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In This Issue of JAMA Internal Medicine
October 2017

Highlights

JAMA Intern Med. 2017;177(10):1405-1407. doi:10.1001/jamainternmed.2016.6169

Research

For this cluster-randomized, single-blind intervention trial, Brach and colleagues compared the effectiveness of the On the Move group exercise program, which focuses on the timing and coordination of movement, with a seated strength, endurance, and flexibility program (usual care) at improving function, disability, and walking ability of older adults. Results showed that the group exercise program was more effective at improving mobility than a usual-care exercise program.

For this quasiexperimental difference-in-differences analysis of Consumer Assessment of Healthcare Providers and Systems survey data, Ndumele and colleagues compared ratings of access to specialists for adult Medicaid and commercial enrollees before and after the implementation of time and distance standards for managed care organizations to ensure an adequate supply of specialist physicians for enrollees. Results showed that specialty access standards did not lead to widespread improvements in access to specialist physicians.

Related Article

For this cross-sectional analysis, Doshi and colleagues analyzed study protocols, statistical analysis plans, and informed consent forms from clinical study reports submitted to the European Medicines Agency to determine the degree to which the study purpose is explained to potential participants in randomized clinical trials (RCTs) of antibiotics. The degree to which study protocols justify their selection of noninferiority hypotheses and amount of “clinically acceptable” inferiority was also examined. Results showed that patients participating in RCTs of antibiotics were not accurately informed of study purposes. Menikoff provides the Invited Commentary.

Invited Commentary

Based on a review of the literature and electronic medical records, Karter and colleagues identified 156 candidate predictor variables to develop and validate a tool to categorize risk of hypoglycemic-related emergency department (ED) or hospital use in patients with type 2 diabetes. The hypoglycemia risk stratification tool used 6 patient-specific inputs: number of prior episodes of hypoglycemia-related ED or hospital use, insulin use, sulfonylurea use, prior year ED use, chronic kidney disease stage, and age. Moving forward, this tool could facilitate targeted population management interventions, potentially reducing hypoglycemia risk.

Continuing Medical Education

For this ancillary study of the Kronos Early Estrogen Prevention Study, Taylor and colleagues attempted to determine the effects of oral or transdermal estrogen therapy vs placebo on sexual function in postmenopausal women. Results showed that treatment with 50 µg/d transdermal 17β-estradiol modestly improved sexual function in early postmenopausal women compared with placebo, but whether it relieved symptoms of distress is not known.

Continuing Medical Education

For this randomized clinical trial including patients with opioid and/or alcohol use disorders (OAUD), Watkins and colleagues studied whether collaborative care for OAUD improves delivery of evidence-based treatments for OAUD and increases self-reported abstinence compared with usual primary care. Results showed that among adults with OAUD in primary care, the collaborative care intervention resulted in significantly more access to treatment and abstinence from alcohol and drugs at 6 months than usual care.

In this meta-analysis of 18 randomized clinical trials comprising 15 924 patients with chronic kidney disease (CKD), Malhotra and colleagues investigated if more intensive compared with less intensive blood pressure control is associated with reduced mortality risk in persons with CKD stages 3 to 5. Results showed that randomization to more intensive blood pressure control is associated with lower mortality risk among trial participants with hypertension and CKD but further studies are required to define absolute blood pressure targets for maximal benefit and minimal harm. Kovesdy provides the Invited Commentary.

Invited Commentary

Clinical Review & Education

Acute coronary syndrome (ACS) is one of the leading causes of mortality in the United States, and the 2014 American Heart Association/American College of Cardiology guidelines conclude that creatine kinase–myocardial band testing provides no additional value for diagnosing acute myocardial infarction. In this Special Communication, Alvin and colleagues discuss the benefits of eliminating creatine kinase–myocardial band testing in suspected acute coronary syndrome and conclude that eliminating a simple laboratory test that provides no incremental value to patient care can lead to millions of health care dollars saved without adversely affecting patient care quality and, in this case, potentially improving patient care.

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