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JAMA Internal Medicine - recientes

June 2017 Issue Highlights
1/6/2017
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Hiding in Plain Sight
1/6/2017
Gupta S, Saint S, Detsky AS.
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This Viewpoint reviews the importance of physical inspection on, or shortly after, initial contact with a patient.

Promoting Mobility and Preventing Falls in the Hospital
1/6/2017
Growdon ME, Shorr RI, Inouye SK.
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This Viewpoint explains the Hospital Elder Life Program (HELP), which enhances mobility for elderly patients while decreasing the risk of falls in the hospital setting, and how implementing programs like HELP can have several potentially beneficial effects.

Early Palliative Care in Advanced Illness
1/6/2017
Iyer AS, Bakitas M.
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As the on-call pulmonary critical care fellow, I listened to a family member plead with me to “do right by Mama.”

Physician Adherence to Breast Cancer Screening Recommendations
1/6/2017
Grady D, Redberg RF.
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We found the Research Letter by Radhakrishnan et al rather dispiriting. It suggests that a large proportion of primary care physicians recommend screening mammography for women who are more likely to experience harms than benefits from the examination. Owing to the greater chance of harm, neither the American Cancer Society nor the US Preventive Services Task Force (USPSTF) recommend routine screening mammography for women ages 40 to 44 years. Despite this, 81% of the primary care physicians surveyed in this study reported that they recommend mammography to women in this age range.

Interactive Voice Response–Based Self-management for Chronic Back Pain
1/6/2017
Heapy AA, Higgins DM, Goulet JL, et al.
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This noninferiority randomized trial assesses the efficacy of interactive voice response–based cognitive behavioral therapy compared with in-person cognitive behavioral therapy for chronic back pain.

Antiviral Therapy for Prevention of Cytomegalovirus Reactivation in Critically Ill Patients
1/6/2017
Cowley NJ, Owen A, Shiels SC, et al.
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This randomized clinical trial assesses whether antiviral therapy is safe and effective for preventing cytomegalovirus reactivation in a general population of critically ill patients.

Gastric Acid Suppression and Recurrent Clostridium difficile Infection
1/6/2017
Tariq R, Singh S, Gupta A, et al.
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This meta-analysis examines the association between recurrent Clostridium difficile infection and use of gastric acid suppressant medications.

Intensive Blood Pressure Control and Kidney Disease Progression
1/6/2017
Tsai W, Wu H, Peng Y, et al.
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This meta-analysis compares intensive blood pressure control (<130/80 mm Hg) with standard blood pressure control (<140/90 mm Hg) on major renal outcomes in patients with chronic kidney disease without diabetes.

Cost-effectiveness of Diagnostic Approaches for Asymptomatic Microscopic Hematuria
1/6/2017
Halpern JA, Chughtai B, Ghomrawi H.
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This study analyzes cost-effectiveness strategies for the initial diagnostic evaluation of patients with asymptomatic microscopic hematuria.

Optimizing Radiation Doses for Computed Tomography Across Institutions
1/6/2017
Demb J, Chu P, Nelson T, et al.
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This study assesses changes in computed tomography radiation doses across 5 University of California medical centers after implementation of institutional-level audit and collaborative efforts to share best practices.

Patient-Centered Approaches to Sexual Orientation and Gender Identity
1/6/2017
Haider AH, Schneider EB, Kodadek LM, et al.
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This study determines attitudes and beliefs of patients and health care professionals on patients’ willingness to provide information on sexual orientation in the emergency department setting.

Low-Value Medical Services in the Safety-Net Population
1/6/2017
Barnett ML, Linder JA, Clark CR, et al.
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This cross-sectional study measure rates of low-value and high-value care received by patients without insurance or with Medicaid compared with privately insured patients, and provided by safety-net vs non–safety-net physicians.

Primary Care Practice Location and the Provision of Low-Value Care
1/6/2017
Mafi JN, Wee CC, Davis RB, et al.
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This study of a nationally representative sample of primary care visits assesses the association of hospital location and hospital ownership with the provision of low-value health services.

Communication Training and Nursing Home Antipsychotic Use Reductions
1/6/2017
Tjia J, Hunnicutt JN, Herndon L, et al.
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This quasi-experimental longitudinal study quantifies the influence of a large-scale communication training program on nursing home antipsychotic use.

Donor Age and Sex and Survival of Patients Receiving Transfusions
1/6/2017
Edgren G, Ullum H, Rostgaard K, et al.
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This cohort study examines the association of donor age and sex with survival of patients receiving transfusions in Sweden and Denmark.

Value-Based Reforms and the Hospital Readmission Reduction Program
1/6/2017
Ryan AM, Krinsky S, Adler-Milstein J, et al.
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This longitudinal study assessed whether US hospital participation in voluntary value-based reforms was associated with improvement under Medicare’s Hospital Readmission Reduction Program.

Asymptomatic Microscopic Hematuria
1/6/2017
Subak LL, Grady D.
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Asymptomatic microscopic hematuria (AMH) is a common problem that can occasionally be a marker of severe disease, including urinary tract cancer. Although there are some areas of agreement related to the definition and evaluation of AMH, there remains considerable discussion regarding the need for evaluation of AMH and the most accurate and cost-effective tests. To a large extent, this disagreement is owing to limited evidence on the accuracy of available tests to identify cancer, and to the complete lack of evidence regarding the benefit of identifying urologic cancer before the patient becomes symptomatic. In this issue of JAMA Internal Medicine, Halpern et al add to the discussion by presenting estimates of the effectiveness and cost per cancer detected for 4 common approaches to the evaluation of AMH.

Communicating Context in Quality Improvement Reports
1/6/2017
Gonzales R, Boscardin C, Auerbach A.
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The study by Demb and colleagues reports on the positive results of an intervention strategy to reduce excess radiation exposure across 5 academic medical centers associated with the University of California. Leading up to this intervention, a variety of initiatives and recommendations had been implemented across these institutions to help guide institutions in this effort. However, significant variation between institutions had remained, in part because single institutions found it difficult to determine the “right” dose of radiation that balances diagnostic accuracy and minimizes radiation exposure for the patient. By creating a venue for leaders from the 5 institutions to collectively define and standardize best practices, with allowance for flexibility within each institution to create an optimal set of tactics best suited for each institution, the study team hypothesized that greater reductions (and less variation) in radiation exposure could be achieved. And they were right.

Statistical Caution in Big Data Approaches to Transfusion Medicine Research
1/6/2017
Roubinian N, Brambilla D, Murphy EL.
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Allogeneic blood transfusions involve complex biological products prepared from donated blood and are considered unique in many respects compared with other health care therapeutics. Blood donors are a demographically and genetically diverse group of individuals with inherited differences that may affect the stability of and outcomes associated with transfused blood components. Given the inherent variation in donated blood, most countries use a regulatory authority, such as the US Food and Drug Administration, to monitor factors associated with blood collection, manipulation, storage, and safety. Following significant advances in the reduction of infectious risks that have been associated with allogeneic blood transfusion during the past 2 decades, there has been a concerted effort to understand and improve the quality and potency of donated blood components. Recent efforts have been devoted to understanding the effect of blood processing methods, storage solutions, and duration of blood product storage on the quality of the product.







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