Precision Medicine and Advancing Clinical Care
This Viewpoint examines how data from an Icelandic large-scale genotyping and sequencing initiative can enhance understanding of basic molecular pathways to advance precision medicine. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - December 10, 2018 Category: Internal Medicine Source Type: research

Assessment of a Targeted Electronic Health Record Intervention to Reduce Telemetry Duration
This cluster-randomized clinical trial assesses whether a targeted electronic health record alert achieves similar advances to multicomponent interventions and safely reduces unnecessary monitoring. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - December 10, 2018 Category: Internal Medicine Source Type: research

Self-monitoring of Blood Glucose in Individuals With Type 2 Diabetes Not Using Insulin
This database analysis quantifies the rate of use and cost of self-monitoring blood glucose supplies that are potentially used inappropriately, specifically focusing on test strips. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - December 10, 2018 Category: Internal Medicine Source Type: research

Inferior Vena Cava Filter Use and Mortality in Older Adults With Acute Pulmonary Embolism
This study uses 3 distinct statistical approaches to examine the association between use of inferior vena cava filters and mortality rates in Medicare fee-for-service beneficiaries with pulmonary embolism. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - December 10, 2018 Category: Internal Medicine Source Type: research

Bundle Branch Block Site in a Patient With a Right-Lying Heart and Wide QRS Complex
This case report presents the electrocardiographic findings in a woman with dextroversion. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - December 10, 2018 Category: Internal Medicine Source Type: research

2018 Update on Medical Overuse
This Special Communication, the fifth annual update on medical overuse, discusses 10 studies published in 2017 that are most relevant to understanding medical overuse in adults. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - December 3, 2018 Category: Internal Medicine Source Type: research

Long-term Physician-Patient Relationships —Persevering in a Practice
This article describes the benefits of maintaining a long-term physician-patient relationship rather than the trend toward more temporary relationships. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - December 3, 2018 Category: Internal Medicine Source Type: research

Dental Clinician –Prescribed Opioids for Adolescents and Young Adults and Subsequent Substance Abuse
This cohort study using the Optum Research Database examines whether opioid prescriptions provided by dental clinicians for pain management of third molar extractions to opioid-naive US adolescents and young adults was associated with subsequent opioid use and abuse. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - December 3, 2018 Category: Internal Medicine Source Type: research

Association of Hospitalization Trauma With Readmission or Emergency Department Visit
This cohort study examines patient reports and implications of difficulties with sleep, movement, eating, and anxiety or depression during hospitalization for at least 48 hours and the association with subsequent readmission or emergency department visits. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - December 3, 2018 Category: Internal Medicine Source Type: research

Analysis of Physician Variation in Provision of Low-Value Services
This study quantifies variation in provision of low-value health care services among primary care physicians and estimates the proportion of variation attributable to physician characteristics that may be indicative of performance among Medicare beneficiaries. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - December 3, 2018 Category: Internal Medicine Source Type: research

Coding Error Resulting in Change in Secondary Outcome Scores in Trial of Safety and Benefit of Discontinuing Statin Therapy Among Terminally Ill Patients
To the Editor On behalf of our coauthors, we write to report errors that occurred in our article, “Safety and Benefit of Discontinuing Statin Therapy in the Setting of Advanced, Life-Limiting Illness: A Randomized Clinical Trial,” that was published online on March 23, 2015, and in the May 2015 issue ofJAMA Internal Medicine. We believe that this represents a “pervasive error” warranting this letter of explanation and a Correction. The overall impact of the errors is minor and once corrected the conclusions of the study remain unchanged. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - December 3, 2018 Category: Internal Medicine Source Type: research

Cost-Related Insulin Underuse Among Patients With Diabetes
This survey study examines the association of higher insulin costs with nonadherence in patients with diabetes. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - December 3, 2018 Category: Internal Medicine Source Type: research

When High Prices Mean Needless Death
I have spent the last 5 years of my life as a journalist writing about the irrational costs and prices across the US health care system. But if there is 1 fact that should cause national embarrassment it is the high price tag we affix to living with type 1 diabetes. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - December 3, 2018 Category: Internal Medicine Source Type: research

Focus on Patient-Centered Care to Address Trauma of Hospitalization
InCrossing the Quality Chasm: A New Health System for the 21st Century, the Institute of Medicine addressed how the nation ’s health care system should be redesigned to improve the delivery of care. The report identifiedpatient-centered care, defined as care that is “respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions,”(p3) as 1 of 6 core components of the desired state-of-the-art care. Unfortunately, delivering patient-centered care in the hospital setting remains challenging because of the complexity and acuity ...
Source: JAMA Internal Medicine - December 3, 2018 Category: Internal Medicine Source Type: research

