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In This Issue of JAMA Internal Medicine
September 2018

Highlights

JAMA Intern Med. 2018;178(9):1149-1151. doi:10.1001/jamainternmed.2017.5229

Research

Bindman and Cox performed this retrospective cohort analysis to investigate if there was an association between the implementation of transitional care management payment codes and changes in cost and health outcomes for Medicare beneficiaries discharged to the community from medical facilities. Results showed that despite benefits of transitional care management services, use remains low, and the adjusted total Medicare costs and mortality were higher among those beneficiaries who did not receive transitional care management services compared with those who did following an eligible discharge. Huckfeldt and colleagues provide the Invited Commentary.

Invited Commentary

In this cluster randomized clinical trial, Coronado and colleagues examined effectiveness of mailing a fecal immunochemical test (FIT) to patients due for colorectal cancer screening when implemented in busy community clinic practices in Oregon and California as part of standard care. Effectiveness was measured as clinic-level proportions of adults who completed a FIT, and secondarily, any colorectal cancer screening during the evaluation interval. Compared with usual care clinics, intervention clinics had significantly higher adjusted clinic-level proportion of participants who completed a FIT and any colorectal cancer screening. Redberg provides the Editor’s Note.

Editor’s Note

In this population-based, retrospective cohort study, Chang and colleagues examined the association between use of oral medication for type 2 diabetes, including sodium-glucose cotransporter 2 (SGLT-2) inhibitors, and lower extremity amputation, peripheral arterial disease, critical limb ischemia, osteomyelitis, and ulcer. Results showed amputations were rare and that there was no statistically significantly increased risk of amputations associated with new use of SGLT-2 inhibitors compared with new use of dipeptidyl peptidase 4 inhibitors and glucagon-like peptide 1 agonists. However, new use of SGLT-2 inhibitors was associated with a statistically significant increased risk of amputation compared with use of metformin, sulfonylureas, and thiazolidinediones. Fralick and colleagues provide the Invited Commentary.

Invited Commentary

Continuing Medical Education

Wesselius and colleagues performed a cross-sectional study to assess the quantity and quality of sleep and the factors associated with sleep disturbances in hospitalized patients when compared with patients’ habitual sleep at home. A total of 39 hospitals in the Netherlands participated, and 2005 patients were included. Results showed the total sleep time in the hospital was 83 minutes shorter than at home, the mean number of nocturnal awakenings was 2.0 times at home vs 3.3 times during hospitalization, and hospitalized patients woke up 44 minutes earlier than their habitual wake-up time at home. The most reported sleep-disturbing factors were noise of other patients, medical devices, pain, and toilet visits. Growdon and Inouye provide the Invited Commentary.

Invited Commentary

Clarke and colleagues evaluated the prevalence of postmenopausal bleeding among women with endometrial cancer and the risk of endometrial cancer in women with postmenopausal bleeding in this systematic review and meta-analysis of studies published from January 1, 1977, through January 1, 2017. The pooled prevalence of postmenopausal bleeding among women with endometrial cancer was 91%, irrespective of tumor stage. The pooled risk of endometrial cancer among women with postmenopausal bleeding was 9%, with estimates varying by use of hormone therapy and geographic region. Matteson and colleagues provide the Invited Commentary.

Invited Commentary

In this case-control study, Caughey and colleagues used data from 2 population-based databases to examine the association between current exposure to statin medications and histologically confirmed idiopathic inflammatory myositis in Australian adults. Statin medications are widely prescribed for cardiovascular risk reduction and are linked to adverse effects such as myalgia and rhabdomyolysis. Results of this study showed there was an almost 2-fold increased likelihood of statin exposure in patients with idiopathic inflammatory myositis compared with controls and that similar results were observed when patients with necrotizing myositis were excluded from the analysis. Curfman provides the Editor’s Note.

Editor’s Note

In this 10-year cohort study, Roncarati and colleagues investigated all-cause and cause-specific mortality and age-stratified incident rate ratios among 445 unsheltered homeless adults in Boston, Massachusetts, compared with the entire Massachusetts population and also with a cohort of sheltered homeless adults in Boston. Results showed the all-cause mortality rate for the unsheltered cohort was almost 10 times higher than that of the Massachusetts population and nearly 3 times higher than that of the sheltered cohort. The most common causes of death were noncommunicable diseases (eg, cancer, heart disease), alcohol use disorder, and chronic liver disease. Incze and Katz provide the Invited Commentary.

Invited Commentary

Clinical Review & Education

In this Special Communication, Ivers and colleagues explored the strengths, challenges, and lessons learned following the introduction of the Canadian single-payer health care system in the late 1960s and compared this system with health care approaches in other countries, including the United States. The authors concluded that while a single-payer health care system offers important advantages and ensures universal access to necessary health services, it does not equate to an integrated, well-managed system that can readily meet the changing health care needs of a population. White provides the Invited Commentary.

Invited Commentary

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