JAMA internal medicine
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JAMA internal medicine · Jan 2015
Getting maintenance of certification to work: a grounded theory study of physicians' perceptions.
Despite general support for the goals of maintenance of certification (MOC), concerns have been raised about its effectiveness, relevance, and value. ⋯ Physicians view MOC as an unnecessarily complex process that is misaligned with its purposes. Acknowledging and correcting these misalignments will help MOC meet physicians' needs and improve patient care.
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JAMA internal medicine · Jan 2015
Cardiac screening of young athletes prior to participation in sports: difficulties in detecting the fatally flawed among the fabulously fit.
Deaths of young athletes from cardiac disease are uncommon but receive considerable media attention and intermittently galvanize debates about cardiac screening prior to participation in sports. Both the American Heart Association (AHA) and European Society of Cardiology (ESC) endorse preparticipation screening in athletes; however, there is disagreement about the best approach. ⋯ For young athletes with normal electrocardiogram results, echocardiography contributes minimally to the diagnosis of serious cardiac diseases. Given all the complexities, cardiac screening of young athletes should be voluntary not mandatory and conducted by highly experienced physicians who fully understand the cardiovascular adaptation to intensive exercise.
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Cardiac biomarker testing is not routinely indicated in the emergency department (ED) because of low utility and potential downstream harms from false-positive results. However, current rates of testing are unknown. ⋯ Cardiac biomarker testing in the ED is common even among those without symptoms suggestive of ACS. Cardiac biomarker testing is also frequently used during visits with a high volume of other tests or services independent of the clinical presentation. More attention is needed to develop strategies for appropriate use of cardiac biomarkers.
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JAMA internal medicine · Jan 2015
Dual use of Department of Veterans Affairs and medicare benefits and use of test strips in veterans with type 2 diabetes mellitus.
Self-monitoring of blood glucose is a costly component of care for diabetes mellitus, with unclear benefits for patients not taking insulin. Veterans with dual Department of Veterans Affairs (VA) and Medicare benefits have access to test strips through both systems, raising the potential for overuse. ⋯ Veterans who receive glucose test strips through both the VA and Medicare use more strips and are more likely to potentially overuse strips. These results illustrate the profound importance of understanding dual VA and Medicare coverage and are emblematic of waste and inefficiency.