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In This Issue of JAMA Internal Medicine
May 2015


JAMA Intern Med. 2015;175(5):677-679. doi:10.1001/jamainternmed.2014.5064

While vitamin D supplementation and exercise are recommended for prevention of falls for older people, results regarding these 2 factors are contradictory. In this randomized clinical trial, Uusi-Rasi and colleagues examined the effects of vitamin D and exercise on physical functioning, falls, and fall injuries among home-dwelling women aged 70 to 80 years. They found that neither treatment had an effect on the total number of falls, but exercisers had a reduced rate of injurious falls and improvement in physical functioning. Vitamin D did not affect the rate of falls or physical functioning, nor did it enhance exercise effects on physical functioning. LeBlanc and Chou provide an Invited Commentary.

Invited Commentary

Reassurance is a core aspect of daily medical practice. Traeger and colleagues performed a systematic review and meta-analysis to test whether education interventions are reassuring for patients with acute low back pain. Their results suggest that compared with usual care, structured patient education is associated with increased reassurance about low back pain and decreased subsequent health care use. Brief interventions were equally, if not more, effective than longer interventions. The largest effects were seen when physicians provided the education. Chou provides an Invited Commentary.

Invited Commentary

The relationship of vegetarian dietary patterns to colorectal cancer risk is not well established. Orlich and colleagues examined the association of vegetarian dietary patterns with incident colorectal cancer among 77 659 members of the Adventist Health Study 2, a North American cohort with a large proportion of vegetarians. They found that vegetarian diets are associated with an overall lower incidence of colorectal cancers. The association was particularly strong in pescovegetarians, who eat fish but no other meats.

Proton pump inhibitors (PPIs) are associated with a first episode of Clostridium difficile infection (CDI) and are frequently overprescribed. McDonald and colleagues conducted a retrospective cohort study of 809 patients with incident health care–associated CDI cases to determine the association between PPI use and CDI recurrence within 90 days. In the multivariable analysis, continuous PPI use was independently associated with recurrence. Use of PPIs was common (61% of patients), with only 48% of patients having an evidence-based indication for therapy. Nonetheless, PPI use was only stopped in 3 cases.

Continuing Medical Education

In a national survey of 1422 radiation oncologists and urologists to assess attitudes toward decision aids (DAs) and shared decision making for prostate cancer, Wang and colleagues asked respondents about familiarity, perceptions, and use of DAs for clinically localized prostate cancer as well as trust in various professional societies in developing decision aids. While most respondents had some familiarity with DAs, only 35% currently use a DA in their clinic. The use of DAs among urologists and radiation oncologists treating patients with prostate cancer remains relatively low in part because of a lack of familiarity with such tools. Barry provides an Invited Commentary.

Invited Commentary

Little is known about the deadoption of ineffective or harmful clinical practices. Using a large database of patients admitted to adult intensive care units in the United States, Niven and colleagues found there was slow adoption of tight glycemic control following an initial clinical trial suggesting it reduced mortality (Leuven I trial), with little to no deadoption following a confirmatory trial that demonstrated it increased mortality (the Normoglycemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation [NICE-SUGAR]). These results highlight the urgent need to understand and promote the deadoption of ineffective clinical practices. Davidoff provides an Invited Commentary.

Invited Commentary, Related Articles 1 and 2

Physicians have long struggled to find the ideal balance between patient autonomy and the obligation to act in the patient’s best interest. Through semistructured interviews at 4 sites in the United States and United Kingdom, Dzeng and colleagues hypothesize that the degree to which a hospital’s culture and policies prioritize these ethical principles affects a physician’s willingness to make recommendations to implement a do-not-resuscitate order if successful resuscitation is unlikely. Although experienced physicians at all sites were willing to make recommendations against resuscitation if appropriate, physician trainees varied in their understanding of autonomy and willingness to recommend, based on their institutions’ prioritization of patient autonomy vs best interest. Mills and Anderson provide an Invited Commentary.

Invited Commentary

Clinical Review & Education

Perioperative medicine has evolved considerably over the past 3 decades. Eagle and colleagues provide an update in the perioperative cardiovascular care in patients undergoing noncardiac surgery. They highlight the current guidelines for preoperative testing, advocating for the use of validated risk stratification tools that help limit such testing to circumstances in which it may change perioperative management. Medical strategies for improving perioperative outcomes are discussed, including a statement on current guidelines for the perioperative use of β-blockade. Davidoff provides an Invited Commentary.

Invited Commentary and Related Articles 1 and 2