JAMA Internal Medicine recientes

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

Project Description

JAMA Internal Medicine - recientes

August 2018 Issue Highlights
1/8/2018
ver resumen

Reviving the FDA’s Authority to Publicly Explain Why New Drug Applications Are Approved or Rejected
1/8/2018
Herder M.
ver resumen
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.

Expression of Concern
1/8/2018
Bauchner H.
ver resumen
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 Dialysis
1/8/2018
Franz D, Zheng Y, Leeper NJ, et al.
ver resumen
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.

Association of a Bundled Hospital-at-Home Program With Clinical Outcomes and Patient Experiences
1/8/2018
Federman AD, Soones T, DeCherrie LV, et al.
ver resumen
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.

Physician Participation in Medicaid Through the ACA Medicaid Primary Care Payment Increase
1/8/2018
Mulcahy AW, Gracner T, Finegold K.
ver resumen
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.

Effect of Tamsulosin on Passage of Symptomatic Ureteral Stones
1/8/2018
Meltzer AC, Burrows P, Wolfson AB, et al.
ver resumen
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.

Characterization of Failures in Infectious Agent Transmission Precaution Practices in Hospitals
1/8/2018
Krein SL, Mayer J, Harrod M, et al.
ver resumen
This qualitative study examines types of precaution practice violations and errors in reducing transmission of infectious agents by hospital personnel in clinical units.

Association of Obesity or Weight Change With Coronary Heart Disease in Young Adults in South Korea
1/8/2018
Choi S, Kim K, Kim S, et al.
ver resumen
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-management
1/8/2018
Persell SD, Karmali KN, Lazar D, et al.
ver resumen
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.

Multicenter Study of Patient-Reported Complications Associated With Indwelling Urethral Catheters
1/8/2018
Saint S, Trautner BW, Fowler KE, et al.
ver resumen
This multicenter cohort study examines infectious and noninfectious complications reported by patients up to a month after receiving an indwelling urethral catheter.

Association of Coffee Drinking With Mortality by Genetic Variation in Caffeine Metabolism
1/8/2018
Loftfield E, Cornelis MC, Caporaso N, et al.
ver resumen
This population-based study of UK Biobank data assesses the association between coffee intake and mortality according to genetic caffeine metabolism scores.

Importance of User-Centered Design and Evaluation
1/8/2018
Horwitz LI.
ver resumen
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.

Hospital-at-Home Care Programs—Is the Hospital of the Future at Home?
1/8/2018
Liao JM, Navathe A, Press MJ.
ver resumen
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.

Reforming Payment for Primary Care—It’s Not Just the Money, It’s the Payment System
1/8/2018
Goroll AH.
ver resumen
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.

Medical Expulsive Therapy for Ureteral Stones
1/8/2018
Dahm P, Hollingsworth JM.
ver resumen
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.

The Carbohydrate-Insulin Model of Obesity Is Difficult to Reconcile With Current Evidence
1/8/2018
Hall KD, Guyenet SJ, Leibel RL.
ver resumen
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.

Reforming the 340B Drug Pricing Program
1/8/2018
Coukell AJ, Dickson S.
ver resumen
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.

Clinicians and Health Care Price Transparency—Buyers vs Sellers?
1/8/2018
Sinaiko AD.
ver resumen
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.

The Carbohydrate-Insulin Model of Obesity
1/8/2018
Ludwig DS, Ebbeling CB.
ver resumen
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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