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Association of Opioids With Increased Pneumonia Risk
In this nested case-control study, Edelman and colleagues assessed the association of prescribed opioids with the risk for community-acquired pneumonia requiring hospitalization among patients with and without HIV in the Veterans Aging Cohort Study. Patients with community-acquired pneumonia requiring hospitalization were matched 1:5 with control individuals without community-acquired pneumonia by age, sex, race/ethnicity, length of observation, and HIV status. Results showed that prescribed opioids, especially higher-dose and immunosuppressive opioids, were associated with increased community-acquired pneumonia risk among persons with and without HIV.
Care for Patients Who Forgo Maintenance Dialysis
Wong and colleagues performed this qualitative analysis using documentation in the electronic medical records of adult patients with advanced kidney disease receiving care from the US Veterans Health Administration to describe how decisions not to start dialysis unfold in the clinical setting. During analysis, 3 prominent themes emerged: (1) clinicians did not readily accept patients’ wishes not to start dialysis, (2) clinicians decided particular patients were not candidates for dialysis seemingly without consideration of the patients’ goals and values, and (3) clinicians seemed to believe they had little more to offer patients who would not be starting dialysis. Ladin and Smith provide the Invited Commentary.
Treatment and Outcomes After Asthma Exacerbation
In this retrospective cohort study, Stefan and colleagues assessed outcomes associated with the addition of antibiotic treatment in patients hospitalized for asthma exacerbation and treated with corticosteroids who had no other indication for antibiotic therapy. The primary outcome measure was hospital length of stay, and other measures were treatment failure within 30 days of discharge, hospital costs, and antibiotic-related diarrhea. Results showed that compared with patients who were not treated with antibiotics, treated patients had a significantly longer hospital stay, similar rate of treatment failure, and higher risk of antibiotic-related diarrhea.
Continuing Medical Education
Liver Transplant Success for Alcohol-Associated Disease
In this multicenter, prospective, national cohort study, Lee and colleagues analyzed data from all liver transplants performed in the United States from 2002 through 2016 to investigate the increase in liver transplants for alcohol-associated liver disease and evaluate the long-term success of transplant in these patients. Results showed that the increase in liver transplant for alcohol-associated liver disease was associated with a decrease in liver transplant for hepatitis C virus infection and that 5-year posttransplant survival was lower in patients with alcohol-associated liver disease. Mitchell and Maddrey provide the Invited Commentary.
Quality of Outpatient Care With or Without Primary Care
Levine and colleagues performed this national survey study of data collected from a large sample of noninstitutionalized US adults to assess whether there is an association between receipt of primary care and high- or low-value services or patient experience in outpatient care. Patients’ self-reported receipt of primary care was determined by the 4 “Cs” of primary care: first-contact care that is comprehensive, continuous, and coordinated. Results showed that receipt of primary care was associated with significantly more high-value care, slightly more low-value care, and significantly better health care access and experience. Goroll provides the Invited Commentary.
Possible Effects of Medicare Reform on Drug Costs
In this retrospective drug cohort study, Hwang and colleagues analyzed 75 brand-name drugs to estimate the costs of proposed Medicare Part B drug pricing reforms on total drug spending and patient cost-sharing after the US Department of Health and Human Services proposed a change that would shift coverage of certain drugs from Medicare Part B to Part D. The analysis showed that the shift was estimated to decrease total drug spending, and out-of-pocket costs for most drugs were projected to be lower in Part D. However, out-of-pocket costs were estimated to increase among beneficiaries with Medicare supplement insurance and among those currently without Part D coverage. Crosson and Christianson provide the Invited Commentary.
Invited Commentary and Related Article
Author Audio Interview
Association of Long-term Exercise With Risk of Falls
In this systematic review and meta-analysis, de Souto Barreto and colleagues investigated the association of long-term exercise interventions with the risk of falls, injurious falls, multiple falls, fractures, hospitalization, and mortality in older adults. Among the 40 long-term randomized clinical trials reviewed, the most used exercise was a multicomponent training, and the mean frequency was 3 times per week, about 50 minutes per session, at a moderate intensity. Results showed an association between long-term exercise and a reduction in falls, injurious falls, and probably fractures in older adults. Landefeld and Kraemer provide the Invited Commentary.
Self-compression Technique in Mammography
Henrot and colleagues performed this randomized clinical trial to evaluate the noninferiority of the self-compression mammography technique for reducing breast thickness compared with standard compression. Participants were women aged 50 to 75 years, did not have a history of recent breast surgical procedure or treatment, and could perform self-compression. Self-compression mammography was found to be noninferior to the standard compression approach in achieving minimal breast thickness. The compression force was higher in the self-compression group compared with the standard compression group without increasing pain or compromising image quality.
Highlights. JAMA Intern Med. 2019;179(3):285–287. doi:10.1001/jamainternmed.2018.5481
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