JAMA internal medicine
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JAMA internal medicine · Aug 2015
Randomized Controlled TrialOral Appliance Therapy in Patients With Daytime Sleepiness and Snoring or Mild to Moderate Sleep Apnea: A Randomized Clinical Trial.
Oral appliances that move the mandible forward during sleep are suggested as treatment for mild to moderate obstructive sleep apnea. ⋯ A custom-made, adjustable oral appliance reduces obstructive sleep apnea, snoring, and possibly restless legs without effects on daytime sleepiness and quality of life among patients with daytime sleepiness and snoring or mild to moderate sleep apnea.
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JAMA internal medicine · Aug 2015
Sudden Death in Patients With Cardiac Implantable Electronic Devices.
Interrogations and autopsies of sudden deaths with cardiac implantable electronic devices (CIEDs) are rarely performed. Therefore, causes of sudden deaths with these devices and the incidence of device failure are unknown. ⋯ Systematic interrogation and autopsy of sudden deaths in one city identified concerns about CIED function that might otherwise not have been observed. Current passive surveillance efforts may underestimate device malfunction. These methods can provide unbiased data regarding causes of sudden death in individuals with CIEDs and improve surveillance for CIED problems.
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JAMA internal medicine · Aug 2015
Effects of a Medical Home and Shared Savings Intervention on Quality and Utilization of Care.
Published evaluations of medical home interventions have found limited effects on quality and utilization of care. ⋯ During a 3-year period, this medical home intervention, which included shared savings for participating practices, was associated with relative improvements in quality, increased primary care utilization, and lower use of emergency department, hospital, and specialty care. With further experimentation and evaluation, such interventions may continue to become more effective.
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JAMA internal medicine · Aug 2015
The Effect of State Policies on Organ Donation and Transplantation in the United States.
Shortages in transplantable solid organs remain a critical public health challenge in the United States. During the past 2 decades, all states have implemented policies to increase organ supply, although their effectiveness is unknown. ⋯ Nearly all state-level policies to encourage organ donation have had no observable effect on the rate of organ donation and transplantation in the United States. The one exception was the establishment of revenue policies to promote organ donation, which may have led to small increases in organ donations and transplantations from deceased donors. New policy designs are needed to increase donation rates and curtail the widening gap between organ supply and demand.