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Reminder Devices and Medication Adherence
In a 4-arm, block-randomized trial, Choudhry and colleagues compared the impact of 3 low-cost reminder devices on medication adherence among patients ages 18 to 64 years and taking 1 to 3 oral medications intended for long-term use. Participants also had to be suboptimally adherent to their prescribed therapies in the year prior to randomization. Results found that there was no significant difference in the odds of optimal adherence between control and any of the reminder devices. There were also no consistent significant effects on optimal adherence when reminder devices were compared directly. Kronish and Moise provide the Invited Commentary.
Thiazolidinediones and Liver Fibrosis in NASH
Advanced liver fibrosis is the strongest predictor of liver-related and overall mortality in nonalcoholic steatohepatitis (NASH) and is not ameliorated by any available treatment to date. In this meta-analysis of 8 randomized trials, Musso and colleagues found that pioglitazone use improves advanced fibrosis in NASH, even in patients without diabetes. Whether this finding translates to improvement in risk for clinical outcomes requires further study. Yee provides the Invited Commentary.
Teleretinal Diabetic Retinopathy Screening Program
In the Los Angeles County health care safety net, the prevalence of diabetic retinopathy (DR) is approximately 50%, and due to limited specialty care resources, wait times for annual diabetic retinopathy screening have averaged greater than 8 months. To address this issue, a large-scale primary care–based teleretinal diabetic retinopathy screening program across 15 Los Angeles County Department of Health Services clinics was established. Daskivich and colleagues performed a quasi-experimental, pretest-posttest evaluation of this program in 5 of these clinics to assess screening rates and wait times to screening and founds that teleretinal DR screening resulted in the elimination of over 14 000 specialty care visits, a 15% increase in annual screening rates, and a 90% reduction in wait times for screening. Sarkar and Lyles provide the Invited Commentary.
Author Audio Interview
Comparison of Male vs Female EM Residents
In this longitudinal, retrospective cohort study, Dayal and colleagues examined the effect of emergency medicine (EM) resident and attending physician sex on resident milestone evaluations. Overall, 33 456 milestone evaluations of 359 EM residents from 8 training programs across the United States were analyzed using multilevel mixed-effects models. Male EM residents attained milestones significantly faster than female EM residents, leading to a substantial “gender gap” in evaluations that continued through graduation. No significant differences in evaluations were found based on attending physician sex or attending physician–EM resident sex pairing. Cooke provides the Invited Commentary.
Related Articles 1 and 2
Racial Disparities in ΑΩΑ Membership
In this retrospective cohort analysis of 4655 medical students, Boatright and colleagues examined the association between medical student race/ethnicity and induction into the Alpha Omega Alpha (ΑΩΑ) honor society. Overall, 58% of residency applicants in the sample reported they were white (72% of AΩA applicants were white); 5% Black (1%, AΩA), 5% Hispanic (3%, AΩA), and 21% Asian (17%, AΩA). After controlling for numerous demographic and educational covariates, results showed that the odds of AΩA membership for white students were nearly 6 times greater than for black students and nearly 2 times greater than for Asian students. Cooke provides the Invited Commentary.
Suicidality and Depression With 5α-Reductase Inhibitors
Using population-based data and a matched cohort design, Welk and colleagues examined if there is an increased risk of suicide, self-harm, or depression among older men starting a 5α-reductase inhibitor for prostatic enlargement. Results did not demonstrate an increased risk of suicide; however, the risk of self-harm and incident depression were significantly elevated in the initial 18 months after 5α-reductase inhibitor initiation. These risks should be considered when prescribing 5α-reductase inhibitors, and in new cases of self-harm or depression, the continued use of these medications should be reevaluated. Thielke provides the Invited Commentary.
Continuing Medical Education
Patient Mortality During Accreditation Surveys
Barnett and colleagues examined the hypothesis that unannounced accreditation surveys at acute care hospitals might be associated with changes in the quality and safety of inpatient care using Medicare administrative claims during nearly 2000 surveys. Result showed that 30-day mortality fell significantly during survey weeks vs nonsurvey weeks, with a particularly pronounced decrease among major teaching hospitals. There was no significant association between survey weeks and other patient safety measures that might explain this change.
Paid Malpractice Claims by Specialty
Schaffer and colleagues performed a comprehensive analysis of all paid medical malpractice claims from 1992 to 2014 contained in the National Practitioner Data Bank (NPDB). The paid claims in the NPDB were linked to physician specialty, allowing the analysis of national trends in malpractice by specialty. The rate of paid claims fell by 55.7% from 1992 to 1996 and 2009 to 2014, ranging from a 13.5% decrease in cardiology to a 75.8% decrease in pediatrics. Overall, the mean compensation payment was $329 565, which increased over the study period by 23.3%, from $286 751 to $353 473 (inflation adjusted to 2014 dollars). There were wide differences across specialties in rate of paid claims, payment amounts, severity of injury, and type of allegation.
Highlights. JAMA Intern Med. 2017;177(5):605–607. doi:10.1001/jamainternmed.2016.6144
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