JAMA internal medicine
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JAMA internal medicine · Oct 2014
Multicenter Study Comparative StudyHospital performance for pharmacologic venous thromboembolism prophylaxis and rate of venous thromboembolism : a cohort study.
Hospitalization for acute medical illness is associated with increased risk of venous thromboembolism (VTE). Although efforts designed to increase use of pharmacologic VTE prophylaxis are intended to reduce hospital-associated VTE, whether higher rates of prophylaxis reduce VTE in medical patients is unknown. ⋯ The occurrence of 90-day VTE in medical patients after hospitalization is low. Patients who receive care at hospitals that have lower rates of pharmacologic prophylaxis do not have higher adjusted hazards of VTE, even after accounting for individual receipt of pharmacologic prophylaxis. Efforts to increase rates of pharmacologic VTE prophylaxis in hospitalized medical patients may not substantively reduce this adverse outcome.
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JAMA internal medicine · Oct 2014
Comparative StudyThe association between residency training and internists' ability to practice conservatively.
Growing concern about rising costs and potential harms of medical care has stimulated interest in assessing physicians' ability to minimize the provision of unnecessary care. ⋯ Regardless of overall medical knowledge, internists trained at programs in hospital referral regions with lower-intensity medical practice are more likely to recognize when conservative management is appropriate. These internists remain capable of choosing an aggressive approach when indicated.
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JAMA internal medicine · Oct 2014
Medical cannabis laws and opioid analgesic overdose mortality in the United States, 1999-2010.
Opioid analgesic overdose mortality continues to rise in the United States, driven by increases in prescribing for chronic pain. Because chronic pain is a major indication for medical cannabis, laws that establish access to medical cannabis may change overdose mortality related to opioid analgesics in states that have enacted them. ⋯ Medical cannabis laws are associated with significantly lower state-level opioid overdose mortality rates. Further investigation is required to determine how medical cannabis laws may interact with policies aimed at preventing opioid analgesic overdose.
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JAMA internal medicine · Oct 2014
Randomized Controlled TrialThe effect of information presentation on beliefs about the benefits of elective percutaneous coronary intervention.
For stable angina, the benefits of percutaneous coronary intervention (PCI) are limited to symptom relief, but patients often believe that PCI prevents myocardial infarction (MI). Whether presenting accurate information about the benefits of PCI would dispel these beliefs remains unknown. We hypothesized that explanatory information would be more effective for influencing volunteers' beliefs. ⋯ In the setting of mild, stable angina, most people assume PCI prevents MI and are likely to choose it. Explicit information can partially overcome that bias and influence decision making. Explanatory information was the most effective intervention in overcoming this bias.
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JAMA internal medicine · Oct 2014
Infection management and multidrug-resistant organisms in nursing home residents with advanced dementia.
Infection management in advanced dementia has important implications for (1) providing high-quality care to patients near the end of life and (2) minimizing the public health threat posed by the emergence of multidrug-resistant organisms (MDROs). ⋯ Antimicrobials are prescribed for most suspected infections in advanced dementia but often in the absence of minimum clinical criteria to support their use. Colonization with MDROs is extensive in nursing homes and is associated with exposure to quinolones and third- and fourth-generation cephalosporins. A more judicious approach to infection management may reduce unnecessary treatment in these frail patients, who most often have comfort as their primary goal of care, and the public health threat of MDRO emergence.