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In This Issue of JAMA Internal Medicine
August 2019

Highlights

JAMA Intern Med. 2019;179(8):1013-1015. doi:10.1001/jamainternmed.2018.5506
Research

In this population-based cohort study, Noel and colleagues assessed the risk of hospitalization or emergency department visit for adverse gastrointestinal (GI) events associated with sodium polystyrene sulfonate use in patients of advanced age (≥66 years). The primary outcome was a composite of adverse GI events (hospitalization or emergency department visit with intestinal ischemia/thrombosis, GI ulceration/perforation, or resection/ostomy) within 30 days of initial sodium polystyrene sulfonate prescription. Results showed that sodium polystyrene sulfonate use was associated with a 1.9-fold higher risk of hospitalization within 30 days of initial prescription for adverse GI events compared with nonuse. Parks and Grady provide an Editorial.

Editorial

Merkow and colleagues performed this cohort study to compare hospitals affiliated with Medicare Prospective Payment System–exempt cancer centers, hospitals affiliated with National Cancer Institute–designated cancer centers, and other US hospitals that provide cancer care. Patients in the cohort were Medicare beneficiaries who underwent 1 of 9 cancer operations. Results showed that hospitals affiliated with Medicare Prospective Payment System–exempt cancer centers and National Cancer Institute–designated cancer centers, but not other hospitals that provide cancer care, had generally similar hospital characteristics, basic cancer-related services, patient comorbidity burden, and cancer surgery outcomes. Steinbrook provides the Editor’s Note.

Editor’s Note

In this randomized clinical trial, Lloyd and colleagues evaluated the effectiveness of a bundle of evidence-supported treatments under conditions of routine care in a representative population hospitalized for community-acquired pneumonia. Treating clinical teams were advised to prescribe prednisolone acetate (in the absence of any contraindication) and de-escalate from parenteral to oral antibiotics according to standardized criteria. Algorithm-guided early mobilization and malnutrition screening and treatment were also implemented. When compared with usual care, the intervention provided no significant effect on length of hospital stay, readmissions, mortality, or other complications of community-acquired pneumonia and resulted in a higher incidence of gastrointestinal bleeding.

Continuing Medical Education

In this cohort study of women aged 35 to 74 years, Park and colleagues assessed whether exposure to artificial light at night while sleeping was associated with general and central obesity. Exposure to artificial light at night while sleeping was reported at enrollment and categorized as no light, small nightlight in the room, light outside of the room, and light or television in the room. Results showed that artificial light at night while sleeping was significantly associated with increased risk of weight gain and obesity, especially in women who had a light or a television on in the room while sleeping.

In this systematic review and meta-analysis of randomized clinical trials comparing decision aids vs usual care, Riikonen and colleagues estimated the association of decision aids with decisional outcomes in prostate cancer screening. The authors found that decision aids are probably associated with a small reduction in decisional conflict and are possibly associated with an increase in knowledge. Decision aids are possibly not associated with whether physicians and patients discuss prostate cancer screening and are possibly not associated with actual screening decisions. Scherer and Lin provide the Invited Commentary.

Invited Commentary

Author Audio Interview

Coupland and colleagues performed this nested case-control study of patients diagnosed with dementia and matched controls to evaluate whether, and to what extent, anticholinergic drug exposure is associated with dementia risk. Participants were matched by age, sex, general practice, and calendar time. Information on prescriptions for 56 drugs with strong anticholinergic properties was used to calculate measures of cumulative anticholinergic drug exposure. Results showed that there were statistically significant associations of dementia risk with exposure to anticholinergic antidepressants, antiparkinson drugs, antipsychotic drugs, bladder antimuscarinics, and antiepileptic drugs after adjusting for confounding variables. Campbell and colleagues provide the Invited Commentary.

Invited Commentary

Continuing Medical Education

In this cohort study, Lee and colleagues examined associations of number of steps taken per day and stepping intensity with all-cause mortality in women with a mean age of 72 years. Women who agreed to participate wore an accelerometer during waking hours for 7 days. Women who averaged approximately 4400 steps/d had significantly lower mortality rates during a follow-up of 4.3 years compared with the least active women who took approximately 2700 steps/d. As more steps per day were accrued, mortality rates progressively decreased before leveling at approximately 7500 steps/d.

Kalra and colleagues performed this population-based observational study to evaluate the incidence of new-onset atrial fibrillation and assess the incidence of in-hospital mortality associated with new-onset atrial fibrillation after transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (AVR). The primary outcome was the occurrence of new-onset atrial fibrillation, which was identified by excluding hospitalizations in which atrial fibrillation was present on admission. New-onset atrial fibrillation was present in roughly 50% of hospitalizations for TAVI and AVR. Hospitalizations with new-onset atrial fibrillation were associated with higher in-hospital mortality compared with TAVI and AVR hospitalizations without new-onset atrial fibrillation.

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