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In This Issue of JAMA Internal Medicine
November 2017


JAMA Intern Med. 2017;177(11):1549-1551. doi:10.1001/jamainternmed.2016.6174


For this data analysis, Hong and colleagues tried to identify characteristics associated with clinicians more likely to order low-value imaging tests. They performed multivariable logistic regression modeling of imaging rates after acute uncomplicated back pain and headache visits as indicated by commercial insurance claims and demographic data from a large US health insurer. Results showed that ordering low-value imaging on a prior patient, high rates of low-value imaging in another clinical scenario, and ownership of imaging equipment are strong predictors of low-value back and headache imaging.

Continuing Medical Education

For this randomized clinical trial, Patel and colleagues tested the effectiveness of a gamification intervention designed using insights from behavioral economics to enhance social incentives within families to increase physical activity. Results showed that gamification designed to leverage insights from behavioral economics to enhance social incentives significantly increased physical activity among families in the community. Kawachi provides the Invited Commentary.

Invited Commentary

For this interview study, Moore and colleagues conducted interviews with patients, family members, and staff at 3 hospitals in the United States that offer communication-and-resolution programs. Patients and families were eligible for participation if they experienced a communication-and-resolution program, spoke English, and could no longer file a malpractice claim because they had accepted a settlement or the statute of limitations had expired. Results showed that opportunities are available to provide institutional responses to medical injuries that are more patient centered. Zeiler provides the Invited Commentary.

Invited Commentary

Author Audio Interview

For this register-based cohort study, Wadström and colleagues used information from the public health care system in Sweden from 2006 to 2015 to identify (1) patients with rheumatoid arthritis (RA) starting tumor necrosis factor inhibitor (TNFi) treatment as their first and second biological disease-modifying antirheumatic drugs (bDMARD); (2) patients with RA starting treatment with non-TNFi; (3) bDMARD-naive patients with RA initiating, or stable while taking, conventional synthetic disease-modifying antirheumatic drugs (csDMARDs); and (4) matched general population comparator patients. The overall risk of cancer among patients with RA initiating TNFi as first or second bDMARD, tocilizumab, abatacept, or rituximab did not differ substantially from that of biologic drug–naive, csDMARD-treated patients with RA, although altered risks for specific cancer types, or those with longer latency, cannot be excluded.

In this microsimulation model–based analysis, Reddy and colleagues used a validated microsimulation model of HIV and applied standard demographic data and recent HIV/AIDS epidemiology statistics with specific details on smoking exposure, combining smoking status (current, former, or never), and intensity (heavy, moderate, or light) to project cumulative lung cancer mortality by smoking exposure. Results showed that people living with HIV who adhere to antiretroviral therapy but smoke were substantially more likely to die from lung cancer than from AIDS-related causes. Katz provides the Editor’s Note.

Editor’s Note

For this systematic review and meta-analysis, Foy and colleagues selected randomized clinical trials that compared a primary strategy of coronary computed tomography (CT) angiography with that of functional stress testing for patients with suspected coronary artery disease (CAD) and reported data on patient clinical events and changes in therapy and found that compared with functional stress testing, coronary CT angiography is associated with a reduced incidence of myocardial infarction but an increased incidence of invasive coronary angiography, revascularization, CAD diagnoses, and new prescriptions for aspirin and statins. Villines and Shaw provide the Invited Commentary.

Invited Commentary

Continuing Medical Education

For this cluster-randomized trial, Colón-Emeric and colleagues tested whether a complexity science–based staff training intervention promoting high-quality staff interactions improved the impact of an evidence-based falls quality improvement program. Results showed that an intervention targeting gaps in staff communication and coordination did not improve the impact of a falls quality improvement program and that new approaches to implementing evidence-based care for complex conditions in the nursing home are urgently needed.

For this cohort study, Berkowitz and colleagues attempted to determine whether the Supplemental Nutrition Assistance Program (SNAP), which addresses food insecurity, can reduce health care expenditures. Results showed that SNAP enrollment is associated with reduced health care spending among low-income adults in the United States, consistent across several analytic approaches. Encouraging SNAP enrollment among eligible adults may help reduce health care costs in the United States.