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In This Issue of JAMA Internal Medicine
September 2017


JAMA Intern Med. 2017;177(9):1233-1235. doi:10.1001/jamainternmed.2016.6164

For this randomized clinical trial, Kane and colleagues compared changes in hospitalization and emergency department visit rates between the preintervention and postintervention periods for nursing homes randomly assigned to receive training and implementation support on the quality improvement program INTERACT (Interventions to Reduce Acute Care Transfers). Results showed that training and support for INTERACT implementation had no effect on hospitalization or emergency department visit rates in the overall population of residents in participating nursing homes.

Prescription opioid misuse is a national crisis, and few interventions have improved adherence to opioid-prescribing guidelines. For this cluster-randomized clinical trial, Liebschutz and colleagues compared a multicomponent intervention (including a nurse care manager, electronic registry, data-driven academic detailing, and electronic decision tools) with electronic decision tools alone to improve adherence to opioid-prescribing guidelines and found that a multicomponent intervention improved guideline-concordant care but did not decrease early opioid refills.

Editor’s Note

Continuing Medical Education

For this systematic review and meta-analysis, Bhindi and colleagues searched MEDLINE, EMBASE, Web of Science, and Scopus databases for studies indexed from database inception to March 2017 without language restriction for articles concerning an association between vasectomy and prostate cancer, high-grade prostate cancer, advanced prostate cancer, and/or fatal prostate cancer. Overall, 53 studies (16 cohort studies including 2 563 519 participants, 33 case-control studies including 44 536 participants, and 4 cross-sectional studies including 12 098 221 participants) were included, and no association between vasectomy and high-grade, advanced-stage, or fatal prostate cancer was found.

Continuing Medical Education

For this population-based study of health coverage in 5 South Asian countries (Afghanistan, Bangladesh, India, Nepal, and Pakistan), Rahman and colleagues used nationally representative survey data to calculate relative indices of health coverage, financial risk protection, and inequality in coverage among wealth quintiles. The dimensions of universal health coverage assessed included access to basic services, financial risk protection, and equity. Results show that health coverage and financial risk protection was low, and inequality in access to health care remains a serious issue for these South Asian countries. Feacham and Shakil provide the Invited Commentary.

Invited Commentary

For this cohort study of patients taking antibiotics, Tamma and colleagues examined medical records of 1488 adult inpatients for 30 days after antibiotic initiation for the development several antibiotic-associated adverse drug events, including gastrointestinal, dermatologic, musculoskeletal, hematologic, hepatobiliary, renal, cardiac, and neurologic. Two infectious diseases trained clinicians examined medical records for 90 days for the development of Clostridium difficile infection or incident multidrug-resistant organism infection. Approximately one-fifth of patients experienced at least 1 antibiotic-associated adverse drug event; these findings underscore the importance of judicious antibiotic prescribing.

For this cohort study, Juraschek and colleagues compared early (within 1 minute) vs later (after 1 minute) orthostatic hypotension (OH) measurements and their association with history of dizziness and long-term adverse outcomes in middle-aged adults. Result showed that, in contrast with prevailing recommendations, OH assessed within 1 minute of standing was associated with higher odds of dizziness and greater risk of falls, fracture, syncope, motor vehicle crash, and mortality than OH assessed after 1 minute. Singer and Low provide the Invited Commentary.

Invited Commentary

For this population-based cohort study, Bhatia and colleagues assessed the frequency of electrocardiograms (ECGs) following an annual health examination (AHE) with a primary care physician among patients with no known cardiac conditions or risk factors, to explore factors predictive of receiving an ECG in this clinical scenario, and to compare downstream cardiac testing and clinical outcomes in low-risk patients who did and did not receive an ECG after their AHE. Results show that despite recommendations to the contrary, ECG testing after an AHE is relatively common, with significant variation among primary care physicians; routine ECG testing seems to increase risk for a subsequent cardiology testing and consultation cascade.

Clinical Review & Education

Through a consensus conference and subsequent activities, Tulsky and colleagues reviewed the state of the science of communicating with patients with serious illnesses, identified key evidence gaps in understanding the impact of communication on patient outcomes, and created an agenda for future research. In total, 7 broad topics were considered: shared decision making, advance care planning, communication training, measuring communication, communication about prognosis, emotion and serious illness communication, and cultural issues. The findings highlight the urgent need to improve quality of communication between health care professionals and patients living with serious illness through communication skills, tools, patient education, and models of care.


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