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In This Issue of JAMA Internal Medicine
March 2018


JAMA Intern Med. 2018;178(3):315. doi:10.1001/jamainternmed.2017.5199


Gunderson and colleagues conducted a US multicenter, community-based 30-year prospective cohort study, to evaluate the association between lactation and progression to diabetes using biochemical testing both before and after pregnancy, accounting for prepregnancy cardiometabolic measures, gestational diabetes, and lifestyle behaviors. Results provided evidence that lactation duration is independently associated with lower incidence of diabetes. Further investigation is required to elucidate mechanisms that may explain this relationship.

For this randomized noninferiority trial conducted in a longitudinal sequencing cohort at the National Institutes of Health, Biesecker and colleagues tested whether a web-based platform is noninferior to a genetic counselor for educating patients about their carrier results from exome sequencing. Results demonstrated noninferiority of web-based return of carrier results among postreproductive, mostly healthy adults. Replication studies among younger and more diverse populations are needed to establish generalizability. Results showed that return of results via a web-based platform may be sufficient for subsets of test results.

Goldman and colleagues estimated changes in household spending on health care nationwide after implementation of the Affordable Care Act (ACA) using population-based data from the Medical Expenditure Panel Survey. Results showed that implementation of the ACA was associated with reduced out-of-pocket spending, particularly for low-income persons; however, many of these individuals continue to experience high-burden out-of-pocket and premium spending. Repeal or substantial reversal of the ACA would especially harm poor and low-income Americans.

For this retrospective, observational study, Constantino and colleagues estimated the prevalence of pulmonary embolism among patients presenting to the emergency department for evaluation of syncope. The prevalence of pulmonary embolism was identified using codes from the International Classification of Diseases, and 2 sensitivity analyses considering prevalence of pulmonary embolism at 90 days of follow-up and prevalence of venous thromboembolism were performed. Results showed that although pulmonary embolism should be considered in every patient, not all patients should undergo evaluation for pulmonary embolism.

Author Audio Interview

Continuing Medical Education

In a cross-sectional, nationally representative, population-based study, Geldsetzer and colleagues examined the prevalence of diabetes and hypertension in India, and its variation by state, rural vs urban location, and individual-level sociodemographic characteristics. This study included a total of 1 320 555 adults 18 years or older with records of plasma glucose and blood pressure measurements. Results of the analysis demonstrated that diabetes and hypertension prevalence is high in middle and older age groups across all geographical areas and sociodemographic groups in India. Hypertension prevalence among young adults is also higher than previously thought. Kanaya provides an Invited Commentary.

Invited Commentary

The Odense Pharmacist Trial Investigating Medication Interventions at Sector Transfer, or OPTIMIST, study, conducted by Ravn-Nielsen and colleagues, examined whether a multifaceted pharmacist intervention based on medication review, patient interview, and follow-up can reduce the number of readmissions and emergency department visits. Included patients were randomized into 3 groups receiving usual care (no intervention), a basic intervention (medication review), and an extended intervention (medication review, 3 motivational interviews, and follow-up with the primary care physician, pharmacy, and nursing home). Findings demonstrated that a multifaceted clinical pharmacist intervention may reduce the number of ED visits and hospital readmissions.

Continuing Medical Education

For this prospective clinical trial, Chaiyachati and colleagues evaluated the association between rideshare-based medical transportation and missed primary care appointments among Medicaid patients. Participants were allocated to being offered complimentary ride-sharing services (intervention arm) or usual care (control arm) based on the prescheduled day of their primary care appointment reminder. The uptake of ridesharing was low and did not decrease missed primary care appointments.

Bansal and colleagues performed a noninterventional cohort study and examined the association of implantable cardioverter defibrillators with risk of death and hospitalization in a community-based population of eligible patients who had heart failure with reduced left ventricular ejection fraction and chronic kidney disease (CKD). Implantable cardioverter defibrillator placement was not significantly associated with improved survival but was associated with increased risk for subsequent hospitalization due to heart failure and all-cause hospitalization. The potential risks and benefits of implantable cardioverter defibrillators should be carefully considered in patients with heart failure and CKD.

Author Audio Interview