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In This Issue of JAMA Internal Medicine
Mar 11, 2013

In This Issue of JAMA Internal Medicine

JAMA Intern Med. 2013;173(5):333. doi:10.1001/jamainternmed.2013.2704

To examine motivations for using dietary supplement, Bailey et al analyzed data from 11 956 adults in the 2007-2010 National Health and Nutrition Examination Survey. The most commonly reported reasons were to “improve” (45%) or “maintain” (33%) overall health. Women used calcium products for “bone health” (36%), whereas men were more likely to report supplement use for “heart health or to lower cholesterol” (18%). Older adults were more likely than younger adults to report motivations related to site-specific reasons such as heart, bone and joint, and eye health. Multivitamin-mineral products were the most frequently reported type of supplement taken, followed by calcium and ω-3 or fish oil supplements. Less than a quarter of supplements used by adults were recommended by a physician or health care provider.

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Michtalik et al surveyed more than 500 hospitalist attending physicians about their practice environments, clinical workload, and perceptions regarding the frequency of an unsafe census. Physicians rated the impact of average census on process and outcome measures using a Likert scale. Forty percent of hospitalists reported unsafe workloads at least monthly. Nearly one-quarter of hospitalists reported that excess workload had an adverse impact on patient outcomes. Twenty-two percent of physicians reported ordering potentially unnecessary tests, procedures, or consults because of not having adequate time.

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This study describes the content of conflicts of interest (COI) policies for US state Medicaid drug selection committees. Policy documents from 27 Medicaid programs were available for analysis. In general, COI policies were not readily available, were highly variable, and had inconsistent enforcement and management of COI. This variability suggests that some policies may not adequately protect drug selection decisions against COI and industry influence. This article describes model core components of a COI policy for disclosure, management, and review of COI within drug selection committees.

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In this study, Weitzman et al engaged an online diabetes social network in reporting about recent and severe hypoglycemia and related patient-centered harms using a privacy-preserving software application that supports bidirectional communication and feedback of research results. They found high prevalence of hypoglycemia. Of 613 respondents, 301 (49.1%) reported experiencing more than 4 episodes of “going low” in the past 2 weeks, using a patient-centered measure, whereas 29.2% reported 1 or more episode of severe hypoglycemia in the past year; 16.6% reported both more than 4 recent lows and 1 or more severe low in the past year. The participatory surveillance model uses consumer engagement in disease-centered online social networks, establishing a new channel between researchers, public health, and individuals.

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Good decision making about prostate-specific antigen (PSA) screening involves men considering how they value the different potential outcomes, but the effects of different methods of helping men consider such values have not been well studied. This study compared 3 methods of values clarification: (1) a balance sheet, (2) rating and ranking task, and (3) a discrete choice experiment in 911 US and Australian men recruited from a survey research firm. The different techniques produced different responses for the most important decision attribute and some differences in the proportion of men preferring the PSA-like option in an unlabeled choice task. However, intent for PSA screening was high and did not differ by values clarification technique when respondents answered a labeled question about intent to have PSA testing, suggesting a strong labeling effect.

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