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JAMA Internal Medicine - recientes

August 2017 Issue Highlight
1/8/2017
ver resumen

Fibrinolysis for ST-Elevation Myocardial Infarction
1/8/2017
Bogaty P, Brophy JM.
ver resumen
Needs Precis

Re-Enchanting Medicine
1/8/2017
Dugdale LS.
ver resumen
On occasion, we meet someone who stirs in us the ancient belief that the world is enchanted.

USPSTF Recommendations on Obesity in Children and Adolescents
1/8/2017
Block JP, Oken E.
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This Editorial highlights the importance of a comprehensive and practical approach to implementing the USPSTF recommendations on childhood obesity screening and treatment.

Cosmetics, Regulations, and the Public Health
1/8/2017
Califf RM, McCall J, Mark DB.
ver resumen
Few physicians consider cosmetics and related products relevant to their professional lives. Cosmetics, of course, are used to alter the body’s appearance, not its actual structure or function. However, the distinction between substances that only alter bodily appearance or aesthetics and medicinal compounds that affect the body’s structure or health (eg, wrinkle removal; prevention of gingivitis) is one the cosmetics industry and the US Food and Drug Administration (FDA) have struggled with for decades. As Paracelsus, the 16th-century Swiss physician and philosopher, observed, any substance applied to or in the body can cause harm, given the right circumstances.

Financial Incentives for Linkage to Care and Viral Suppression Among HIV-Positive Patients
1/8/2017
El-Sadr WM, Donnell D, Beauchamp G, et al.
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This randomized clinical trial examines the effectiveness of financial incentives on linkage to care and viral suppression in HIV-positive patients.

Medication Reminders to Improve Outcomes After Myocardial Infarction
1/8/2017
Volpp KG, Troxel AB, Mehta SJ, et al.
ver resumen
This randomized clinical trial investigates whether a system of medication reminders using financial incentives and social support delays subsequent vascular events in patients following acute myocardial infarction compared with usual care.

PREPARE Website vs an Easy-to-Read Advance Directive Among Veterans
1/8/2017
Sudore RL, Boscardin J, Feuz MA, et al.
ver resumen
This comparative effectiveness randomized clinical trial compares the efficacy of an interactive, patient-centered advance care planning website (PREPARE) with an easy-to-read advance directive to increase planning documentation.

Diagnostic Accuracy of Fecal Immunochemical Test
1/8/2017
Katsoula A, Paschos P, Haidich A, et al.
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This meta-analysis assesses the diagnostic accuracy of fecal immunochemical tests for colorectal cancer or advanced neoplasia in asymptomatic patients with an above-average risk.

Older Adults’ Views About Cancer Screening Cessation
1/8/2017
Schoenborn NL, Lee K, Pollack CE, et al.
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This qualitative interview study examines community-dwelling older adults’ perspectives on the decision to stop cancer screening when life expectancy is limited.

Antimicrobial Stewardship and Appropriate Antimicrobial Prescribing in Hospitals
1/8/2017
Sikkens JJ, van Agtmael MA, Peters EG, et al.
ver resumen
This study examines whether an antimicrobial stewardship approach grounded in behavioral theory and focusing on preserving prescriber autonomy and participation is associated with appropriateness of antimicrobial prescribing in hospitals.

Variation in Emergency Department vs Internal Medicine Excess Charges in the United States
1/8/2017
Xu T, Park A, Bai G, et al.
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This study compares Medicare charges for common physician services conducted in emergency departments vs those of internal medicine physicians in the United States.

Association Between Persistent Pain and Memory Decline and Dementia
1/8/2017
Whitlock EL, Diaz-Ramirez L, Glymour M, et al.
ver resumen
This longitudinal, population-based cohort study uses Health and Retirement Study data to investigate the association between persistent pain and memory decline and dementia.

Prevention of Catheter-Associated Urinary Tract Infection
1/8/2017
Mody L, Greene M, Meddings J, et al.
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This population-based study examines the effect of a multifaceted project to reduce the incidence of urinary tract infection in residents of nursing homes participating in the Agency for Healthcare Research and Quality Safety Program for Long-term Care.

Educational Attainment and Lifetime Risk of Cardiovascular Disease
1/8/2017
Kubota Y, Heiss G, MacLehose RF, et al.
ver resumen
This population-based observational study estimates lifetime risks of cardiovascular disease according to categories of educational attainment.

Cardiovascular Testing in Emergency Department Patients With Chest Pain
1/8/2017
Sandhu AT, Heidenreich PA, Bhattacharya J, et al.
ver resumen
This cohort analysis evaluates clinical outcomes of the association of cardiovascular testing with patients who present to the emergency department with chest pain.

Fecal Immunochemical Tests in Patients at Increased Risk for CRC
1/8/2017
Leontiadis GI.
ver resumen
Colorectal cancer (CRC) is a common cancer for which effective screening strategies are available; CRC screening strategies aim for both primary prevention (diagnosis and resection of adenomas, the precursors of the majority of CRCs) and secondary prevention (diagnosis and treatment of early-stage, asymptomatic CRC). There are 2 possible approaches: single-step screening with colonoscopy (a simultaneously diagnostic and therapeutic procedure) and 2-step screening with a triage diagnostic test, the positive results of which are followed by colonoscopy. Two-stage strategies aim to reduce the number of individuals with normal colon who undergo unnecessary colonoscopies. Obviously, triage diagnostic tests alone will not alter the natural history of colonic neoplasms or affect clinically important outcomes such as long-term CRC incidence and mortality; such beneficial effects are achieved through colonoscopies triggered by positive triage test results.

Talking to Patients About Screening Cessation
1/8/2017
Torke AM.
ver resumen
There has been a growing realization that many individuals who have advanced illness or multiple medical conditions continue to receive cancer screening that is unlikely to benefit them. Such screening tests may also cause burden owing to the cascade of interventions that follows a positive test result and the burdens of the tests themselves. This has led to an important movement to stop unnecessary cancer screening by considering risks and benefits for individual patients and communicating effectively with the patient when the benefits no longer outweigh the risks. Screening guidelines are also beginning to consider when cancer screening should be individualized based on factors such as age, comorbidity, or life expectancy. Other guidelines note that evidence is insufficient to recommend a screening test for those older than a certain age.

A Triumph for the AHRQ Safety Program for Long-term Care
1/8/2017
Turnipseed EG, Landefeld C.
ver resumen
Most Americans view nursing homes as a home of last resort, and few physicians practice in them. Many of us would prefer to drive by and look away. Yet, the care of nursing home residents is critically important: most Americans will either stay in a nursing home during the course of serious illness or will visit a loved one there. In this issue of JAMA Internal Medicine, Mody et al report results that can be used to improve care in all US nursing homes.

Why We Need to Know Patients’ Education
1/8/2017
Adler NE, Glymour M.
ver resumen
Kubota and colleagues have further strengthened the literature linking education to risk of cardiovascular disease (CVD). Using a large longitudinal community-based sample of African American and white men and women with careful outcome adjudication, they report significant associations between educational attainment and lifetime risk of CVD. The chance of incident CVD by age 85 years was 47% for 45-year-old male high school graduates vs 55% for men without high school credentials, nearly an 8–percentage point advantage. The advantage of a high school diploma was even larger for women: 15 percentage points. These associations were graded, and the gap between the highest (graduate/professional school) and lowest (grade school) education groups was 17 and 23 percentage points in men and women, respectively. Associations between education and CVD were seen for both African Americans and whites, although they were smaller for African American men and women than for their white counterparts.







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