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In a prospective study of 1984 older adults, hearing loss was independently associated with accelerated cognitive decline and incident cognitive impairment. The magnitude of these associations is clinically significant, with individuals with hearing loss having a 30% to 40% accelerated rate of cognitive decline over a 6-year period compared with individuals with normal hearing. On average, individuals with hearing loss required 7.7 years to decline by 5 points on the Modified Mini-Mental State Examination (a commonly accepted level of change indicative of cognitive impairment) vs 10.9 years in those with normal hearing.
With the new Institute of Medicine report, along with the American Board of Internal Medicine Foundation's “Choosing Wisely” campaign, and JAMA Internal Medicine’s “Less Is More” series, the topic of health care value and cost awareness is currently of great interest to community-based and academic internists and subspecialists. Residency programs are now tasked with integrating these concepts into training; however, most lack curricula to address this need. In this article, Moriates et al describe the implementation of a unique, multifaceted cost awareness curriculum for medicine residents, sharing keys to success and defining guiding principles.
In This Issue of JAMA Internal Medicine. JAMA Intern Med. 2013;173(4):256. doi:10.1001/jamainternmed.2013.2698
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