JAMA Internal Medicine - recientes
This Viewpoint examines the US Food and Drug Administration’s ability to make the reasons for its regulatory decisions to approve, and in some cases to reject, drugs clear to the public.
This Expression of Concern warns of potential validity issues with articles written by Brian Wansink and published in JAMA and the JAMA Network journals.
Rates of Lower Extremity Amputation Among Patients With End-stage Renal Disease Who Receive Dialysis1/8/2018
Franz D, Zheng Y, Leeper NJ, et al.
This study uses more than 3 million records from the US national end-stage renal disease registry between 2000 and 2014 to assess the rates of lower extremity amputation among patients with end-stage renal disease who receive dialysis and whether those rates are associated with patient characteristics and comorbidities.
Federman AD, Soones T, DeCherrie LV, et al.
This case-control study compares the patient outcomes and ratings of care between patients who received hospital-at-home care bundled with a 30-day postacute transitional care period vs traditional inpatient care.
Mulcahy AW, Gracner T, Finegold K.
This longitudinal analysis evaluates the Patient Protection and Affordable Care Act Medicaid primary care payment increase policy and assesses whether it was associated with changes in Medicaid participation rates or Medicaid service volume among primary care physicians.
Meltzer AC, Burrows P, Wolfson AB, et al.
In this randomized clinical trial, participants were randomized to treatment with either tamsulosin, 0.4 mg, or matching placebo daily for 28 days to determine if tamsulosin promotes the passage of urinary stones within 28 days among emergency department patients.
Krein SL, Mayer J, Harrod M, et al.
This qualitative study examines types of precaution practice violations and errors in reducing transmission of infectious agents by hospital personnel in clinical units.
Choi S, Kim K, Kim S, et al.
This population-based longitudinal study assesses whether an association exists between body mass index or a change in body mass index and coronary heart disease among more than 2.6 million young adults in South Korea.
Effect of EHR-Based Medication Support and Nurse-Led Education on Hypertension Medication Self-management1/8/2018
Persell SD, Karmali KN, Lazar D, et al.
This cluster randomized clinical trial assesses medication management tools delivered through a commercial electronic health record (EHR) with and without a nurse-led education intervention vs usual care among patients with hypertension and complex drug regimens.
Saint S, Trautner BW, Fowler KE, et al.
This multicenter cohort study examines infectious and noninfectious complications reported by patients up to a month after receiving an indwelling urethral catheter.
Loftfield E, Cornelis MC, Caporaso N, et al.
This population-based study of UK Biobank data assesses the association between coffee intake and mortality according to genetic caffeine metabolism scores.
The 2002 severe acute respiratory syndrome outbreak in Asia and the 2014 Ebola virus disease outbreak in Africa collectively infected thousands of health care workers and dramatically raised their consciousness about the correct use of personal protective equipment (PPE). A combination of intensive training, ample equipment, rigorous protocols, direct observation, and triage of patients to specialized centers ensured that only 3 of the hundreds of health care workers who cared for 24 patients with Ebola infection in the United States and Europe became infected.
Liao JM, Navathe A, Press MJ.
Medicare continues to lead the national effort to improve health care value by reforming how clinicians and hospitals are paid. Participation in Medicare’s prominent alternative payment models, such as accountable care organizations (ACOs) and bundled payments, has been associated with some promising early results. Under new incentives created by the 2015 Medicare Access and CHIP Reauthorization Act, engagement in these and other value-based payment models will continue to increase.
Poor Medicaid reimbursement stands as a frequently cited cause of reluctance by many primary care practices to serve Medicaid’s expanding population. With payment rates a fraction of those for Medicare and commercial insurance, most primary care practices find Medicaid reimbursement insufficient. The expansion of Medicaid eligibility by the Patient Protection and Affordable Care Act (ACA) creates an urgent need to engage more primary care practices and, if already participating, to expand their Medicaid roles. To encourage this expansion, the ACA legislated a normalizing of Medicaid reimbursement so that the reimbursement matched Medicare fee-for-service (FFS) rates.
Dahm P, Hollingsworth JM.
In this issue of JAMA Internal Medicine, Meltzer and colleagues report the results of a randomized clinical trial assessing the role of an α-blocker, tamsulosin, among patients presenting to the emergency department with renal colic secondary to a ureteral stone. In the absence of indications for immediate intervention (eg, pyelonephritis, obstruction of a solitary kidney, intractable pain), a trial of conservative treatment is warranted in this population, given that many patients will pass their stones spontaneously. However, since a number will fail conservative treatment and require a procedure for stone removal, there is great interest in strategies for increasing the likelihood of stone passage. The use of α-blockers like tamsulosin and calcium channel blockers, commonly referred to as medical expulsive therapy, has been championed as one such strategy.
Hall KD, Guyenet SJ, Leibel RL.
Ludwig and Ebbeling compare 2 mechanistic models of obesity, the so-called conventional model (CM) and the carbohydrate-insulin model (CIM). The CM considers energy intake and expenditure to be functionally independent processes receiving no feedback from circulating fuels or endocrine signals. Food intake and physical activity are portrayed to be under conscious control, albeit subject to environmental influences. Thus, preventing and treating obesity simply requires the willpower to eat less and move more.
Coukell AJ, Dickson S.
The maligned and ardently defended 340B drug pricing program allows qualifying hospitals and clinics (those serving a disproportionate share of low-income patients or receiving federal grants to provide specific services) to generate revenue by purchasing prescription drugs from pharmaceutical manufacturers at discounted prices while being reimbursed by Medicare and other payers at standard levels. The discounted price available to 340B purchasers has 2 components: a fixed base discount (23.1% for brand drugs) and an additional discount triggered by manufacturer price increases greater than inflation (termed the inflation penalty). This inflation penalty accounts for more than one-half of the 340B discount.
The inaccessibility of price information in the US health care system prevents patients from anticipating and incorporating their health care costs into care-seeking decisions and from choosing the best-value clinician (physician or facility). There is wide price variation across clinicians in the same geographic areas, which means that patients, especially those enrolled in high-deductible health plans, can potentially spend less for many services. The goal behind health care price transparency is that prices can be part of a patient’s decision about where to seek care, giving clinicians an incentive to lower costs or make a compelling case for the comparative quality of care to attract patients. Increasing transparency could also benefit the health care system broadly because it would be increasingly difficult for clinicians to charge significantly higher prices than others without commensurate differences in quality; these high prices are a key contributor to higher health care spending in the US relative to other countries who are members of the Organisation for Economic Co-operation and Development.
Ludwig DS, Ebbeling CB.
This article discusses the association of a high-carbohydrate diet with postprandial hyperinsulinemia, deposition of calories in fat cells instead of oxidation in lean tissues, and predisposion to weight gain through increased hunger, slowing metabolic rate, or both.
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