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In This Issue of JAMA Internal Medicine
May 13, 2013

In This Issue of JAMA Internal Medicine

JAMA Intern Med. 2013;173(9):722. doi:10.1001/jamainternmed.2013.51

This study evaluates the extent to which an intervention (Working Inside for Smoking Elimination [WISE]), based on motivational interviewing and cognitive behavior, decreases relapse to smoking after being released from a smoke-free prison. A total of 262 inmates who smoked prior to incarceration were recruited approximately 8 weeks before their release. Participants were randomized to 6 weekly sessions of either education videos (control) or the WISE intervention. At the 3-week follow-up, 25% of the WISE intervention and 7% of the control participants continued to be tobacco abstinent (odds ratio, 4.4; 95% CI, 2.0-9.7). In the logistic regression analysis, participants randomized to the WISE intervention were 6.6 (95% CI, 2.5-17.0) times more likely to remain tobacco abstinent at the 3-week follow-up than those randomized to the control condition.

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In this nationwide population-based case-control study including 38 765 patients with venous thromboembolism diagnosed between 2005 and 2011 and 387 650 population controls matched by birth year and sex, Johannesdottir et al found that compared with nonusers, present users of systemic glucocorticoids (use within 90 days before the index date) were at a 2-fold increased risk of venous thromboembolism, particularly of pulmonary embolism. New users were at highest risk. The effect prevailed, although less pronounced, for inhaled glucocorticoids and glucocorticoids acting on the intestines.

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To estimate the association between nonbenzodiazepine hypnotic drug use and the risk for hip fracture, overall and stratified by individual and facility-level characteristics, Berry et al conducted a case-crossover study among a nationwide sample of 15528 long-stay nursing home residents. Odds ratios of hip fracture were estimated using conditional logistic regression models by comparing the exposure to nonbenzodiazepine hypnotic drugs during the 0 to 29 days before the hip fracture (hazard period) with the exposure during the 60 to 89 and 120 to 149 days before the hip fracture (control periods). The results demonstrate that the risk of hip fracture was elevated among nonbenzodiazepine hypnotic users (odds ratio, 1.66; 95% CI, 1.45-1.90).

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Heyland et al administered an in-person questionnaire to 278 elderly patients who were at high risk of dying in the next 6 months and their family members to understand their engagement in advance care planning and preferences for end-of-life (EOL) care. They found that prior to hospitalization, most patients (76.3%) had thought about EOL care, 47.9% had completed an advance care plan, and 73.3% had formally named a surrogate decision maker for health care. Of patients who had discussed their wishes, only 30.3% had done so with the family physician and 55.3% with any member of the health care team. Agreement between patients who expressed preferences for EOL care and documentation in the medical record was 30.2%. The authors conclude that many elderly patients at high risk of dying and their families have expressed preferences for medical treatments at EOL.

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In a prospective cohort study of 984 outpatients with stable coronary heart disease, higher levels of cardiac troponin T measured with a high-sensitivity assay (hs-cTnT) were associated with higher rates of myocardial infarction, heart failure, and cardiovascular death. Participants in the highest tertile of hs-cTnT level experienced cardiovascular events at 5 times the rate of participants in the lowest tertile of hs-cTnT. After adjusting for clinical risk factors, measures of cardiac structure and function, and other biomarkers, hs-cTnT remained independently associated with a higher risk of events.

Rates of separate and combined cardiovascular events outcomes by tertile of hs-cTnT level.

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