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In This Issue of JAMA Internal Medicine
October 2018


JAMA Intern Med. 2018;178(10):1289-1291. doi:10.1001/jamainternmed.2017.5234


Li and colleagues performed a randomized clinical trial to compare the effectiveness of a tai ji quan intervention with multimodal exercise and stretching exercise in reducing falls in older adults who had fallen in the past year. The study involved 670 community-dwelling adults 70 years or older who were randomly allocated to 1 of 3 interventions, all of which involved a 60-minute exercise session twice weekly for 24 weeks. For older adults at high risk for falls, a therapeutically tailored tai ji quan balance training intervention was more effective than conventional exercise approaches for reducing the incidence of falls.

Continuing Medical Education

In this qualitative content analysis of 14 recorded and transcribed outpatient clinical encounters, Brenner and colleagues assessed the quality of shared decision making about the initiation of lung cancer screening (LCS) in clinical practice. Results showed that of the 14 identified conversations between physicians and patients about initiation of LCS, none met the minimum skill criteria for 8 of 12 items on the Observing Patient Involvement in Decision Making scale, discussion of harms was nearly absent, and there was no evidence that decision aids or other patient education materials for LCS were used. Redberg provides an Editorial, and Ebell and Lin provide the Invited Commentary.

Editorial, Related Article, and Invited Commentary

Author Audio Interview

Panagioti and colleagues examined the association of physician burnout with an increased risk of patient safety incidents, suboptimal care outcomes due to low professionalism, and lower patient satisfaction in this meta-analysis of 42 473 physicians in 47 studies. Results showed that burnout was associated with 2-fold increased odds for unsafe care, unprofessional behaviors, and low patient satisfaction. The depersonalization dimension of burnout had the strongest links with these outcomes, and the association between unprofessionalism and burnout was particularly high across studies of early-career physicians. Linzer provides the Invited Commentary.

Invited Commentary

In this randomized clinical trial, Diokno and colleagues compared the effectiveness, cost, and cost-effectiveness of group-administered behavioral treatment (GBT) with no treatment for urinary incontinence in 463 community-dwelling women 55 years or older. The study was conducted at 3 academic medical centers where patients were randomized to either the GBT group or no treatment (control group). Women in the GBT group attended a 2-hour bladder health and self-management session, supported by written materials and an audio CD. The novel 1-time GBT program was modestly effective and cost-effective for reducing urinary incontinence frequency, severity, and bother, as well as improving quality of life.

Author Audio Interview

Morishita and colleagues investigated the effect of 2 air filtration systems vs a sham unfiltered system on personal exposures to fine particulate matter and blood pressure among older adults in this randomized, double-blind crossover intervention study. Through filtration systems in their bedrooms and living rooms, 40 nonsmoking adults in a low-income senior residential building were exposed to three 3-day scenarios—unfiltered air, low-efficiency filtered air, and high-efficiency filtered air—separated by 1-week washout periods. Short-term use of any portable air filtration system reduced personal fine particulate matter exposure and systolic blood pressure.

In this randomized clinical trial, Kravitz and colleagues examined whether participation in an individually designed single-patient multi-crossover (n-of-1) trial supported by a mobile app improved pain-related or patient-engaged outcomes compared with usual care among patients with chronic musculoskeletal pain. Patients who participated in the n-of-1 arm met with their clinicians to select treatments, and the mobile app provided reminders to follow treatment and to respond to daily questions on pain and adverse effects. Results of the study showed the mobile device–supported n-of-1 trials were feasible and associated with a satisfactory user experience but did not significantly improve pain interference at 6 months compared with usual care. Mirza and Guyatt provide the Invited Commentary.

Invited Commentary

In this population-based cohort study of 6732 intensive care unit (ICU) patients from 9 hospitals in Alberta, Canada, Stelfox and colleagues evaluated the 30-day hospital readmission, health care utilization, and clinical outcomes of patients discharged home directly from the ICU vs from a hospital ward. Although fewer patients are discharged directly home from the ICU vs from a hospital ward, findings showed that the discharge of select adult patients directly home is common and is not associated with increased health care utilization or increased mortality. Safavi provides the Invited Commentary.

Invited Commentary

Clinical Review & Education

In this Special Communication, Korenstein and colleagues reviewed case reports of overused medical tests and treatments and mapped out 6 domains of negative consequences for patients. The 6 domains—physical, psychological, social, financial, treatment burden, and dissatisfaction with health care—can result from overused services and from downstream services; they can also trigger further downstream services that in turn can lead to more negative consequences. The authors concluded that clarifying the breadth of potential negative consequences of overuse of tests and treatments for patients, and the processes that can lead to them, can inform efforts to understand and reduce overuse.