Medical Overuse as a Cognitive Error
Medical overuse, or health services for which potential harms outweigh benefits, is common and persistent. Medical overuse is assumed to exist when regional variation occurs without improvements in outcomes and is believed to be driven largely by perverse financial incentives and local cultures of care. In this issue ofJAMA Internal Medicine, Schwartz and colleagues quantified variations in primary care physician provision of low-value services (largely representing overuse) among Medicare beneficiaries and characterized associations with physician characteristics such as age, training, and research activities. Although pr...
Source: JAMA Internal Medicine - December 3, 2018 Category: Internal Medicine Source Type: research

Coding Error Resulting in Change in Secondary Outcome Scores
This article has been corrected online. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - December 3, 2018 Category: Internal Medicine Source Type: research

Diagnosing an Acutely Breathless Patient
This report of a case describes a man in his 70s with type 2 diabetes, hypertension, and hyperlipidemia who presented to the emergency department with 4 days of progressive dizziness, shortness of breath, and chest pain on exertion. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - December 3, 2018 Category: Internal Medicine Source Type: research

JAMA Internal Medicine
Mission Statement: To promote the art and science of medicine and the betterment of human health by publishing manuscripts of interest and relevance to internists practicing as generalists or as medical subspecialists. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - December 1, 2018 Category: Internal Medicine Source Type: research

East River Greenway, New York City
Courtesy of: Manfred Hauben, MD, MPH, Pfizer, Safety Sciences Research, 235 E 42nd St, New York, NY 10017 (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - December 1, 2018 Category: Internal Medicine Source Type: research

Rewording of Conclusions and Corrected Data in Table 1
In the article titled “Association of Frequency of Organic Food Consumption With Cancer Risk: Findings From the NutriNet-Santé Prospective Cohort Study,” the conclusions in the Abstract and article body, as well as the Meaning of the Key points, have been reworded. The rows of data for “Low” and “High” under the category “Physical activity, %d” in Table 1 have also been transposed. The article was corrected online. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - December 1, 2018 Category: Internal Medicine Source Type: research

Omitted Funding Source
This article was corrected online. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - December 1, 2018 Category: Internal Medicine Source Type: research

Updated Disclosure Statement for Invited Commentary
The Conflict of Interest Disclosures for the article “Organic Foods for Cancer Prevention—Worth the Investment?”, published on October 22, 2018, inJAMA Internal Medicine, have been updated to include the following inadvertently omitted disclosures: “Dr Hu also received honoraria for lectures from Metagenics and Standard Process and honoraria from Diet Quality Photo Navigation, outside the submitted work.” (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - December 1, 2018 Category: Internal Medicine Source Type: research

Updated Disclosure Statement for Invited Commentary
To the Editor I write to update my disclosure of potential conflicts of interest in the Invited Commentary, “Organic Foods for Cancer Prevention-Worth the Investment?”, published online October 22, 2018, inJAMA Internal Medicine. In the interest of full disclosure, my statement should also have included that I received “honoraria for lectures from Metagenics and Standard Process and honoraria from Diet Quality Photo Navigation, outside the submitted work.” I regret this oversight and have asked the journal to correct the article online. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - December 1, 2018 Category: Internal Medicine Source Type: research

Discharge Home From Critical Care: Comparing Different Healthcare Systems —Reply
In Reply We thank Roshdy and colleagues for sharing their local experiences with the discharge of patients directly home from the intensive care unit (ICU). Their data complements those published in our study and others highlighting that flow failure, the inefficient movement of patients across the health care system, is a growing global problem with ramifications that extend to the care of critically ill patients. Delays in patient discharge from the ICU have risks. Resources may be misallocated, and non-ICU related treatments may be deferred. Communication may fail because physicians primarily communicate when patients a...
Source: JAMA Internal Medicine - December 1, 2018 Category: Internal Medicine Source Type: research

Discharge Home From Critical Care: Comparing Different Health Care Systems
To the Editor We commend Stelfox and colleagues for their excellent work in evaluating the practice of directly discharging patients home from critical care. The authors clearly identified local practice and service structure as factors in ensuring safety in this less-than-ideal practice. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - December 1, 2018 Category: Internal Medicine Source Type: research

Poor Sleep in Hospitalized Patients: Are Hospital-Related Factors at Fault? —Reply
In Reply We thank Quah Qin Xian and colleagues for their comments regarding our study concerning sleep in hospitalized patients. In their letter, the authors raise concerns about the subjective nature of the study and highlight the chance of overestimation of a poor sleep experience in hospitalized patients owing to the possibility of confirmation bias. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - December 1, 2018 Category: Internal Medicine Source Type: research

