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JAMA Internal Medicine - recientes

October 2017 Issue Highlights
1/10/2017
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The Use of Storytelling in Medicine
1/10/2017
Silverman E.
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This Viewpoint describes an organization created to share stories and experiences of medical professionals.

Risk Stratification to Reduce Errors in Cervical Cancer Prevention
1/10/2017
Perkins RB, Cain JM, Feldman S.
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This Viewpoint posits that safely and effectively implementing consensus guidelines for Papanicolou and human papillomavirus testing for cervical cancer prevention requires accurate risk stratification of patients.

Making All Lives Matter in Medicine From the Inside Out
1/10/2017
Mensah MO.
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This Viewpoint examines racial bias in the health care workplace.

Don’t Just Do Something, Stand There!
1/10/2017
Sinha P.
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Penalty kicks in soccer can make fans crumple with anguish or weep with elation. The kicker sends the ball rocketing toward the goal and goalkeepers lunge acrobatically to stop it. Often the fate of the match hangs in the balance. Analyses suggest that goalkeepers may block more goals by staying stolidly in the center of the goal instead of diving to one side. Surprisingly, goalkeepers rarely adopt this strategy. One explanation is that staying in the middle looks deceptively foolish when kickers shoot toward the side. On the contrary, even when their dive is unsuccessful, goalkeepers are seen to have failed while trying. Knowing the ferocity of soccer, this is an understandable decision.

Mistakes Were Made (by Me)
1/10/2017
Manesh R.
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I still remember taking care of a particular patient when I was a medical student. She was a middle-aged woman with cyclic vomiting syndrome who presented with nausea, vomiting, and abdominal pain. The plan was the same as always: nothing by mouth, intravenous fluid, antiemetics, and discharge once she could eat. On hospital day 2 she suddenly developed chest pain. An electrocardiogram (EKG) revealed ST-segment elevations, which prompted emergent cardiac catheterization. I reviewed her admission EKG and realized it had identical ST-segment elevations. I became nauseated myself, because no one from our team had looked at the initial EKG. The angiogram excluded acute coronary syndrome, but the guilt of a potentially tragic mistake remained. I wanted to share this experience with my colleagues so we could learn from it. I asked a colleague for the best forum to discuss our mistake, and my colleague gestured “hush” and said, “There is no need to tell anyone because she didn’t have plaque rupture.” I was confused by that reaction. Was I to be ashamed of my mistake?

Meeting the Needs of Patients for Specialty Care
1/10/2017
Katz MH.
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Timely access to specialists has been a longstanding concern for patients with Medicaid compared with patients who have private insurance. Thus, instituting requirements that Medicaid managed care plans adhere to timeliness and proximity standards seems like an excellent solution to a longstanding problem. However, as with so many things in health care, the issue is more complicated.

A Call for Social Responsibility and Suicide Intervention
1/10/2017
O'Brien K, Knight JR, Jr, Harris SK.
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The national suicide rate has risen steadily in recent decades, making suicide now the second leading cause of death among young people, accounting for more than 1 in 6 deaths. Adolescent reports of suicide ideation and attempts are on the rise. According to national high school Youth Risk Behavior Survey, the percentage of high school respondents who reported that they seriously considered attempting suicide during the 12 months preceding the survey rose from 13.8% in 2009 to 17.7% in 2015; during this same interval, the percentage of high school students making a plan for how they would attempt suicide increased (10.9% to 14.6%), as did the percentage who actually attempted suicide (6.3% to 8.6%).

Consent to Study Purpose in Randomized Clinical Trials of Antibiotics
1/10/2017
Doshi P, Hur P, Jones M, et al.
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This cross-sectional analysis of trial documents submitted to regulators examines the degree to which the study purpose is explained to potential participants in randomized clinical trials of antibiotics.

Social Determinants of Health in Managed Care Payment Formulas
1/10/2017
Ash AS, Mick EO, Ellis RP, et al.
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This modeling analysis adds social determinants of health variables to a diagnosis-based payment formula that allocates funds to managed care plans and physician networks.

Association of a Communication Tool With Docusate Administration
1/10/2017
Pasay D, Guirguis M, Shkrobot R, et al.
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This study assesses the association of dissemination of an educational document about the lack of efficacy of docusate with docusate administration and whether changes in docusate administration were associated with changes in the administration of comparable laxatives.

Group Exercise Program to Improve Mobility in Older Adults
1/10/2017
Brach JS, Perera S, Gilmore S, et al.
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This cluster-randomized trial compares the effectiveness of a group exercise program that focuses on the timing and coordination of movement with a seated strength, endurance, and flexibility program (usual care) on function, disability, and walking ability of older adults.

State Access Standards and Accessibility to Specialists for Medicaid Managed Care Enrollees
1/10/2017
Ndumele CD, Cohen MS, Cleary PD.
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This study compares ratings of access to specialists for adult Medicaid and commercial insurance enrollees before and after the implementation of specialty access standards.

Identifying Patients at Risk of Hypoglycemia-Related Use
1/10/2017
Karter AJ, Warton E, Lipska KJ, et al.
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This study develops and validates a risk stratification tool to categorize risk of future hypoglycemia-related emergency department or hospital use in patients with type 2 diabetes.

Effects of Oral vs Transdermal Estrogen Therapy on Sexual Function
1/10/2017
Taylor HS, Tal A, Pal L, et al.
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This ancillary study of a randomized clinical trial assesses the effects of oral or transdermal estrogen therapy vs placebo on sexual function in postmenopausal women.

Collaborative Care for Opioid and Alcohol Use Disorders in Primary Care
1/10/2017
Watkins KE, Ober AJ, Lamp K, et al.
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This randomized clinical trial examines whether collaborative care for patients with opioid and/or alcohol use disorders improves the delivery of evidence-based treatments and increases self-reported abstinence compared with usual primary care.

Association of Evidence-Based Care Processes and Mortality in Staphylococcus aureus Bacteremia
1/10/2017
Goto M, Schweizer ML, Vaughan-Sarrazin MS, et al.
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This cohort study examines the association of evidence-based care processes in routine care for Staphylococcus aureus bacteremia with mortality at Veterans Health Administration hospitals.

Blood Pressure Lowering and Risk of Mortality in Chronic Kidney Disease
1/10/2017
Malhotra R, Nguyen H, Benavente O, et al.
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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.

Lessons From an Educational Never Event
1/10/2017
Lucey CR, Navarro R, King TE, Jr.
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The event described by Mensah in this issue occurred when he was a student at a school known for its commitment to preparing a workforce capable of meeting the needs of our increasingly diverse communities, with faculty committed to using science to solve complex problems for our most vulnerable communities, in a medical educational program with social justice as a foundational pillar.

Social and Behavioral Determinants of Spending
1/10/2017
Joynt Maddox KE.
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A growing proportion of state and federal health care dollars are spent via managed care, in which government pays private companies to administer insurance coverage on its behalf. Recent reports suggest that as many as 77% of Medicaid beneficiaries are enrolled in some type of managed care plan, and Medicare Advantage, which is Medicare’s managed care option, now enrolls nearly a third of Medicare beneficiaries.







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