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In This Issue of JAMA Internal Medicine
January 2019


JAMA Intern Med. 2019;179(1):1-3. doi:10.1001/jamainternmed.2018.4702


In this cluster-randomized clinical trial, Najafi and colleagues used a targeted electronic health record (EHR) alert to determine if the single-component intervention could achieve similar gains as multicomponent interventions and safely reduce unnecessary telemetry monitoring. The EHR alert, which displayed during daytime hours when physicians attempted to place an order for patients not in the intensive care unit and whose telemetry order duration exceeded the recommended duration for a given indication, was randomized to 6 of 12 teams on the general medicine service of a medical center. Results demonstrated that a targeted EHR alert can safely and successfully reduce unnecessary cardiac monitoring by prompting discontinuation when appropriate.

Schwartz and colleagues performed this observational study using Medicare claims data to quantify variation in provision of low-value health care services among primary care physicians and estimate the proportion of variation attributable to physician characteristics that may be used to predict performance. The retrospective analysis included national Medicare fee-for-service claims of 3 159 834 beneficiaries served by 41 773 generalist physicians. Findings showed that physician practices may substantially contribute to low-value service use and that because little variation is predicted by measured physician characteristics, direct measures of low-value care provision may aid organizational efforts to encourage high-value practices. Korenstein provides the Invited Commentary.

Invited Commentary

For this randomized clinical trial, Martínez-Velilla and colleagues assessed the effects of an innovative multicomponent exercise intervention on the functional status of very elderly patients hospitalized for acute care. A total of 370 patients undergoing acute-care hospitalization were randomly assigned to an exercise or control intervention. The control group received usual-care hospital care, which included physical rehabilitation when needed, and the in-hospital intervention included individualized moderate-intensity resistance, balance, and walking exercises during 2 daily sessions. The exercise intervention proved to be safe and effective in reversing the functional decline associated with acute hospitalization in very elderly patients. Hall provides the Invited Commentary.

Invited Commentary

Author Audio Interview and Continuing Medical Education

In this prospective cohort study, Rawal and colleagues characterized the trauma of hospitalization by measuring inpatient-reported disturbances in sleep, mobility, nutrition, and mood, then examined the association between these disturbances and the risk of 30-day readmission or emergency department visit after hospital discharge. Participants were adults admitted to the internal medicine ward in 2 academic hospitals for more than 48 hours. Participants were interviewed before discharge using a standardized questionnaire to assess sleep, mobility, nutrition, and mood. Disturbances in sleep, mobility, nutrition, and mood were commonly reported in inpatients, and such trauma of hospitalization may be associated with a greater risk of 30-day readmission or emergency department visit after discharge. Brown provides the Invited Commentary.

Invited Commentary

Thurston and colleagues performed this prospective cohort study to investigate the association of history of sexual harassment and sexual assault with blood pressure, mood, anxiety, and sleep among midlife women. The study included 304 nonsmoking women aged 40 to 60 years without cardiovascular disease who were recruited to undergo physical measurements (blood pressure, height, weight), medical history, and questionnaire psychosocial assessments (workplace sexual harassment, sexual assault, depression, anxiety, sleep). Results showed that sexual harassment was associated with higher blood pressure and poorer sleep, and sexual assault was associated with poorer mental health and sleep.

Related Article

In this cross-sectional study, Pooler and Srinivasan used National Health Interview Survey data to investigate participation in the Supplemental Nutrition Assistance Program (SNAP) and its association with cost-related medication nonadherence among older adults with diabetes. Individuals assessed in the study were diagnosed with diabetes or borderline diabetes, were eligible to receive SNAP benefits, were prescribed medications, and incurred more than zero US dollars in out-of-pocket medical expenses in the past year. The study findings suggested that participants in SNAP had a moderate decrease in cost-related medication nonadherence compared with eligible nonparticipants and that connecting older adults with diabetes with SNAP may be a feasible strategy for improving health outcomes.

For this nested case-control study, Smith-Bindman and colleagues quantified the risk of malignant ovarian cancer based on ultrasonographic characteristics of ovarian masses, including simple cysts, in a large unselected population. Of the 72 093 women who underwent pelvic ultrasonography, 210 were diagnosed as having ovarian cancer. Results further showed that the ultrasonographic appearance of ovarian masses was strongly associated with a woman’s risk of ovarian cancer and that simple cysts were not associated with an increased risk of ovarian cancer, whereas complex cysts or solid masses were associated with a significantly increased risk of ovarian cancer. Levine provides the Invited Commentary.

Invited Commentary

Continuing Medical Education

Gibson and colleagues performed this cross-sectional analysis of data from a multiethnic cohort of midlife and older women to examine the associations of intimate partner violence, sexual assault, and posttraumatic stress with menopause symptoms. Patient data on exposures to intimate partner violence and sexual assault, and symptoms of posttraumatic stress disorder were drawn from self-administered or interviewer-administered questionnaires at an integrated health care system. Study findings showed emotional intimate partner violence and posttraumatic stress were associated with sleep-related, vasomotor, and vaginal symptoms; physical intimate partner violence was associated with night sweats; and sexual assault was associated with vaginal symptoms. Thurston and Miller provide the Invited Commentary.

Invited Commentary