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In This Issue of JAMA Internal Medicine
April 2016

Highlights

JAMA Intern Med. 2016;176(4):421-423. doi:10.1001/jamainternmed.2015.4870

Research

Levine and colleagues evaluated the relative effectiveness of 2 different approaches to preventing postpartum smoking relapse. Women received postpartum-adapted smoking relapse prevention intervention and were randomly assigned to cognitive behavioral intervention with content and strategies to address concerns about mood, stress, and weight or a time= and attention-controlled comparison. Overall, 38%, 34%, and 24% of the sample maintained biochemically confirmed sustained tobacco abstinence at 12, 24, and 52 weeks’ postpartum, respectively, with no differences between interventions. Depressive symptoms and perceived stress significantly improved, and women with fewer depressive symptoms and less perceived stress were more likely to achieve abstinence. Cognitive behavioral intervention designed to address postpartum concerns about mood, stress, and weight did not differentially improve rates of sustained tobacco abstinence postpartum relative to a time- and attention-controlled comparison. All women reported improvements in mood and stress, and the experience of fewer depressive symptoms, as well as less stress related to sustained abstinence.

Editor’s Note

In a systematic review and meta-analysis of 5 published studies and 3 unpublished studies including nearly 6000 women, Jaspers and colleagues found that treatment with flibanserin, on average, resulted in half of 1 additional satisfying sexual event per month while substantially increasing the risk of dizziness, somnolence, nausea, and fatigue. Overall, the quality of the evidence was very low. Before flibanserin can be recommended in guidelines and clinical practice, future studies should include women from diverse populations, particularly women with comorbidities, medication use, and surgical menopause.

Editorial

Continuing Medical Education

Author Audio Interview

Dhavle and colleagues analyzed the optional free-text Notes field in a sample of ambulatory new e-prescriptions and found that nearly 15% included prescriber notes. Of these, approximately two-thirds contained inappropriate content or content more appropriate for an existing designated data field available in the widely implemented National Council for Prescription Drug Programs’ SCRIPT standard 10.6 version. Dhavle and colleagues also found that a significant proportion of prescriber notes included directions for patients that conflict with information in the standard patient instructions field of the e-prescription message, therefore introducing potential patient safety risks.

Invited Commentary

Qato and colleagues used a population-based study of 2351 nationally representative participants to evaluate how the use of prescription and over-the-counter medications and dietary supplements among older US adults has changed between 2005 and 2011 and found that older adults are increasingly using multiple medications and supplements with more than two-thirds regularly using 5 or more and 1 in 6 potentially at risk for a major drug-drug interaction. The majority of these interacting regimens involved cardiovascular medications and dietary supplements such as statins, antiplatelets, and omega-3 fish oil increasingly used between 2010 and 2011.

Invited Commentary

Related Article

In an observational study of 1000 general medicine patients readmitted within 30 days of discharge, Auerbach and colleagues sought to determine readmission preventability and opportunities for care improvement by using data from multiple viewpoints and a structured dual physician review process to better understand the issues involved with readmitted patients. Of the patients studied, more than one-fourth had readmissions that were potentially preventable. In these patients, problems with the initial decision to admit the patient in the emergency department, discharging a patient prematurely, difficulty keeping postdischarge appointments, and not knowing who to contact after discharge were the most common factors associated with potentially preventable readmissions. These results suggest that while risks for preventable readmissions span multiple phases of care, targets for focused improvements can be identified.

Invited Commentary

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Identifying which patients are at high risk for 30-day hospital readmission is challenging. The simple, previously developed HOSPITAL prediction model showed promising accuracy but needed to be validated in other populations. In a retrospective study, Donzé and coauthors use a large multinational multicenter restrospective cohort study including 117 065 adults to externally validate the HOSPITAL score and found that the HOSPITAL score identified patients at high risk of 30-day potentially avoidable readmission with high accuracy, moderately high discrimination, and excellent calibration. This score has the potential to identify patients in need of more intensive transitional care interventions to prevent avoidable hospital readmissions.

Invited Commentary

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In a Danish nationwide cohort study, Numé and colleagues found that syncope was associated with a 2-fold risk of motor vehicle collisions compared with the general population, a risk that remained elevated throughout a follow-up of 5 years. The study suggests that patients with syncope are at increased risk of motor vehicle crashes, but as the absolute risk was relatively small, syncope should be considered as one of several factors in a broad assessment of fitness to drive rather than an absolute criterion.

Invited Commentary

Continuing Medical Education

In the China PEACE-Retrospective CathPCI Study, Zheng and colleagues used a nationally representative sample of 11 241 patients undergoing coronary catheterization and percutaneous coronary intervention (PCI) at 55 urban Chinese hospitals in 2001, 2006, and 2011 to provide a detailed overview of the trends in the practice of interventional cardiology and found that the practice of interventional cardiology evolved over time, with a 21-fold increase in PCI volume, broad adoption of domestically procedure drug-eluting stents and radial access, and reduced risk of bleeding complications. However, there were substantial gaps in assessing the quality of care that could serve as targets of future quality improvement efforts.

