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Pesticide Residue and Pregnancy Outcomes
For this cohort study, Chiu and colleagues examined the association of preconception intake of pesticide residues in fruits and vegetables with outcomes of infertility treatment with assisted reproductive technologies (ART). This analysis included 325 women who completed a diet assessment and subsequently underwent 541 ART cycles, and results showed that higher consumption of high–pesticide residue fruits and vegetables was associated with lower probabilities of pregnancy and live birth following infertility treatment with ART. Landrigan provides the Invited Commentary.
Blood Pressure Lowering, Mortality, and CVD
For this systematic review and meta-analysis, Brunström and Carlberg included 74 trials comprising more than 300 000 patients to assess the association between blood pressure–lowering treatment and death and cardiovascular disease (CVD) at different blood pressure levels. Data analysis indicated that primary preventive blood pressure lowering is associated with reduced risk for death and CVD if baseline systolic blood pressure is 140 mm Hg or higher; at lower blood pressure levels, treatment is not associated with any benefit in primary prevention but might offer additional protection in patients with coronary heart disease.
Continuing Medical Education
Laboratory Testing and Teaching vs Nonteaching Hospitals
For this cross-sectional study using a statewide database to identify hospitalizations with a primary diagnosis of bacterial pneumonia or cellulitis, Valencia and colleagues examined differences in the use of laboratory tests between teaching and nonteaching hospitals. A total of 43 329 hospitalized patients had a principal diagnosis of bacterial pneumonia or cellulitis across 11 major teaching hospitals, 12 minor teaching hospitals, and 73 nonteaching hospitals in Texas. Compared with nonteaching hospitals, patients admitted to major teaching hospitals received significantly more laboratory tests after controlling for illness severity, length of stay, and patient demographics.
Inpatients Referred for Palliative Care Consultation
For this prospective cohort study, Bischoff and colleagues examined 73 145 patients in inpatient palliative care teams to describe the population of patients referred to inpatient palliative care consultation teams for care planning, the needs identified by palliative care clinicians, the care planning activities that occur, and the results of these activities. Results showed that care planning was the most common reason for inpatient palliative care consultation, and care planning needs were often found even when the consultation was for other reasons. Surrogates were consistently identified, and patients’ preferences regarding life-sustaining treatments were frequently updated.
Database Use for Supplemental Medication Indications
For this cohort study, Fralick and colleagues examined whether longitudinal data from a health care database supported the results of a randomized clinical trial that led to a supplemental indication for telmisartan. The cohort included 640 951 patients newly prescribed telmisartan or ramipril, and insurance claims data from a nationwide health care database were used to compare patient outcomes. Results showed that real-world data analyses of patients receiving routine care provided findings similar to those in the randomized clinical trial that established telmisartan’s supplemental indication. Califf provides the Invited Commentary.
Patient-Sharing Networks and Medicare Beneficiaries
For this cross-sectional study, Landon and colleagues examined the association between physician network properties and health care spending, utilization, and quality of care among Medicare beneficiaries. Total spending was higher for patients of physicians with more connections to other physicians and more shared care outside of their network. Patients whose physicians’ networks had more primary care physicians had more primary care visits and fewer specialist and emergency visits. Reschovsky and Rich provide the Invited Commentary.
Overlapping Surgery and Risk for Complications
For this population-based cohort study of patients with hip fracture and hip arthritis, Ravi and colleagues examined whether overlapping surgery is associated with greater risk for complications following surgical treatment for hip fracture and arthritis. This study encompassed 2 large cohorts from the population of Ontario, Canada, from 2009 to 2014: the hip fracture cohort captured all persons older than 60 years who underwent surgery for a hip fracture during the study period, and the total hip arthroplasty (THA) cohort captured all primary elective THA recipients for arthritis during the study period. Results showed that overlapping surgery was relatively rare but was associated with an increased risk for surgical complications. Zhang provides the Invited Commentary.
Opioid Availability and Prescription Opioid Initiation
For this retrospective cohort study, Seamans and colleagues investigated whether individuals living in a household with a prescription opioid user are more likely to initiate prescription opioids themselves, compared with individuals in households with a prescription nonsteroidal anti-inflammatory drug user. Overall, 12 695 280 commercial insurance beneficiaries with a household member who started a new prescription of opioids were compared with 6 359 639 beneficiaries with a household member who started a new prescription of nonopioid pain relievers. Results showed that living in a household with a prescription opioid user may increase risk of prescription opioid use, which may reflect both increased access to these products as well as shared risk factors, such as prescriber preference and prescription drug monitoring.
Highlights. JAMA Intern Med. 2018;178(1):1. doi:10.1001/jamainternmed.2017.2506
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