Bischoff-Ferrari and colleagues compared monthly higher doses of vitamin D (60 000 IU of vitamin D3 or 24 000 IU of vitamin D3 plus calcifediol) with monthly 24 000 IU vitamin D3 and found that the higher doses were effective in achieving a threshold of at least 30 ng/mL 25-hydroxyvitamin D at 6 and 12 months. However, both higher doses conferred no benefit on the prevention of functional decline and increased falls in patients 70 years and older with a prior fall event.
Cunningham and colleagues mailed nicotine patches to a cohort of adult smokers recruited across Canada. The study participants did not receive behavioral support on tobacco cessation. Cunningham and colleagues found that providing a 5-week supply of nicotine patches via mail resulted in more than a doubling of 30-day abstinence quit rates at a 6-month follow-up compared with a no intervention control group that did not receive nicotine patches. Importantly, those who did not receive nicotine patches were unaware that the nicotine patches were being offered to others. Because this instance of nicotine replacement therapy was performed without behavioral assistance, the results of this trial provide evidence for the effectiveness of nicotine patches as a tobacco cessation aid in real-world settings.
Fenton and colleagues tested the effectiveness of a standardized patient-based intervention designed to boost resident physician skill and patient-centeredness during encounters with patients who request low-value diagnostic tests. Within 2 academic primary care clinics, the intervention had no detectable effect on patient-centeredness, use of targeted counseling techniques, or ordering of requested low-value tests during postintervention visits with unannounced standardized patients, but standardized patients were significantly more satisfied with intervention physicians.
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Steffens and colleagues found that exercise—alone or in combination with education—probably prevents back pain. In contrast, education alone, back belts, shoe insoles, and ergonomic interventions may not prevent back pain or sick leave due to back pain. Because back pain is a major worldwide disease, these findings have potential significant implications on both the clinical level and policy level.
Continuing Medical Education
In a Swedish national cohort study of over 1.5 million military conscripts in Sweden, Crump and colleagues found that high body mass index (BMI) and low aerobic capacity were together associated with a 3.5-fold risk of hypertension in adulthood. Although high BMI was the strongest risk factor for hypertension, low aerobic capacity was also a strong risk factor among patients with a normal BMI. If confirmed, these findings suggest that interventions to prevent hypertension should begin early in life and include both weight control and aerobic fitness, even among those with a normal BMI.
Dharod and colleagues conducted a longitudinal analysis to determine if asymptomatic bradycardia had protective or deleterious associations with incident cardiovascular disease and mortality. Results indicate that asymptomatic bradycardia is not harmful in most adults. The findings also suggest the possibility that, in the subgroup taking heart rate modifying medications, a heart rate below 50 bpm is associated with an increased risk of mortality compared with a heart rate above 50 bpm.
Wong and colleagues performed a qualitative analysis of the electronic medical records of a randomized cohort of 1691 patients in the United States receiving care within the Department of Veterans Affairs Veterans Health Administration who initiated maintenance dialysis between January 1, 2000, and December 31, 2009. Analysis of the medical records suggested that dialysis initiation occurred at the intersection of at least 3 interrelated and dynamic processes. These processes included the care practices of individual physicians, clinical events that served as sources of momentum for dialysis initiation, and the interactions between patients and physicians.
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Lazarus and colleagues evaluated the association between proton pump inhibitors and the development of chronic kidney disease in the Atherosclerosis Risk in Communities study and replicated results in the Geisinger Health System. Lazarus and colleagues found that proton pump inhibitor use was associated with a 20% to 50% increased risk of chronic kidney disease that persisted in all sensitivity analyses. In contrast, the use of histamine2 receptor antagonists, a class of medications prescribed for the same indication as proton pump inhibitors, was not associated with chronic kidney disease.
Highlights. JAMA Intern Med. 2016;176(2):151-153. doi:10.1001/jamainternmed.2015.4858