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In This Issue of JAMA Internal Medicine
July 2018

Highlights

JAMA Intern Med. 2018;178(7):881-883. doi:10.1001/jamainternmed.2017.5219
Research

For this repeated cross-sectional study, Naimi and colleagues developed the Alcohol Policy Scale (APS), which assesses the degree of implementation and the efficacy of 29 alcohol policies from 1999 to 2014 in the United States, to examine the association between the restrictiveness of state alcohol policy environments and the likelihood of alcohol involvement among those dying in motor vehicle crashes in the United States. Results demonstrated that each 10–percentage point increase in the APS score (corresponding to more restrictive state policies) was associated with reduced individual-level odds of alcohol involvement in a crash fatality. Rosekind provides the Invited Commentary.

Invited Commentary

Lazarus and colleagues performed a community-based cohort study of 2 large populations of patients with diabetes to quantify the association between metformin use and hospitalization with acidosis across the range of estimated glomerular filtration rate (eGFR), accounting for change in eGFR stage over time. Compared with alternative diabetes management, time-dependent metformin use was not associated with incident acidosis overall or in patients with higher eGFR. However, metformin use was associated with an increased risk of acidosis in patients with lower eGFR. Good and Pogach provide the Invited Commentary.

Invited Commentary

In this systematic review and meta-analysis of 10 randomized clinical trials with 4147 unique patients who presented with ST-segment elevation myocardial infarction (STEMI), Dahal and colleagues examined existing literature to determine the role of therapy with aldosterone antagonists in this patient population. The outcomes analyzed were mortality, new congestive heart failure, recurrent myocardial infarction, ventricular arrhythmia, and changes in left ventricular ejection fraction (LVEF), serum potassium level, and creatinine level at follow-up. Results showed that treatment with aldosterone antagonists is associated with a mortality benefit in patients with STEMI with LVEF greater than 40% or without heart failure. Pitt and Zannad provide the Invited Commentary.

Invited Commentary

Continuing Medical Education

Loizeau and colleagues analyzed the combined data from 2 cohort studies that prospectively followed 764 residents with advanced dementia and their proxies in Boston-area nursing homes for 12 months to determine the accuracy of proxies’ prognostic estimates for residents, identify factors associated with those estimates, and examine the association between their estimates and use of burdensome interventions. Results showed proxies estimated the prognosis of residents with moderate accuracy and that being asked their opinion about the goal of care was associated with the proxies’ perception that the resident had less than 6 months to live; that perception was associated with a lower likelihood that the resident experienced burdensome interventions.

Continuing Medical Education

In this randomized clinical trial, Curtis and colleagues evaluated the effect of a communication-priming intervention designed to increase patient-reported goals-of-care discussions between patients with serious illness and clinicians. The primary outcome was patient-reported occurrence of a goals-of-care conversation during a target outpatient visit. This intervention increased the occurrence, documentation, and quality of goals-of-care communication during routine outpatient visits and increased goal-concordant care at 3 months among patients with stable goals, with no change in symptoms of anxiety or depression. Paladino and Bernacki provide the Invited Commentary.

Invited Commentary

In this 9-month randomized clinical trial conducted at Massachusetts General Hospital, Finn and colleagues examined the effect of increased attending physician supervision on a resident inpatient team for both patient safety and educational outcomes. Twenty-two faculty provided either increased direct supervision, in which attending physicians joined work rounds on previously admitted patients, or standard supervision, in which attending physicians were available but did not join work rounds. Each faculty member participated in both arms in random order. Results showed the medical error rate was not significantly different between standard vs increased supervision. Happel and colleagues provide the Invited Commentary.

Invited Commentary

Mitchell and colleagues examined whether an advance care planning video had an effect on documented advance directives, level of care preferences, goals-of-care discussions, and burdensome treatments among nursing home residents with advanced dementia in this cluster randomized clinical trial. A total of 402 residents and their proxies were assessed quarterly for 12 months after proxies viewed the video and indicated preferred levels of care. Results showed that an advance care planning video did not have an effect on preferences, do-not-hospitalize status, or burdensome treatments among residents with advanced dementia, but did increase directives to withhold tube-feeding. Goldstein and Mather provide the Invited Commentary.

Invited Commentary

Clinical Review & Education

Yeow and colleagues conducted a comprehensive literature search to identify studies that involved hospitalized patients, evaluated telemetry use, and reported results of intervention(s) to improve telemetry appropriateness. Existing literature demonstrated that using multimodal interventions that include indication-based ordering, automatic discontinuation, routine review of use and appropriateness, and education can lead to significant reduction in inappropriate telemetry use, and subsequently significant cost savings. Dhruva provides the Invited Commentary.

Invited Commentary

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