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Reducing Nicotine in Cigarettes
Reducing the nicotine content of cigarettes to a minimally addictive level could decrease smoking prevalence by inhibiting the progression of smoking initiation to nicotine dependence. Hatsukami and colleagues randomized 1250 daily smokers to receive cigarettes with immediate vs gradual reductions of nicotine and found that the immediate reduction group had greater decreases in biomarkers of smoke exposure.
Effect of Bundled Payments on Quality and Costs
The rationale for combining payments for all services related to a specific treatment, such as hip replacement, is to encourage coordination of care and reduce unnecessary utilization. In a randomized trial of hospital payment models for lower extremity joint replacement in 196 metropolitan statistical areas, Finkelstein and colleagues found that areas covered by a bundled payment model had a lower proportion of patient discharges to institutional postacute care but no difference in total spending per joint replacement episode. In an Editorial, Ryan suggests that studies of bundled payment programs will lead to further improvements in quality and cost control.
Editorial and Related Article
Volume and Case Mix in a Bundled Payment Program
It has been suggested that voluntary bundled payment programs may prompt hospitals to “cherry pick” lower-risk patients to enhance quality and cost performance. Navathe and colleagues analyzed claims data for total of 1 717 243 Medicare beneficiaries who underwent lower extremity joint replacement and found that hospital participation in a bundled payment program was not associated with changes in procedure volume and was associated with minimal changes in case mix.
Clinical Review & Education
Screening for Syphilis Infection in Pregnant Women
Congenital syphilis is associated with bone deformities, neurologic impairment, stillbirth, and neonatal death. This US Preventive Services Task Force statement recommends early screening for syphilis infection in all pregnant women.
Related Article and JAMA Patient Page
Outcomes of Syphilis Screening in Pregnancy
The incidence of congenital syphilis in the United States has increased after reaching historic lows in the early 2000s. Lin and colleagues reviewed 7 studies and found that screening for syphilis infection in pregnant women is associated with a decreased incidence of congenital syphilis.
Drugs for Tobacco Dependence
Pharmacologic treatments can help nicotine-dependent patients quit smoking by relieving cravings and withdrawal symptoms. This Medical Letter on Drugs and Therapeutics discusses the efficacy and safety of nicotine replacement therapies, bupropion, and varenicline for the treatment of nicotine dependence.
Highlights. JAMA. 2018;320(9):849–851. doi:10.1001/jama.2017.12526
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