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May 2018, Vol 178, No. 5, Pages 593-732

In This Issue of JAMA Internal Medicine

Highlights

Abstract Full Text
free access
JAMA Intern Med. 2018;178(5):593-595. doi:10.1001/jamainternmed.2017.5209
Viewpoint

Health Care Policy and Law

The Personal Care Products Safety Act

Abstract Full Text
JAMA Intern Med. 2018;178(5):601-602. doi:10.1001/jamainternmed.2018.0064

This Viewpoint outlines goals of the proposed Personal Care Products Safety Act, a response to the problems associated with the current regulatory approach to cosmetics and personal care products in the United States.

Medical Students in Puerto Rico After Hurricane Maria

Abstract Full Text
JAMA Intern Med. 2018;178(5):603-604. doi:10.1001/jamainternmed.2018.0633

This Viewpoint explains the difficulties for medical students in Puerto Rico after Hurricane Maria.

Improving Communication With Patients With Limited English Proficiency

Abstract Full Text
JAMA Intern Med. 2018;178(5):605-606. doi:10.1001/jamainternmed.2018.0373

This Viewpoint stresses the importance of institutions providing clinicians who are fluent in the language of patients with limited English proficiency.

Italy’s New Advance Directive Law: When in Rome…

Abstract Full Text
JAMA Intern Med. 2018;178(5):607-608. doi:10.1001/jamainternmed.2018.0462

This Viewpoint describes the sociopolitical factors that led Italy to adopt its first advance directive legislation.

Perspective

Physician Work Environment and Well-Being

Does More Achievement Make Us Better Physicians?The Academic Arms Race

Abstract Full Text
JAMA Intern Med. 2018;178(5):597-598. doi:10.1001/jamainternmed.2018.0023

This Perspective describes the increasing pressures for achievement experienced by physicians as they start their careers and how this leads to neglect of the very qualities of inner character that need to be cultivated by physicians.

Toenails as the “Hemoglobin A1c” of Functional Independence—Beyond the Polished Wingtips

Abstract Full Text
JAMA Intern Med. 2018;178(5):598-599. doi:10.1001/jamainternmed.2018.0099

This article argues that the physical examination finding of long toenails should alert the clinician to other possible care needs and help guide questions as to the underlying differential diagnosis of the untrimmed toenails.

Would Have—A Physician's Personal Reflection On Alzheimer Dementia

Abstract Full Text
JAMA Intern Med. 2018;178(5):599-600. doi:10.1001/jamainternmed.2018.0129

The article describes a physician’s experience with a family member with Alzheimer disease.

Editorial

USPSTF Recommendations for Behavioral Counseling for Skin Cancer Prevention: Throwing Shade on UV Radiation

Abstract Full Text
JAMA Intern Med. 2018;178(5):609-611. doi:10.1001/jamainternmed.2018.0846

Is There a Future for Ovarian Cancer Screening?

Abstract Full Text
JAMA Intern Med. 2018;178(5):611-612. doi:10.1001/jamainternmed.2018.0591
Original Investigation

Alcohol-Related Nurse Care Management in Primary Care: A Randomized Clinical Trial

Abstract Full Text
free access
JAMA Intern Med. 2018;178(5):613-621. doi:10.1001/jamainternmed.2018.0388

This randomized clinical trial assessed the effect of 12 months of patient-centered nurse care management vs usual care on heavy drinking and alcohol-related problems among patients in primary care.

Cardiovascular Safety of Varenicline, Bupropion, and Nicotine Patch in Smokers: A Randomized Clinical Trial

Abstract Full Text
free access
JAMA Intern Med. 2018;178(5):622-631. doi:10.1001/jamainternmed.2018.0397

This randomized clinical trial evaluates the cardiovascular risk associated with use of varenicline, bupropion, and nicotine replacement therapy in individuals who smoke.

Sex Differences in Outcomes After STEMI: Effect Modification by Treatment Strategy and Age

Abstract Full Text
free access
JAMA Intern Med. 2018;178(5):632-639. doi:10.1001/jamainternmed.2018.0514

This observational study examines sex differences in outcomes in patients after ST-segment elevation myocardial infarction.

