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In This Issue of JAMA Internal Medicine
May 2018


JAMA Intern Med. 2018;178(5):593-595. doi:10.1001/jamainternmed.2017.5209


Bradley and colleagues conducted a randomized clinical trial to test whether 12 months of alcohol care management improved drinking outcomes among patients with or at high risk for alcohol use disorders compared with usual care. Between October 11, 2011, and September 30, 2014, the study enrolled 304 outpatients who reported heavy drinking (≥4 drinks per day for women and ≥5 drinks per day for men) who were subsequently allocated to an intervention or usual care. Results demonstrated that the intervention did not decrease heavy drinking or related problems despite increased engagement in alcohol-related care.

For this double-blind, randomized, triple-dummy, placebo- and active-controlled trial—the Evaluating Adverse Events in a Global Smoking Cessation Study (EAGLES)—Benowitz and colleagues examined the relative cardiovascular safety risk of varenicline, bupropion, and nicotine patch in 8058 smokers. The incidence of cardiovascular events during treatment and follow-up was low and did not differ significantly by treatment, and no evidence that the use of smoking cessation pharmacotherapies increased the risk of serious cardiovascular adverse events during or after treatment was observed.

Cenko and colleagues conducted this observational study to investigate whether the risk of 30-day mortality after ST-segment elevation myocardial infarction (STEMI) is higher in women than men and, if so, to assess the role of age, medications, and primary percutaneous coronary intervention (PCI) in this excess of risk. Data from a total of 8834 patients who were hospitalized and received medical treatment for STEMI were examined, and results showed that younger age was associated with higher 30-day mortality rates in women with STEMI even after adjustment for medications, primary PCI, and other coexisting comorbidities.

For this interrupted time-series analysis, Maust and colleagues examined the association of the Centers for Medicare & Medicaid Services’ (CMS) National Partnership to Improve Dementia Care in Nursing Homes with trends in prescribing of antipsychotic and other psychotropic medication among older adults in long-term care. The study included 637 426 fee-for-service Medicare beneficiaries in long-term care with Part D coverage. Results showed that prescribing of psychotropic medications to patients in long-term care has declined, although the partnership did not accelerate this decrease.

Resnick and colleagues performed this population-based analysis of Medicare beneficiaries to examine whether Medicare Shared Savings Program Accountable Care Organization (ACO) enrollment changed the appropriateness of screening for breast, colorectal, and prostate cancers. Medicare data from 2007 through 2014 was used to evaluate changes in screening associated with ACO enrollment. Results demonstrated that Medicare Shared Savings Program ACO enrollment was associated with more appropriate breast and colorectal screening, although the magnitude of the observed ACO effect was modest in the early ACO experience. Lipitz-Snyderman provides the Invited Commentary.

Invited Commentary

Kurella Tamura and colleagues conducted this retrospective cohort study of patients from the US Medicare and Veterans Affairs health care systems to compare initiation of dialysis and mortality among older veterans with incident kidney failure who received pre–end-stage renal disease (ESRD) nephrology care in fee-for-service Medicare vs the Department of Veterans Affairs. Results showed that veterans who received pre-ESRD nephrology care in Medicare received dialysis more often yet were also more likely to die within 2 years compared with those in Veterans Affairs health system. Chen and Hsu provide an Invited Commentary.

Invited Commentary

For this 12-week multicenter randomized clinical trial of 302 postmenopausal women with moderate to severe symptoms of vulvovaginal itching, pain, dryness, irritation, or pain with penetration, Mitchell and colleagues compared the efficacy of a low-dose vaginal estradiol tablet or a vaginal moisturizer vs placebo. Results suggest that neither prescribed vaginal estradiol tablet nor over-the-counter vaginal moisturizer provides additional benefit over placebo vaginal tablet or placebo gel in reducing postmenopausal vulvovaginal symptoms. Huang and Grady provide the Invited Commentary.

Invited Commentary

Kaufman and colleagues conducted a cross-sectional study of firearm death rates for 3108 counties in the 48 contiguous states of the United States to examine whether counties located closer to states with lenient firearm policies have higher firearm death rates. Results showed that strong state firearm policies were associated with lower suicide rates regardless of other states’ laws. Strong policies were associated with lower homicide rates, and strong interstate policies were also associated with lower homicide rates, where home state policies were permissive. Steinbrook provides the Editor’s Note.

Editor’s Note

Continuing Medical Education