.
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).
Dahal K, Hendrani A, Sharma SP, et al.
This systematic review and meta-analysis of 10 randomized clinical trials explores the role of treatment with aldosterone antagonists in patients with ST-segment elevation myocardial infarction (STEMI) without heart failure or left ventricular ejection fraction greater than 40%.
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.
In this week’s issue of JAMA are the updated US Preventive Services Task Force (USPSTF) recommendations on vitamin D, calcium, or combined supplementation for the primary prevention of fractures in community-dwelling adults and for falls prevention in community-dwelling adults, as well as accompanying evidence reports. Overall, the summary recommendations have not changed much compared with previous recommendations released in 2013 and 2012. The major change is the downgrade of the vitamin D supplementation recommendation for preventing falls from being a B grade (recommended based on high certainty of moderate benefit or on moderate certainty of moderate to substantial benefit) to a D grade (recommended against based on moderate or high certainty of no benefit or that harms outweigh the benefit). For falls prevention, exercise remains a B grade recommendation, and multifactorial interventions remains a C grade (selectively offer) recommendation. Both falls prevention recommendations are consistent with a 2017 meta-analysis of falls prevention interventions. Recommendations for fracture prevention have not changed, including insufficient evidence to make recommendations on calcium and vitamin D to prevent fractures in men and premenopausal and postmenopausal women. Although it is unclear whether supplementation with more than 400 IU of vitamin D and more than 1000 mg of calcium in postmenopausal women is beneficial for preventing fractures, the USPSTF recommends against (D grade) supplementing postmenopausal women with doses of 400 IU or less of vitamin D and 1000 mg or less of calcium. Of note, the USPSTF supplementation recommendations do not apply to those with previous osteoporotic fracture, with osteoporosis, or who are at risk of falls.
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].
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.
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.
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.
Vickers AJ, Cronin AM, Maschino AC, et al.
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.
Lurie N, Carr BG.
This Viewpoint discusses the role of telehealth in the medical response to disasters.
Depression Is a Risk Factor for Noncompliance With Medical Treatment Meta-analysis of the Effects of Anxiety and Depression on Patient Adherence24/7/2000
DiMatteo M, Lepper HS, Croghan TW.
BackgroundDepression 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.
MethodsResearch 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).
ResultsTwelve 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).
ConclusionsCompared 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.
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