Poor Sleep in Hospitalized Patients: Are Hospital-Related Factors at Fault?
To the Editor We thank Wesselius and colleagues for their thought-provoking investigation into the quality and quantity of sleep in hospitalized patients. Sleep is a key aspect of the hospital stay, contributes to overall patient satisfaction, and is well documented to affect recovery. The obtained results of the study suggested that most sleep disturbances were attributable to hospital-related factors. However, we contend that the role played by these factors in disrupting sleep may be overstated in this study. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - December 1, 2018 Category: Internal Medicine Source Type: research

The Alleged Health-Protective Effects of Coffee —Reply
In Reply We fully agree that observational studies should be interpreted cautiously and with noncausal explanations thoroughly considered. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - December 1, 2018 Category: Internal Medicine Source Type: research

The Alleged Health-Protective Effects of Coffee —Reply
In Reply For analyses of both all-cause and cause-specific mortality in our study, follow-up was calculated from date of baseline assessment to date of death (from any cause) or end of follow-up. For analyses of cause-specific mortality, we censored at the age of death from any cause. Consequently, the hazard ratio presented in our study for each cause of death is the relative risk of dying from that cause among the risk set of people who are alive. This approach not only ensured consistency with past studies of coffee drinking and mortality, but also offered an easily understandable quantity —namely the relative ris...
Source: JAMA Internal Medicine - December 1, 2018 Category: Internal Medicine Source Type: research

The Alleged Health-Protective Effects of Coffee
To the Editor We read with interest the study by Loftfield and colleagues in which they found an inverse association between coffee consumption and mortality, regardless of genetic caffeine metabolism score. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - December 1, 2018 Category: Internal Medicine Source Type: research

The Alleged Health-Protective Effects of Coffee
To the Editor In their large prospective analyses, Loftfield and colleagues reported an inverse association between coffee drinking and mortality, and suggested a possible benefit even for those drinking 8 or more cups per day. We believe that there are issues with their analytical approach and that the seemingly protective association of coffee drinking is likely an artifact inflicted by reverse causation. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - December 1, 2018 Category: Internal Medicine Source Type: research

The Alleged Health-Protective Effects of Coffee
To the Editor Loftfield and colleagues reported on the association between coffee consumption and mortality, and used genetic variants affecting caffeine metabolism to determine the contribution of caffeine to any associations observed. They concluded that coffee consumption is inversely associated with overall mortality regardless of genetic differences affecting caffeine metabolism. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - December 1, 2018 Category: Internal Medicine Source Type: research

The Alleged Health-Protective Effects of Coffee
To the Editor Using UK Biobank data from more than 400  000 people, Loftfield and colleagues examined associations between coffee drinking and mortality. Uniquely among observational studies of coffee and health, study participants were assigned a genetic caffeine metabolism score based on the presence of common polymorphisms that either facilitate or impair caffeine metabolism. Consistent with a large body of observational evidence, coffee drinking was found to be inversely associated with mortality. Similar associations were observed in both slow and fast metabolizers, which implicated noncaffeine bioactive compounds (...
Source: JAMA Internal Medicine - December 1, 2018 Category: Internal Medicine Source Type: research

December 2018 Issue Highlights
(Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - December 1, 2018 Category: Internal Medicine Source Type: research

A Global Public Health Victory for Tobacco Plain-Packaging Laws in Australia
This Viewpoint discusses the legal and public health ramifications of an Australian law mandating the sale of tobacco in plain packaging only. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - November 26, 2018 Category: Internal Medicine Source Type: research

Assessment of Pregabalin Postapproval Trials and the Suggestion for Efficacy in New Indications
This systematic review identifies 238 trials of pregabalin for nonapproved indications and examines how often exploratory trials generate a suggestion of efficacy but are not followed up by confirmatory trials. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - November 26, 2018 Category: Internal Medicine Source Type: research

Association of Team-Based Primary Care With Health Care Utilization and Costs Among Chronically Ill Patients
This study evaluates the association of establishing team-based primary care with health care utilization and costs among chronically ill. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - November 26, 2018 Category: Internal Medicine Source Type: research

Surrogates ’ Knowledge of Patient Treatment Goals and Confidence to Make Surrogate Treatment Decisions
This study uses telephone interviews of patients and their surrogates to evaluate surrogates ’ knowledge of patients’ treatment goals and confidence in their ability to make patients’ treatment decisions. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - November 26, 2018 Category: Internal Medicine Source Type: research

