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In This Issue of JAMA Internal Medicine
September 2019


JAMA Intern Med. 2019;179(9):1157-1159. doi:10.1001/jamainternmed.2018.5511


Pack and colleagues performed this retrospective cohort study of data from a large multihospital database to evaluate the association between hospital rates of echocardiography use and outcomes in adult patients with acute myocardial infarction. Of 98 999 admissions for acute myocardial infarction among 397 US hospitals in 2014, higher hospital rates of echocardiography use were associated with longer length of stay and greater costs. However, no difference was found in rates of inpatient mortality or 3-month readmission.

This case-control study by Khan and colleagues used more than 25 million insurance claims to assess whether individuals who did not receive an opioid prescription had greater odds of overdose when an opioid prescription was dispensed to a family member. Individuals who experienced overdose were identified by their first opioid overdose after the baseline period and matched to control participants by time in the claims database, calendar time, age, sex, and number of individuals in the family unit. Results showed that prior opioid dispensing to family members was associated with 2.89-fold higher odds of individual overdose, which persisted in young children and increased with greater quantities of opioid medications dispensed to family members.

For this cohort study, Gomajee and colleagues examined the association of the regular use of electronic cigarettes with the number of cigarettes smoked per day, smoking cessation among current smokers, and smoking relapse among former smokers. Data were collected from the CONSTANCES (Consultants des Centres d’Examens de Santé) cohort study based in France. Findings suggested that, among adult smokers, electronic cigarette use appeared to be associated with a decrease in smoking level and an increase in smoking cessation attempts, but also with an increase in the level of smoking relapse in the general population after approximately 2 years of follow-up.

Judge-Golden and colleagues conducted this economic decision model to estimate the financial and reproductive health implications for implementation of a 12-month option for dispensing oral contraceptive pills in the Veterans Affairs health care system. The Veterans Affairs health care system currently stipulates a 3-month maximum dispensing limit for all medications, including oral contraceptive pills. Results demonstrated that adoption of a 12-month dispensing option for oral contraceptive pills would be expected to produce substantial cost savings for the payer compared with standard 3-month dispensing while also reducing unintended pregnancies among women veterans. Grossman provides the Invited Commentary.

Invited Commentary

For this cohort study, Kerlikowske and colleagues assessed strategies to identify women at high risk of advanced breast cancer to target patient-practitioner discussions about the need for supplemental imaging after routine mammography screening. Results showed that high rates of advanced breast cancer occurred in women with heterogeneously dense breasts and a 5-year risk of 2.5% or higher and those with extremely dense breasts and a 5-year risk of 1.0% or higher. Identification of density-risk subgroups at high risk of advanced cancer provided the most efficient approach for targeting women for supplemental imaging discussions. Richman and Busch provide the Invited Commentary.

Invited Commentary

Lintzeris and colleagues performed this randomized clinical trial to examine the safety and efficacy of nabiximols, a combination of tetrahydrocannabinol and cannabidiol, in the treatment of adults with cannabis dependence. Participants, who were seeking treatment and were nonresponsive to prior treatment attempts, received a 12-week treatment involving weekly clinical reviews, structured counseling, and flexible medication doses of nabiximols vs placebo. Participants in the placebo group reported more days using cannabis during the 12 weeks than the nabiximols group, and both groups showed comparable improvements in health status with no substantial changes in other substance use. Medication was well tolerated with few adverse events.

This prospective cohort study by Kapoor and colleagues evaluated records of residents in New England nursing homes who returned to their nursing homes after hospitalization to measure the frequency, severity, and preventability of adverse events after hospitalization. The main outcome was an adverse event (eg, pressure ulcers, skin tears, falls, health care–acquired infections, adverse drug events) within the 45-day period after transition from hospital. Results showed that adverse events developed 37.3% of the time and that of these events, 70.4% were preventable or remediable, with skin tears, pressure ulcers, and falls being the most common events.

In this systematic review and meta-analysis, Koutoukidis and colleagues assessed randomized clinical trials of participants with nonalcoholic fatty liver disease who underwent weight loss interventions to determine whether the interventions were associated with changes in nonalcoholic fatty liver disease biomarkers. Trials were included if they compared any intervention aiming to reduce weight (eg, behavioral weight loss programs, pharmacotherapy, and surgical procedures) with no or lower-intensity weight loss intervention. Results demonstrated that weight loss interventions were associated with clinically meaningful improvements in biomarkers of liver disease, though no evidence of changes in fibrosis was found. Adler and Brandman provide the Invited Commentary.

Invited Commentary and Related Article

Author Audio Interview