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    1 Comment for this article
    EXPAND ALL
    We can defeat CAD with or without predisposition to AMI
    Sergio Stagnaro | Director of Quantum Biophysical Semeiotic Laboratory Research
    I am usually looking for Highlights to choose the article succession to read, so that
    \"Interventional Cardiology in China From 2001 to 2011\" has attracted now my attention. As I have demonstrated in previous articles, to defeat CAD growing epidemic, we need a clinical and thus inexpensive tool, that allows us to bedside diagnose CAD Inherited Real Risk, starting from the birth, and remove it by no expensive Restructuring Mitochondrial Quantum Therapy (1-10).
    Unfortunately, till now physicians are treating patients suffering from overt CAD, when healing is never possible, because they ignore what does it means CAD Inherited Real Risk,
    characterized by coronary vasa vasorum microcirculatory remodeling, due to new-born pathological Endoarteriolar Blocking Devices in small arteries and arterioles, according to Hammersen, I have described earlier (1, 4). As a consequence, from birth, in idividuals, apparently healthy, but involved by the above mentioned heritable predisposition to CAD, is present the so-called microcirculatory blood flow centralisation, that brings about blood dangerous hypertension in nutritional capillary, promoting endothel dysfunction and finally low grade chronic inflammation. The heritable predisposition to AMI occurs in presence of severe microcirculatory blood flow centralisation, due to a flurry of new-born pathological Endoarteriolar Blocking Devices.

    References

    1) Sergio Stagnaro and Simone Caramel. The Inherited Real Risk of Coronary Artery Disease, Nature PG., EJCN, European Journal Clinical Nutrition, Nature PG., http://www.nature.com/ejcn/journal/v67/n6/full/ejcn201337a.html [Medline]
    2) Stagnaro-Neri M., Stagnaro S. Deterministic Chaos, Preconditioning and Myocardial Oxygenation evaluated clinically with the aid of Biophysical Semeiotics in the Diagnosis of Ischaeemic Heart Disease even silent. Acta Medica Mediterranea 13, 109-116, 1997.
    3) Stagnaro S. Role of Coronary Endoarterial Blocking Devices in Myocardial Preconditioning - c007i. Lecture, V Virtual International Congress of Cardiology.2007. http://www.fac.org.ar/qcvc/llave/c007i/stagnaros.php
    4) Stagnaro S. CAD Inherited Real Risk, Based on Newborn- Pathological, Type I, Subtype B, Aspecific, Coronary Endoarteriolar Blocking Devices. Diagnostic Role of Myocardial Oxygenation and Biophysical-Semeiotic Preconditioning. IAS, International Atherosclerosis Society, www.athero.org, 29 April, 2009, http://www.athero.org/commentaries/comm907.asp
    5) Stagnaro S. Caotino's Sign and Gentile's Sign in bedside Diagnosing CAD Inherited Real Risk and Acute Myocardial Infarction, even initial or silent. Patho-Physiology and Therapy. Lectio Magistralis. III SISBQ Congress, 9-10 June, 2012, Porretta Terme (Bologna). www.sisbq.org. http://www.sisbq.org/uploads/5/6/8/7/5687930/presentazione_stagnaro_it.pdf
    6) Sergio Stagnaro and Simone Caramel. The Key Role of Vasa Vasorum Inherited Remodeling in QBS Microcirculatory Theory of Atherosclerosis. Frontiers in Epigenomics and Epigenetics. [Pub-Med indexed for MEDLINE] In press.
    7) Sergio Stagnaro. Without CAD Inherited Real Risk, All Environmental Risk Factors of CAD are innocent Bystanders. Canadian Medical Association Journal. CMAJ, 14 Dec 2009, http://www.cmaj.ca/cgi/eletters/181/12/E267#253801 ”
    8) Pyatakovich F.A., Stagnaro S., Caramel S., Yakunchenko T.I., Makkonen K.F., Moryleva O.N. Background Millimeter Radiation Influence in Cardiology on patients with metabolic and pre-metabolic syndrome. Journal of Infrared and Millimeter Waves, , Shanghai, China
    http://journal.sitp.ac.cn/hwyhmb/hwyhmben/ch/reader/view_abstract.aspx?file_no=120750&flag=1

    9) Sergio Stagnaro (2012). I Segni di Caotino* e di Gentile** nella Diagnosi di Reale Rischio Congenito di CAD e di Infarto Miocardico, ancorché iniziale o silente. Fisiopatologia e Terapia. Lectio Magistralis. III Convegno della SISBQ, 9-10 Giugno 2012, Porretta Terme (Bologna). www.sisbq.org. http://www.sisbq.org/uploads/5/6/8/7/5687930/presentazione_stagnaro_it.pdf
    10)Stagnaro Sergio. Bedside Evaluation of CAD biophysical-semeiotic inherited real risk under NIR-LED treatment. EMLA Congress, Laser Helsinki August 23-24, 2008. \"Photodiagnosis and photodynamic therapy\", Elsevier, Vol. 5 suppl 1 august 2008 issn 1572-1000. 2008.
    CONFLICT OF INTEREST: None Reported
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