Routine Inpatient Mobility Assessment and Hospital Discharge Planning
This cohort study examines whether use of a mobility assessment tool in hospitalized patients with impaired mobility is associated with discharge to a postacute facility. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - November 26, 2018 Category: Internal Medicine Source Type: research

Preparing Surrogates for Complex Decision Making
Advance care planning (ACP) has been defined as a process that supports individuals and patients in defining their values, goals, and preferences for future medical care and sharing that information with others. The main goals of ACP include preparing patients for complex medical decision making and ensuring that they receive medical care aligned with their goals in case of decisional incapacity. If patients lose decision-making capacity, surrogate decision making often falls to close family members or friends. However, in many instances, these family members and friends do not know that they were named on advance directiv...
Source: JAMA Internal Medicine - November 26, 2018 Category: Internal Medicine Source Type: research

Anatomy and Physiology of Primary Care Teams
Health care teams have a structure (anatomy) and culture (physiology). Team structure has 2 facets: (1) who is on the team and (2) how stable is the team. Primary care teams are often composed of a core team orteamlet (clinicians working with medical assistants) and an extended-care team (registered nurses, pharmacists, social workers, and behaviorists) that supports several core teams. Team stability means that members of the team always work together and patients on the team ’s panel receive all care from their team. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - November 26, 2018 Category: Internal Medicine Source Type: research

Coordinating Clinical Trials to Confirm Drug Safety and Efficacy
How do we know whether a drug works? In the United States, the US Food and Drug Administration (FDA) has established guidance to inform drug development, including testing to establish safety and efficacy for a specific clinical indication, prior to market approval. The FDA generally requires that companies complete numerous clinical studies, including 1 or 2 pivotal trials, of which more than 80% are randomized; use double-blinded allocation; and include a placebo or active control comparator arm. Because these trials are often small, short, and use surrogate markers of disease for primary trial endpoints, some uncertaint...
Source: JAMA Internal Medicine - November 26, 2018 Category: Internal Medicine Source Type: research

Electrocardiographic Harbingers of Ventricular Tachycardia Arrest —A Moment of Pause
This case report describes the electrocardiographic indications and challenges involved in the diagnosis of pause-dependent torsades de pointes ventricular tachycardia. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - November 26, 2018 Category: Internal Medicine Source Type: research

Magic in Mouthwash for Oral Mucositis
This teachable moment assesses the effectiveness of magic mouthwash for oral mucositis. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - November 19, 2018 Category: Internal Medicine Source Type: research

Softening Our Approach to Discussing Prognosis
This essay discusses the use of “I” statements in communicating a prognosis to patients. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - November 19, 2018 Category: Internal Medicine Source Type: research

Intimate Partner Violence, Sexual Assault, and PTSD Among Midlife and Older Women
This cross-sectional analysis of data from a multiethnic cohort of midlife and older women examines the associations of intimate partner violence, sexual assault, and posttraumatic stress with menopause symptoms. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - November 19, 2018 Category: Internal Medicine Source Type: research

Supplemental Nutrition Assistance Program and Medication Nonadherence in Older Adults With Diabetes
This cross-sectional study uses National Health Interview Survey data to investigate participation in the Supplemental Nutrition Assistance Program (SNAP) and its association with cost-related medication nonadherence among older adults with diabetes. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - November 19, 2018 Category: Internal Medicine Source Type: research

Causes of Protected Health Information Breaches
This study evaluates the internal and external sources of and preventive steps for data breaches in health care organizations from 2009 to 2017. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - November 19, 2018 Category: Internal Medicine Source Type: research

Association of Interpersonal Violence With Women ’s Health
The scale of interpersonal violence against women in the United States is striking; an estimated 1 in 3 women have been sexually assaulted, and 1 in 4 have been victims of intimate partner violence (IPV). The consequences include increased risk for mental and physical health problems including depression, anxiety, eating disorders, posttraumatic stress disorder, addiction, injury, chronic pain, disability, and possibly cardiovascular disease. Although research typically focuses on women of reproductive age, IPV and sexual assault also affect older women. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - November 19, 2018 Category: Internal Medicine Source Type: research

Unhealthy Alcohol Use in Primary Care —The Elephant in the Examination Room
Unhealthy alcohol use is a serious public health challenge that requires full attention. In its recommendation statement, supported by an evidence report and systematic review, the US Preventive Services Task Force (USPSTF) “recommends screening for unhealthy alcohol use in primary care settings in adults 18 years or older, including pregnant women, and providing persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce unhealthy alcohol use (B recommendation).” One in 8 adults in the United States reports unhealthy alcohol use. Unhealthy alcohol use includes &ldquo...
Source: JAMA Internal Medicine - November 13, 2018 Category: Internal Medicine Source Type: research