JAMA Internal Medicine recientes

JAMA Internal Medicine recientes 2017-01-13T02:45:50+00:00

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JAMA Internal Medicine - recientes

October 2018 Issue Highlights
1/10/2018
ver resumen

Clinician-Patient Discussions of Successful CPR
1/10/2018
Breu AC.
ver resumen
This article explores the importance of goals of care discussions between clinicians and patients before setting a do-not-resuscitate order or administering CPR.

Cervical Cancer Screening—Moving From the Value of Evidence to the Evidence of Value
1/10/2018
Sawaya GF.
ver resumen
Widespread implementation of cytology-based screening programs has resulted in marked declines in cervical cancer incidence and mortality in the United States. Nonetheless, an estimated 13 240 women will be diagnosed with cervical cancer in 2018, and 4170 will die from the disease. It is likely that a sizable proportion of these women will not have been appropriately screened.

Failing Grade for Shared Decision Making for Lung Cancer Screening
1/10/2018
Redberg RF.
ver resumen
As we accrue more data on the benefits and harms from cancer screening, it is clear that the benefits do not always exceed the harms. This imbalance is particularly at issue in lung cancer screening by low-dose computed tomography (LDCT), for which 1 randomized clinical trial found a mortality benefit in high-risk smokers and ex-smokers, but 3 other randomized clinical trials found no benefit. In addition, data from the National Health Interview Survey show that most people undergoing screening for lung cancer do not fall in the recommended groups, and thus their harms of LDCT, including radiation exposure, will likely exceed the benefits.

Screening for Atrial Fibrillation Comes With Many Snags
1/10/2018
Mandrola J, Foy A, Naccarelli G.
ver resumen
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.

Tai Ji Quan vs a Multimodal Exercise Intervention for Preventing Falls in High-Risk Older Adults
1/10/2018
Li F, Harmer P, Fitzgerald K, et al.
ver resumen
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.

Evaluating Shared Decision Making for Lung Cancer Screening
1/10/2018
Brenner AT, Malo TL, Margolis M, et al.
ver resumen
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.

Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction
1/10/2018
Panagioti M, Geraghty K, Johnson J, et al.
ver resumen
This meta-analysis examines whether physician burnout is associated with low-quality, unsafe patient care.

Effect of Group-Administered Behavioral Treatment on Urinary Incontinence in Older Women
1/10/2018
Diokno AC, Newman DK, Low LK, et al.
ver resumen
This multisite randomized clinical trial compares the effectiveness, cost, and cost-effectiveness of group-administered behavioral treatment vs no treatment for urinary incontinence in older women.

Trends in Visits to Acute Care Venues for Treatment of Low-Acuity Conditions in the United States
1/10/2018
Poon SJ, Schuur JD, Mehrotra A.
ver resumen
This cohort study investigates trends in patterns of care for low-acuity patients with acute conditions from 2008 to 2015 using data from a large commercial health plan in the United States.

Effect of Portable Air Filtration Systems on Blood Pressure in a Senior Facility
1/10/2018
Morishita M, Adar SD, D’Souza J, et al.
ver resumen
This randomized, double-blind crossover trial investigates the effect of 2 air filtration systems vs a sham unfiltered system on personal exposures to fine particulate matter and blood presssure among older adults in a US urban location.

Patient-Reported Experiences of Dialysis Care Within a National Pay-for-Performance System
1/10/2018
Brady BM, Zhao B, Niu J, et al.
ver resumen
This cross-sectional analysis examines associations of dialysis facility performance and patient, facility, with geographic characteristics using measures of patient experiences.

Effect of Mobile Device–Supported n-of-1 Trials on Chronic Musculoskeletal Pain
1/10/2018
Kravitz RL, Schmid CH, Marois M, et al.
ver resumen
This randomized clinical trial examines outcomes of participation in an individually designed single-patient multi-crossover (n-of-1) trial supported by a mobile app compared with usual care among patients with chronic musculoskeletal pain.

