JAMA internal medicine
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JAMA internal medicine · Dec 2018
Association of Angiotensin-Converting Enzyme Inhibitor or Angiotensin Receptor Blocker Use With Outcomes After Acute Kidney Injury.
Patients with acute kidney injury (AKI) are at an increased long-term risk of death. Effective strategies that improve long-term outcomes in patients with AKI are unknown. ⋯ Among patients with AKI, ACEI or ARB therapy appeared to be associated with lower mortality but a higher risk of hospitalization for a renal cause. These results suggest a potential benefit of ACEI or ARB use after AKI, but cautious monitoring for renal-specific complications may be warranted.
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JAMA internal medicine · Dec 2018
Meta AnalysisEvaluation of Interventions Intended to Increase Colorectal Cancer Screening Rates in the United States: A Systematic Review and Meta-analysis.
Colorectal cancer screening (CRC) is recommended by all major US medical organizations but remains underused. ⋯ Fecal blood test outreach and patient navigation, particularly in the context of multicomponent interventions, were associated with increased CRC screening rates in US trials. Fecal blood test outreach should be incorporated into population-based screening programs. More research is needed on interventions to increase adherence to continued FBTs, follow-up of abnormal initial screening test results, and cost-effectiveness and other implementation barriers for more intensive interventions, such as navigation.
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JAMA internal medicine · Dec 2018
Randomized Controlled TrialEngaging Diverse English- and Spanish-Speaking Older Adults in Advance Care Planning: The PREPARE Randomized Clinical Trial.
Advance care planning improves the receipt of medical care aligned with patients' values; however, it remains suboptimal among diverse patient populations. To mitigate literacy, cultural, and language barriers to advance care planning, easy-to-read advance directives and a patient-directed, online advance care planning program called PREPARE For Your Care (PREPARE) were created in English and Spanish. ⋯ The patient-facing PREPARE program and an easy-to-read advance directive, without clinician-level or system-level interventions, increased documentation of advance care planning and patient-reported engagement, with statistically higher gains for PREPARE vs advance directive alone. These tools may mitigate literacy and language barriers to advance care planning, allow patients to begin planning on their own, and could substantially improve the process for diverse English-speaking and Spanish-speaking populations.
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JAMA internal medicine · Dec 2018
Combustible and Electronic Tobacco and Marijuana Products in Hip-Hop Music Videos, 2013-2017.
Hip-hop is the leading music genre in the United States and its fan base includes a large proportion of adolescents and young adults of all racial and ethnic groups, particularly minorities. The appearance of combustible and electronic tobacco and marijuana products, especially brand placement and use by popular and influential artists, may increase the risk of tobacco and marijuana use and decrease perceptions of harm. ⋯ Combustible and electronic tobacco and marijuana use frequently occurred in popular hip-hop music videos. The genre's broad appeal, use of branded products by influential artists, and rise of electronic product and marijuana use may contribute to a growing public health concern of tobacco and marijuana use.