Opening Hospitals to More Patients During the COVID-19 Pandemic
This essay details the importance in the COVID-19 era of making the changes needed to ensure that hospitals are safe for all patients who want to use them and, as importantly, to ensure that the patients feel that they are safe. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - May 27, 2020 Category: Internal Medicine Source Type: research

Taking Stock of Employer Wellness Program Effectiveness
Today, most large US employers offer their workers access to wellness programs as part of their compensation. These programs typically include a coordinated set of activities for employees to assess their health risks and engage in lifestyle behavior modification. Historically, employer investments in these programs have been motivated by the prospect of an economic return in the form of lower employer medical costs for workers and increased worker productivity resulting from disease prevention or improved management of conditions, such as diabetes, heart disease, depression, and lower back pain. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - May 26, 2020 Category: Internal Medicine Source Type: research

Estimation of the Incident Homebound Population in the US Among Older Medicare Beneficiaries
This cohort study examines the incidence of becoming homebound, being placed in a nursing home, and death in the US from 2012 to 2018 among Medicare beneficiaries aged 65 years and older. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - May 26, 2020 Category: Internal Medicine Source Type: research

Effects of a Workplace Wellness Program on Employee Health, Health Beliefs, and Medical Use
This randomized clinical trial evaluates the effect of a comprehensive workplace wellness program on employee health, health beliefs, and medical use after 12 and 24 months. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - May 26, 2020 Category: Internal Medicine Source Type: research

What Should I Know About Opioids and Living With Chronic Pain?
This JAMA Patient Page describes the risks and possible side effects of taking opioids to treat chronic pain. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - May 26, 2020 Category: Internal Medicine Source Type: research

The Easy Elective —A Surprising Revelation in Medical School
This essay describes how the author unexpectedly discovered something meaningful about herself, a classmate, and the world in general during an elective class in medical school. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - May 26, 2020 Category: Internal Medicine Source Type: research

Preventing COVID-19 in Assisted Living Facilities —A Balancing Act
Since the initial cases of coronavirus disease 2019 (COVID-19) were identified in the US, the unique vulnerability of older adults has been painfully demonstrated with several nursing home –associated outbreaks. The public health response, though entirely appropriate to halt transmission and save lives, requires draconian limits on movement and visitation. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - May 21, 2020 Category: Internal Medicine Source Type: research

Investigation of a COVID-19 Outbreak in an Independent and Assisted Living Facility
This case series examines the implementation of surveillance for severe acute respiratory coronavirus 2 and describe symptoms of coronavirus disease 2019 among residents and staff of an independent/assisted living community. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - May 21, 2020 Category: Internal Medicine Source Type: research

Need for Transparency and Reliable Evidence in Emergency Use Authorizations for COVID-19 Therapies
This Viewpoint discusses potential problems with the US Food and Drug Administration ’s emergency use authorization document allowing hydroxychloroquine and chloroquine for the treatment of coronavirus disease 2019 (COVID-19). (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - May 19, 2020 Category: Internal Medicine Source Type: research

Correction Notices Added to Articles Related to Retracted Article
The following Letters and Invited Commentary have been corrected to indicate that an article on which these articles commented was retracted on May 18, 2020. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - May 18, 2020 Category: Internal Medicine Source Type: research

Patient Portal Reminders —Easy but Ineffective
The critical role of vaccinations in public health has perhaps never been more apparent. The novel coronavirus disease 2019 pandemic has caused a health and humanitarian crisis unprecedented in the modern era. The scientific and medical communities are racing to develop a vaccine for the severe acute respiratory syndrome coronavirus 2 virus. While this critical work is underway, it is worth noting that access to an efficacious vaccine is only part of the solution. Improving real-world outcomes also requires widespread adoption of safe and effective vaccines. In this issue of JAMA Internal Medicine, Szilagyi and colleagues ...
Source: JAMA Internal Medicine - May 18, 2020 Category: Internal Medicine Source Type: research