Association of the Centers for Medicare & Medicaid Services’ National Partnership to Improve Dementia Care With the Use of Antipsychotics and Other Psychotropics in Long-term Care in the United States From 2009 to 2014

Abstract Full Text
free access
JAMA Intern Med. 2018;178(5):640-647. doi:10.1001/jamainternmed.2018.0379

This interrupted time-series analysis of a 20% Medicare sample examines the association of CMS’s National Partnership to Improve Dementia Care in Nursing Homes with trends in prescribing of antipsychotic and other psychotropic medication among older adults in long-term care.

Health Care Reform

Medicare Accountable Care Organization Enrollment and Appropriateness of Cancer Screening

Abstract Full Text
free access
JAMA Intern Med. 2018;178(5):648-654. doi:10.1001/jamainternmed.2017.8087

This population-based analysis of Medicare data examines whether Medicare Shared Savings Program accountable care organization enrollment changes appropriateness of screening for breast, colorectal, and prostate cancers.

Dialysis Initiation and Mortality Among Older Veterans With Kidney Failure Treated in Medicare vs the Department of Veterans Affairs

Abstract Full Text
free access
JAMA Intern Med. 2018;178(5):657-664. doi:10.1001/jamainternmed.2018.0411

This cohort study compares use of dialysis and survival in patients with end-stage renal disease who receive care through Veterans Affairs vs Medicare.

Health Care Policy and Law

Association Between US State Medical Cannabis Laws and Opioid Prescribing in the Medicare Part D Population

Abstract Full Text
free access has audio
JAMA Intern Med. 2018;178(5):667-672. doi:10.1001/jamainternmed.2018.0266

This longitudinal study examines the association between prescribing patterns for opioids in Medicare Part D and the implementation of state medical cannabis laws.

Health Care Policy and Law

Association of Medical and Adult-Use Marijuana Laws With Opioid Prescribing for Medicaid Enrollees

Abstract Full Text
free access has audio
JAMA Intern Med. 2018;178(5):673-679. doi:10.1001/jamainternmed.2018.1007

This population-based, cross-sectional study examines the association of state implementation of medical and adult-use marijuana laws with opioid prescribing rates and spending among Medicaid enrollees.

Efficacy of Vaginal Estradiol or Vaginal Moisturizer vs Placebo for Treating Postmenopausal Vulvovaginal Symptoms: A Randomized Clinical Trial

Abstract Full Text
free access has audio
JAMA Intern Med. 2018;178(5):681-690. doi:10.1001/jamainternmed.2018.0116

This randomized clinical trial compares the efficacy of a low-dose vaginal estradiol tablet and a vaginal moisturizer, each vs placebo, for treatment of moderate-to-severe postmenopausal vulvovaginal symptoms.

State Firearm Laws and Interstate Firearm Deaths From Homicide and Suicide in the United States: A Cross-sectional Analysis of Data by County

Abstract Full Text
free access
JAMA Intern Med. 2018;178(5):692-700. doi:10.1001/jamainternmed.2018.0190

This cross-sectional analysis of US county data examines whether counties in states located closer to states with lenient firearm policies have higher firearm death rates.

Invited Commentary

Accountability for Underuse and Overuse of Cancer Screening

Abstract Full Text
JAMA Intern Med. 2018;178(5):655-656. doi:10.1001/jamainternmed.2017.8086

Appropriate Time for Chronic Dialysis Initiation: A Cause for Humility

Abstract Full Text
JAMA Intern Med. 2018;178(5):664-666. doi:10.1001/jamainternmed.2018.0470

The Role of Cannabis Legalization in the Opioid Crisis

Abstract Full Text
has audio
JAMA Intern Med. 2018;178(5):679-680. doi:10.1001/jamainternmed.2018.0254

Rethinking the Approach to Managing Postmenopausal Vulvovaginal Symptoms

Abstract Full Text
JAMA Intern Med. 2018;178(5):690-691. doi:10.1001/jamainternmed.2018.0094

Local Movement to Ban Menthol Tobacco Products as a Result of Federal Inaction

Abstract Full Text
JAMA Intern Med. 2018;178(5):711-713. doi:10.1001/jamainternmed.2018.0053

