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Collaborative Medication Reviews in Older Patients
In this cluster randomized clinical trial, Romskaug and colleagues investigated the effect of clinical geriatric assessments and collaborative medication reviews by geriatricians and family physicians on health-related quality of life and other patient-relevant outcomes in home-dwelling older patients receiving polypharmacy. The study intervention consisted of clinical geriatric assessment of the patients combined with a thorough review of their medications, a meeting between the geriatrician and the family physician, and clinical follow-up. Results showed that health-related quality of life at follow-up at 16 weeks was statistically significantly better in patients who received the intervention compared with those who received usual care.
Testosterone Therapy and Venous Thromboembolism Risk
Walker and colleagues performed this case-crossover study to assess whether testosterone therapy is associated with short-term risk of venous thromboembolism in men with and without hypogonadism. Men in the case period were matched with themselves in the control period. Case periods of 6 months, 3 months, and 1 month before the venous thromboembolism events were defined, with equivalent control in the 6 months before the case period. National drug codes were used to identify billed testosterone therapy prescriptions in the case period. Use of testosterone therapy in the 6-month case period was associated with an increased risk of venous thromboembolism among men both with and without hypogonadism.
Smoking Cessation Intervention at Emergency Departments
This randomized clinical trial by Li and colleagues examined the effectiveness of a brief intervention based on self-determination theory for smoking cessation among Chinese smokers presenting at emergency departments in Hong Kong. The intervention group received brief advice (about 1 minute) and could choose their own quit schedules (immediate or progressive). The control group received a smoking cessation leaflet. Follow-up visits were conducted at 1, 3, 6, and 12 months. The primary outcome measure, by intent to treat, was biochemically validated abstinence at 6 months. Results demonstrated that the intervention was effective in increasing the biochemically validated quit rate at 6 months.
Work Schedules of Hospitalists and Patient Outcomes
For this cohort study using 3 years of Medicare claims data from hospitals in Texas, Goodwin and colleagues analyzed whether admitted patients receiving care from hospitalists with more discontinuous schedules experienced worse outcomes. For each admission, the weighted mean of schedule continuity for the treating hospitalists, assessed as the percentage of all their working days in that year that were part of a block of 7 or more consecutive working days, was calculated. Patients receiving care from hospitalists whose schedules permitted continuity of care had significantly better outcomes, including lower 30-day mortality after discharge, lower readmissions, higher rates of discharge to the home, and lower 30-day postdischarge costs.
Author Audio Interview CME
Evaluation of a Palliative Care Program for Nursing Homes
Van den Block and colleagues performed this cluster-randomized clinical trial to examine the effect of implementing the Palliative Care for Older People (PACE) Steps to Success Program in 78 nursing homes in 7 countries with residents and staff outcomes at resident end of life. The PACE Steps to Success Program is a multicomponent intervention to integrate basic nonspecialist palliative care in nursing homes. Comparing PACE Steps to Success with usual care, residents’ comfort in the last week of life did not improve. Staff knowledge of palliative care improved, but the difference was very small. Hunt and colleagues provide the Invited Commentary.
Association of Plant Closures and Overdose Mortality
In this difference-in-differences study, Venkataramani and colleagues estimated the extent to which automotive assembly plant closures in the United States were associated with increasing opioid overdose mortality rates among working-age adults. Manufacturing counties located in 30 commuting zones (primarily in the US South and Midwest) that experienced an automotive assembly plant closure were compared with counties in which automotive plants remained open from 1999 to 2016. Results showed that automotive assembly plant closures in the commuting zone of residence were associated with a statistically significant increase in county-level opioid overdose mortality rates among adults aged 18 to 65 years.
Ultraprocessed Food Consumption and Risk of Diabetes
For this population-based prospective cohort study, Srour and colleagues examined whether a higher proportion of ultraprocessed foods in the diet was associated with a higher risk of type 2 diabetes. Participants 18 years or older from the French NutriNet-Santé cohort were included. Dietary intake data were collected using repeated 24-hour dietary records, designed to register participants’ usual consumption for more than 3500 different food items. Associations were adjusted for known risk factors (sociodemographic, anthropometric, lifestyle, medical history, and nutritional factors). Results demonstrated that a higher proportion of ultraprocessed foods in the diet was associated with a higher risk of type 2 diabetes.
Clinical Review & Education
Confidentiality Orders in Drug and Device Litigation
This Special Communication by Egilman and colleagues reviews the rules governing confidentiality orders and discusses the tension between these rules and prevailing legal practices relating to court secrecy in medical product litigation, including competing interests among manufacturers, plaintiffs, and courts. Prevailing legal practices can undermine access to information by patients, clinicians, and the US Food and Drug Administration and also obscure patterns of injury and disease associated with the drugs and medical devices at issue. The authors suggest that substantial progress is possible if medical experts engaged in medical product litigation make a commitment to push for the disclosure of important documents. Cohen and Bagley provide the Invited Commentary.
Highlights. JAMA Intern Med. 2020;180(2):173–175. doi:10.1001/jamainternmed.2019.4351
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