Association of Rapid Molecular Testing With Duration of Respiratory Isolation for Patients With Possible Tuberculosis
1/10/2018
Chaisson LH, Duong D, Cattamanchi A, et al.
ver resumen
This cohort study evaluates the association of implementation of a molecular testing strategy with length of isolation for patients with possible tuberculosis in a US hospital.

Assessments of the Safety of Discharging Select Patients Directly Home From the Intensive Care Unit
1/10/2018
Stelfox HT, Soo A, Niven DJ, et al.
ver resumen
This population-based cohort study of 6732 intensive care unit (ICU) patients from 9 hospitals evaluates the 30-day hospital readmission, health care utilization, and clinical outcomes of patients discharged home directly from the ICU vs from a hospital ward.

Clinician Burnout and the Quality of Care
1/10/2018
Linzer M.
ver resumen
Burnout, a syndrome of emotional exhaustion, depersonalization, and a lack of sense of accomplishment, is a negative reaction to adverse work conditions. Prior to 2001, there were concerns about waning preferences for career choices in primary care and a developing notion that clinician satisfaction was related to favorable outcomes, again in terms of career choice by learners. In 2001, John Eisenberg, a leading health services researcher and 1 of the early directors of the Agency for Healthcare Research and Quality, defined the healthy workplace for clinicians and patients; the field of clinician well-being was then launched.

A Randomized Clinical Trial of n-of-1 Trials—Tribulations of a Trial
1/10/2018
Mirza RD, Guyatt GH.
ver resumen
In this issue of JAMA Internal Medicine, Kravitz and colleagues report, to our knowledge, the largest randomized trial comparing n-of-1 randomized clinical trials (RCTs) applied in clinical care to standard care. The investigators enrolled 215 patients undergoing management for chronic musculoskeletal pain. The investigation is noteworthy for its innovative methodology, use of mobile health tools, and failure to demonstrate any important benefit of applying the n-of-1 methodology in clinical practice.

Molecular Assay Testing to Rule Out Tuberculosis—Be That Early Adopter
1/10/2018
Salfinger M.
ver resumen
Tuberculosis (TB) infection is attributed to a slow-growing acid-fast bacilli (AFB), which requires weeks or even months for a culture to show a positive result. Since the resurgence of drug-susceptible and drug-resistant TB beginning in the mid-1980s, laboratories needed better and faster tools for diagnosis of tuberculosis. In 1991, Eisenach et al described the first laboratory-developed nucleic acid amplification test (NAAT), polymerase chain reaction (PCR), which allowed results to be available within 48 hours, being very sensitive and specific. In 1995, the US Food and Drug Administration (FDA) approved the first commercially available NAAT for tuberculosis. In 2009, the Centers for Disease Control and Prevention (CDC) recommended the universal use of a NAAT for patients with suspected pulmonary TB and “for whom the test result would alter case management or TB control activities.”(p7)

The Complexity and Challenges of Intensive Care Unit Admissions and Discharges
1/10/2018
Safavi K, Wiener-Kronish J, Hanidziar D.
ver resumen
Patients admitted to the intensive care unit (ICU) are heterogeneous in their underlying illnesses, comorbidities, and requirements for either invasive or nearly continuous monitoring of physiologic and laboratory values. There is also variance in their need for mechanical ventilation, renal replacement therapy, and other mechanical support. Given this heterogeneity, it has been difficult to make broad conclusions about “critically ill” patients.

Accounting for the Harms of Lung Cancer Screening
1/10/2018
Ebell MH, Lin KW.
ver resumen
Overdiagnosis is an often underappreciated harm of screening. In the context of cancer screening, it refers to the detection of cancers that appear histopathologically to be invasive malignant tumors but grow so slowly that they never would have become clinically evident during a usual lifetime or occur in a person who dies of another cause before the cancer symptoms appear. The causes of overdiagnosis include more sensitive screening tests, increasing biopsy rates, and lower thresholds for reporting abnormal-appearing cells in biopsy specimens as malignant.







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