Delayed Generic Market Saturation After Patent Expiration—A Billion-Dollar Problem

Abstract Full Text
JAMA Intern Med. 2018;178(5):721-722. doi:10.1001/jamainternmed.2018.0989
Editor's Note

Interstate Association of State Firearm Laws With Suicide and Homicide

Abstract Full Text
JAMA Intern Med. 2018;178(5):701. doi:10.1001/jamainternmed.2018.0200
Teachable Moment

Less Is More

Unnecessary Repeat Enzyme Testing in Acute Pancreatitis: A Teachable Moment

Abstract Full Text
JAMA Intern Med. 2018;178(5):702-703. doi:10.1001/jamainternmed.2018.0106

This Teachable Moment questions the value of repeat lipase level assay as a follow-up measure for patients with a diagnosis of acute pancreatitis and proposes a more effective alternative.

Less Is More

Overtreatment of Asymptomatic Hypertension—Urgency Is Not an Emergency: A Teachable Moment

Abstract Full Text
JAMA Intern Med. 2018;178(5):704-705. doi:10.1001/jamainternmed.2018.0126

This Teachable Moment differentiates between hypertensive emergency and hypertensive urgency and examines the case of a woman who was incorrectly treated for hypertensive emergency when treatment for hypertensive urgency would have been more appropriate.

Research Letter

Patient-Centered Prescription Opioid Tapering in Community Outpatients With Chronic Pain

Abstract Full Text
open access
JAMA Intern Med. 2018;178(5):707-708. doi:10.1001/jamainternmed.2017.8709

This education intervention study reports on voluntary, patient-centered opioid tapering in outpatients with chronic pain without behavioral treatment.

Using Chaplains to Facilitate Advance Care Planning in Medical Practice

Abstract Full Text
free access
JAMA Intern Med. 2018;178(5):708-710. doi:10.1001/jamainternmed.2017.7961

This quality improvement study examines the effectiveness of having a board-certified chaplain conduct advance care planning conversations and end of life preferences with patients at the time of a routine office visit with a physician.

Health Care Policy and Law

Association of Ontario’s Ban on Menthol Cigarettes With Smoking Behavior 1 Month After Implementation

Abstract Full Text
free access
JAMA Intern Med. 2018;178(5):710-711. doi:10.1001/jamainternmed.2017.8650

This study compares respondents’ planned behavior before the 2017 menthol cigarette ban in Ontario with actual behavior 1 month after the ban.

Hypoglycemia in Hospice Patients With Type 2 Diabetes in a National Sample of Nursing Homes

Abstract Full Text
free access
JAMA Intern Med. 2018;178(5):713-715. doi:10.1001/jamainternmed.2017.7744

This retrospective cohort study examines whether patients with type 2 diabetes on hospice are assessed for dysglycemia, receive insulin or oral hypoglycemic medications, or experience hypoglycemia and hyperglycemia in the nursing home setting.

Association of Veterans Health Administration Home-Based Programs With Access to and Participation in Cardiac Rehabilitation

Abstract Full Text
free access
JAMA Intern Med. 2018;178(5):715-717. doi:10.1001/jamainternmed.2017.8039

This study examines whether implementing new home-based cardiac rehabilitation programs is associated with cardiac rehabilitation participation in the Veterans Health Administration.

Proportion of Decedents’ Expenditures Among Recent Reductions in Medicare Expenditures

Abstract Full Text
free access
JAMA Intern Med. 2018;178(5):717-719. doi:10.1001/jamainternmed.2017.8213

This cohort study uses Medicare data from the Dartmouth Atlas Project to determine the source of recent changes in end-of-life Medicare expenditures.

Health Care Policy and Law

Trends in Use and Expenditures of Brand-name Atorvastatin After Introduction of Generic Atorvastatin

Abstract Full Text
free access
JAMA Intern Med. 2018;178(5):719-721. doi:10.1001/jamainternmed.2018.0990

This study uses the Medical Expenditure Panel Survey (MEPS) database to analyze trends in use and expenditures of brand-name atorvastin after generic atorvastatin became available.

