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In This Issue of JAMA
October 1, 2014


Author Affiliations

Copyright 2014 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA. 2014;312(13):1273-1275. doi:10.1001/jama.2013.279753

Readmissions after hospital discharge are common, and interventions that reliably reduce readmission rates have not been identified. To assess the effect of a postdischarge virtual ward—an interprofessional team approach to community-based care after hospital discharge—on hospital readmissions and mortality, Dhalla and colleagues randomly assigned 1923 hospital patients at high risk of readmission to either the virtual ward or usual follow-up care. The authors found the virtual ward model of care did not reduce the composite outcome of readmission or death within 30 days of hospital discharge. In an Editorial, Boling discusses challenges and opportunities in managing care transitions after a hospitalization.

Editorial Related Article

Author Video Interview and Continuing Medical Education

To assess the efficacy of laser and needle acupuncture for chronic knee pain, Hinman and colleagues randomly assigned 282 patients with moderate to severe knee pain of 3 months’ duration or longer to receive needle acupuncture, laser acupuncture, sham laser acupuncture, or no acupuncture (control) for 12 weeks. The authors report that compared with sham laser acupuncture, neither needle nor laser acupuncture treatment resulted in significant improvement in patients’ reports of pain or function.

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Author Audio Interview

The optimal valve prosthesis for younger patients with severe aortic valve disease needing valve replacement is not clear. In a retrospective cohort analysis of 4253 patients aged 50 to 69 years who underwent either bioprosthetic or mechanical primary aortic valve replacement, Chiang and colleagues compared long-term outcomes according to valve type. The authors report that among 2002 propensity-matched patients, replacement valve type was not associated with a significant difference in 15-year survival or stroke rate. Patients who received a bioprosthetic valve had a greater likelihood of reoperation and a lower likelihood of bleeding.

Clinical Review & Education

Holland and colleagues report results of a systematic review of the evidence relating to 2 unresolved questions in the management of patients with Staphylococcus aureus bacteremia: Is transesophageal echocardiography necessary in all cases, and what is optimal antibiotic therapy for methicillin-resistant S aureus (MRSA) bacteremia. Based on their evidence review, the authors conclude that all patients with S aureus bacteremia should undergo echocardiography and that first-line antibiotic therapy for MRSA bacteremia is vancomycin or daptomycin.

When assessing the clinical utility of therapies intended to improve subjective outcomes such as pain or function, the smallest amount of improvement important to patients—the minimal clinically important difference—must be determined. In this JAMA Guide to Statistics and Methods article, McGlothlin and Lewis discuss methods of determining the minimal clinically important difference and explain why this measure is important in study design and interpretation.

Related Article

A recent article in JAMA Internal Medicine reported results of a systematic review and meta-analysis of data from randomized trials of interventions to reduce early hospital readmissions. Among the authors’ findings was that effective interventions are complex and support patients’ capacity for self-care after hospital discharge. In this From the JAMA Network article, Chokshi and Chang discuss factors associated with successful recovery or readmission after a hospitalization.

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