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In this study, Snyder and colleagues allocated a cohort of 211 men 65 years or older with serum testosterone concentration less than 275 ng/dL who also participated in the Testosterone Trials to receive testosterone or placebo for 1 year. Volumetric bone mineral density and strength of the spine and hip were evaluated by quantitative computed tomography at baseline and after 1 year, and it was found that testosterone treatment for 1 year compared with placebo significantly increased volumetric bone mineral density and strength of the spine and hip.
Editorial 1 and 2 and Related Articles 1 and 2
Author Video Interview
In this study, Roy and colleagues allocated a cohort of men 65 years or older with serum testosterone concentration less than 275 ng/dL who also participated in the Testosterone Trials to receive testosterone or placebo for 1 year; 126 of these men were anemic (hemoglobin <12.7 g/dL) at baseline. Testosterone treatment compared with placebo treatment for 1 year significantly increased the percentage of men whose hemoglobin increased 1.0 g/dL or more above baseline for both men who had unexplained anemia and for men who had anemia of known cause.
In this study, Cheetham and colleagues studied testosterone replacement therapy in a population of androgen-deficient men. The primary outcome was a composite of cardiovascular events (acute myocardial infarction, revascularization procedures, unstable angina, stroke, TIA and sudden cardiac death), and it was found that among men with androgen deficiency, testosterone replacement therapy was associated with a lower risk of composite cardiovascular outcomes.
For this randomized clinical trial, Dr Zhao and colleagues evaluated whether true acupuncture vs sham acupuncture or being placed on a waiting list for treatment is effective in preventing future migraine attacks. Overall, 249 patients who had migraines without aura were included in the trial. Acupuncture and sham acupuncture consisted of 20 sessions per patient over 4 weeks. The mean change in frequency of migraine attacks differed significantly among the 3 groups, and true acupuncture significantly reduced the frequency of migraine attacks compared with sham acupuncture and being placed on a waiting list. Gelfand provides the Invited Commentary.
In this study, McWilliams and colleagues found that the Medicare Shared Savings Program—the largest of Medicare’s Accountable Care Organization (ACO) programs—has been associated with significant reductions in spending on postacute care, mainly in skilled nursing facilities (SNFs) without changes in readmission rates or mortality. Reductions in SNF use and length of stay were owing largely to within-hospital and within-SNF changes in care specifically for ACO patients rather than hospital-wide initiatives by ACOs or use of preferred SNFs. Spending reductions were similar for ACOs with and without financial ties to hospitals. These findings suggest that bundled payment programs that place hospitals at risk for postacute spending are not the only viable strategy to curb excessive postacute care. Colla and Fisher provide the Invited Commentary.
Related Article and Invited Commentary
Author Audio Interview
Treatment strategies for undocumented patients with end–stage renal disease (ESRD) in the United States vary both between and within states, and most provide hemodialysis to undocumented immigrants only when they present to an emergency department with life-threatening complications. In this study, Cervantes and colleagues conducted qualitative, in-depth interviews of 20 undocumented immigrants with kidney failure that receive emergent-only hemodialysis in Denver to explore their illness experience. Patients with kidney failure and access to emergent-only hemodialysis describe significant physical and psychosocial distress related to the weekly symptom accumulation. Fernandez and Rodriguez provide the Invited Commentary.
In this study, McConnell and colleagues assessed performance differences among 2 states—Colorado and Oregon—that adopted early Accountable Care Organizations (ACOs). The Coordinated Care Organizations in Oregon were characterized by a move to global budgets and a large investment from the federal government. The Accountable Care Collaborative in Colorado maintained fee-for-service payments and did not impose downside financial risk on providers, and did not receive federal investments on the scale of those provided to Oregon. No significant differences in standardized expenditures for either state were demonstrated, although the program in Oregon was associated with reductions in avoidable emergency department visits, acute preventable hospital admissions, and relative improvements on selected quality measures. Colla and Fisher provide the Invited Commentary.
In this study conducted in the US Department of Veterans Affairs Health System, Stevens and colleagues evaluated the impact of initial treatment with metronidazole or oral vancomycin on the risk of recurrence and 30-day all-cause mortality for patients with Clostridium difficile infection (CDI). More than 10 000 cases of CDI were evaluated over 8 years. Vancomycin use was relatively uncommon overall, but use increased over the study period. Rates of recurrence were similar between the treatment groups. There was no difference in the risk of mortality between patients initially treated with vancomycin and those treated with metronidazole among mild-to-moderate CDI infections, but patients who had severe CDI infections were less likely to die if they received oral vancomycin.
Highlights. JAMA Intern Med. 2017;177(4):453–455. doi:https://doi.org/10.1001/jamainternmed.2016.6139
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