Comment & Response

Admitting What We Do Not Know in Rheumatologic Disease: The First Step Toward Learning More

Abstract Full Text
JAMA Intern Med. 2018;178(5):722-723. doi:10.1001/jamainternmed.2017.8557

This essay examines the levels of evidence used by specialty societies for creating treatment and diagnosis guidelines for patients with rheumatologic diseases.

Admitting What We Do Not Know in Rheumatologic Disease—The First Step Toward Learning More

Abstract Full Text
JAMA Intern Med. 2018;178(5):723-724. doi:10.1001/jamainternmed.2018.1251

Rigor in Quality Improvement Studies and the Role of Time-Series Methodologies

Abstract Full Text
JAMA Intern Med. 2018;178(5):724-725. doi:10.1001/jamainternmed.2018.0863

Admitting What We Do Not Know in Rheumatologic Disease—The First Step Toward Learning More—Reply

Abstract Full Text
JAMA Intern Med. 2018;178(5):724. doi:10.1001/jamainternmed.2018.0986

Rigor in Quality Improvement Studies and the Role of Time-Series Methodologies

Abstract Full Text
JAMA Intern Med. 2018;178(5):725. doi:10.1001/jamainternmed.2018.0866

Rigor in Quality Improvement Studies and the Role of Time-Series Methodologies—Reply

Abstract Full Text
JAMA Intern Med. 2018;178(5):725-726. doi:10.1001/jamainternmed.2018.0872

Voluntarily Stopping Eating and Drinking Among Patients With Serious Advanced Illness—A Label in Search of a Problem?

Abstract Full Text
JAMA Intern Med. 2018;178(5):726. doi:10.1001/jamainternmed.2018.1150

Voluntary Stopping Eating and Drinking Among Patients With Serious Advanced Illness—A Label in Search of a Problem?—Reply

Abstract Full Text
JAMA Intern Med. 2018;178(5):726-727. doi:10.1001/jamainternmed.2018.1147

Uncoupling Diagnosis and Treatment of Incidentally Imaged Renal Masses

Abstract Full Text
JAMA Intern Med. 2018;178(5):727-728. doi:10.1001/jamainternmed.2018.1180

Uncoupling Diagnosis and Treatment of Incidentally Imaged Renal Masses

Abstract Full Text
JAMA Intern Med. 2018;178(5):728. doi:10.1001/jamainternmed.2018.1186

Uncoupling Diagnosis and Treatment of Incidentally Imaged Renal Masses—Reply

Abstract Full Text
JAMA Intern Med. 2018;178(5):729. doi:10.1001/jamainternmed.2018.1183

Less Is More

Potential Methods to Reduce Unnecessary Use of Laboratory Testing—Reply

Abstract Full Text
JAMA Intern Med. 2018;178(5):729-730. doi:10.1001/jamainternmed.2018.1213

Potential Methods to Reduce Unnecessary Use of Laboratory Testing

Abstract Full Text
JAMA Intern Med. 2018;178(5):729. doi:10.1001/jamainternmed.2018.1216

Dual Bronchodilators and β-Blockade for Cardiovascular Risk in Chronic Obstructive Pulmonary Disease

Abstract Full Text
JAMA Intern Med. 2018;178(5):730-731. doi:10.1001/jamainternmed.2018.1442

Correcting Errors That Modify Descriptive Statistics

Abstract Full Text
JAMA Intern Med. 2018;178(5):731-732. doi:10.1001/jamainternmed.2018.1447

Less Is More

Dual Bronchodilators and β-Blockade for Cardiovascular Risk in Chronic Obstructive Pulmonary Disease—Reply

Abstract Full Text
JAMA Intern Med. 2018;178(5):731. doi:10.1001/jamainternmed.2018.1450
Correction

Errors in Abstract, Results Section, and Table 2

Abstract Full Text
free access
JAMA Intern Med. 2018;178(5):732. doi:10.1001/jamainternmed.2018.1367
Images From Our Readers

February Sunrise

Abstract Full Text
JAMA Intern Med. 2018;178(5):732. doi:10.1001/jamainternmed.2018.1463
JAMA Internal Medicine Masthead

JAMA Internal Medicine

Abstract Full Text
free access
JAMA Intern Med. 2018;178(5):596. doi:10.1001/jamainternmed.2017.5210
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