Factors Associated With High Risk for Firearm Suicide Among US Adults
This cohort study assesses the association of firearm suicide risk with sociodemographic characteristics among US adults. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - May 18, 2020 Category: Internal Medicine Source Type: research

Primary Care Spending in the United States, 2002-2016
This economic evaluation study uses 2002-2016 Medical Expenditure Panel Survey data to assess primary care expenditures relative to other sources of health care spending in the United States. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - May 18, 2020 Category: Internal Medicine Source Type: research

The Importance of Pediatric Safety in Tetrahydrocannabinol Education
To the Editor It was with interest that we read the Patient Page, “What Should I Know About Medical Cannabis,” by Incze et al, which was published in the April 2020 issue of JAMA Internal Medicine. We laud the authors’ unbiased and medically accurate approach to patient education and believe that their efforts may guide patients in rational conversation with their physicians. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - May 18, 2020 Category: Internal Medicine Source Type: research

The Importance of Pediatric Safety in Tetrahydrocannabinol Education —Reply
In Reply We thank Goodnough and Canseco for their thoughtful comments on our Patient Page, “What Should I Know About Medical Cannabis?” In their letter, they highlight the potential for pediatric harms through unintentional delta-tetrahydrocannabinol exposure, raising an important safety issue that was not explicitly covered in the Patient Page. Preventing accidental exposure to presc ription medications, including medical cannabis, through safe storage practices is a critical part of patient counseling, yet it has proven to be a significant challenge. For example, despite ubiquitous public health messaging sur...
Source: JAMA Internal Medicine - May 18, 2020 Category: Internal Medicine Source Type: research

Effect of Patient Portal Reminders Sent by a Health Care System on Influenza Vaccination Rates
This randomized clinical trial evaluates the effect of patient reminders sent via a health care system ’s electronic health record patient portal on influenza vaccination rates. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - May 18, 2020 Category: Internal Medicine Source Type: research

Retraction
We hereby retract this article from JAMA Internal Medicine and from the medical literature. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - May 18, 2020 Category: Internal Medicine Source Type: research

Assessment of Deaths From COVID-19 and From Seasonal Influenza
This Viewpoint uses publicly available data to analyze the number of deaths from seasonal influenza deaths compared with deaths from coronavirus disease 2019. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - May 14, 2020 Category: Internal Medicine Source Type: research

Risk Score for Development of Critical Illness in Patients With COVID-19
This cohort study examines the characteristics of patients admitted to the hospital with COVID-19 will need admission to an intensive care unit, mechanical ventilation, or will die, and develops a COVID-19 risk score to predict outcomes. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - May 12, 2020 Category: Internal Medicine Source Type: research

Errors in Data and Units of Measure
This article was corrected on line. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - May 11, 2020 Category: Internal Medicine Source Type: research

Considering the Effect of Combining Alpha Blockers With Bladder Antimuscarinics in Treatment of Overactive Bladder Symptoms
To the Editor We read the article by Burgio et al on the effectiveness of combined behavioral and drug therapy for overactive bladder (OAB) symptoms in men with interest. The authors aimed to examine whether combining behavioral and drug therapies improves outcomes compared with each therapy alone. The participants were randomized to 6 weeks of behavioral training alone, drug therapy (antimuscarinic plus α-blocker) alone, or combined behavioral and drug therapy. After 6 weeks, participants receiving monotherapy were stepped up to combined (behavioral plus drug therapy) for an additional 6 weeks. At 6 weeks, posttreat...
Source: JAMA Internal Medicine - May 11, 2020 Category: Internal Medicine Source Type: research

Errors in Study of Patients With COVID-19 in Wuhan, China
To the Editor We write on behalf of our coauthors to report errors that occurred in our article entitled “Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China,” which was published online in JAMA Internal Medicine on March 13, 2020. We are very grateful that a reader recently contacted us to inquire about the unit of measure used for interleukin-6 and brought the error to our attention. After that, several authors (C. W., X. C., Y. Zhang) rechecked the units of measure and reference ranges of all laboratory tests against e...
Source: JAMA Internal Medicine - May 11, 2020 Category: Internal Medicine Source Type: research

Considering the Effect of Combining α-Blockers With Bladder Antimuscarinics in Treatment of Overactive Bladder Symptoms—Reply
In Reply In designing this trial, we sought to test 2 treatments with known effectiveness for urinary symptoms and implement them as one would in clinical practice. To optimize the drug therapy, we chose to use both an antimuscarinic and an α-adrenergic antagonist (α-blocker), based on evidence that using both drugs can yield better outcomes than either one alone. We had previously shown the behavioral intervention to be useful for urinary symptoms in men. The study objective was to determine whether combining behavioral and drug the rapies improves outcomes compared with each therapy alone for overactive bladd...
Source: JAMA Internal Medicine - May 11, 2020 Category: Internal Medicine Source Type: research

An Antimicrobial Stewardship Program for the Treatment of Cystitis in Nursing Home Residents
This quality improvement study examines the association of a multifaceted antimicrobial stewardship and quality improvement intervention with the reduction in unnecessary antimicrobial use for unlikely cystitis among noncatheterized nursing home residents. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - May 11, 2020 Category: Internal Medicine Source Type: research

The Dangers of Using Tumor Markers to Evaluate Nonspecific Symptoms
This Teachable Moment emphasizes the importance of using tumor marker testing only in the most appropriate clinical context to avoid patient anxiety and delayed diagnosis. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - May 11, 2020 Category: Internal Medicine Source Type: research

Commercial Influences on Electronic Health Records and Adverse Effects on Clinical Decision Making
This Viewpoint describes how the clinical decision support tools that are part of electronic health records and are used by physicians may be corrupted by commercial influence. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - May 11, 2020 Category: Internal Medicine Source Type: research

The Disproportionate Burden of COVID-19 for Immigrants in the Bronx, New York
This Viewpoint explains why COVID-19 presents a greater burden for immigrant communities and advocates for a more equitable health care system. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - May 8, 2020 Category: Internal Medicine Source Type: research

Care Partners and Patient Portals —Faulty Access, Threats to Privacy, and Ample Opportunity
Millions of people manage their health and illness with the help of family members and friends. These informal care partners (or caregivers) take responsibility, sometimes at a cost to their own health, for a wide variety of tasks, including arranging and attending medical appointments, participating in decision-making, coordinating services, and addressing various patient needs. Despite the vital role played by care partners, particularly in serious advancing illness and at the end of life, they are often unable to access health information in the electronic health record (EHR) that is necessary to coordinate and manage c...
Source: JAMA Internal Medicine - May 4, 2020 Category: Internal Medicine Source Type: research

Health Status and Barriers to Employment Among Medicaid Beneficiaries Not Meeting Work Requirements
This cross-sectional study quantifies the proportion of nonexempt Medicaid beneficiaries not meeting work requirements, compares their health with nonexempt beneficiaries fulfilling requirements, and assesses their inability to work for health-related reasons. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - May 4, 2020 Category: Internal Medicine Source Type: research

Assessing the Opioid Analgesic Risk Evaluation and Mitigation Strategy Program
To the Editor We note the review by Heyward et al critiquing the US Food and Drug Administration ’s (FDA’s) oversight of the extended-release/long-acting (ER/LA) opioid analgesic Risk Evaluation and Mitigation Strategy (REMS). The authors’ conclusions reiterate those that the FDA presented at a public advisory committee meeting on May 3 and 4, 2016, regarding the assessment of the ER/LA R EMS, a voluntary continuing education (CE) program. At this meeting, there was discussion of how this REMS was 1 among many educational activities and other interventions being implemented at local, state, and federal le...
Source: JAMA Internal Medicine - May 4, 2020 Category: Internal Medicine Source Type: research

Assessing the Opioid Analgesic Risk Evaluation and Mitigation Strategy Program —Reply
In Reply We studied the US Food and Drug Administration ’s (FDA’s) oversight and management of an industry-funded prescriber education program aimed at improving prescriber practices and reducing adverse events from use of prescription opioids. Five years into the Risk Evaluation and Mitigation Strategy (REMS) program governing extended release/long- acting (ER/LA) opioids, the FDA was unable to evaluate the effect of the REMS on prescribing behavior or safety outcomes. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - May 4, 2020 Category: Internal Medicine Source Type: research

Security and Privacy Risks Associated With Patient Portal Accounts
This cross-sectional study examines the use and risks of proxy access to adult patient portals in independently operated and system-affiliated US hospitals. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - May 4, 2020 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 - May 1, 2020 Category: Internal Medicine Source Type: research

Contact Tracing, Testing, and Control of COVID-19 —Learning From Taiwan
Taiwan is a country of about 24 million people, 81 miles off the coast of mainland China. As of late April 2020, Taiwan had about 330 confirmed cases of coronavirus disease 2019 (COVID-19) and 6 deaths. By comparison, the US had about 1 million confirmed cases of COVID-19, and 60  000 deaths. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - May 1, 2020 Category: Internal Medicine Source Type: research

Contact Tracing Assessment of COVID-19 Transmission Dynamics in Taiwan
This study delineates the transmission dynamics of coronavirus disease 2019 (COVID-19) and evaluates the transmission risk at different exposure window periods before and after symptom onset. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - May 1, 2020 Category: Internal Medicine Source Type: research

The Risks of Prescribing Hydroxychloroquine for Treatment of COVID-19
On March 21, 2020, President Donald Trump tweeted that hydroxychloroquine and azithromycin have “a real chance to be one of the biggest game changers in the history of medicine.” The president later said of hydroxychloroquine, “What do you have to lose? I’ll say it again: What do you have to lose? Take it.” (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - April 29, 2020 Category: Internal Medicine Source Type: research

Internet Searches for Unproven COVID-19 Therapies in the United States
This cross-sectional study examines internet searches indicative of shopping for chloroquine and hydroxychloroquine, including after high-profile endorsements. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - April 29, 2020 Category: Internal Medicine Source Type: research

COVID-19 in Prisons and Jails in the United States
This Viewpoint describes the importance of minimizing COVID-19 transmission in prisons and jails and details policies and programs for doing so. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - April 28, 2020 Category: Internal Medicine Source Type: research

Public Health Interventions for Lowering Dietary Sodium Intake
The link between dietary sodium intake and hypertension has been well established, with reductions in dietary sodium intake being associated with decreases in blood pressure and cardiovascular morbidity and mortality. The World Health Organization recommends reducing sodium intake (limit sodium intake to
Source: JAMA Internal Medicine - April 27, 2020 Category: Internal Medicine Source Type: research

Assessing Hospital Performance Agreement on 3 National Mortality Ratings for 2 Inpatient Conditions
This study assesses the agreement of the US Centers for Medicare& Medicaid Services Hospital Compare, Healthgrades, and US News& World Report Best Hospitals on hospital performance for chronic obstructive pulmonary disease and heart failure. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - April 27, 2020 Category: Internal Medicine Source Type: research

FDA Acceptance of Surrogate End Points for Cancer Drug Approval
This retrospective review assesses the frequency of surrogate measures used for the first time vs subsequent times in a cancer setting and the surrogate ’s strength of correlation with patient-centered outcomes. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - April 27, 2020 Category: Internal Medicine Source Type: research

Association of a Province-Wide Intervention With Salt Intake and Hypertension in China
This cross-sectional study evaluates the change in urinary sodium excretion and other factors associated with blood pressure during a government-led, multisectoral, province-wide 5-year intervention in Shandong Province, China, from 2011 to 2016. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - April 27, 2020 Category: Internal Medicine Source Type: research

Challenges in Prediction, Diagnosis, and Treatment of Alcohol Withdrawal in Medically Ill Hospitalized Patients
This Teachable Moment describes a patient who reported alcohol use for many years who was admitted to the hospital for a bowel resection. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - April 27, 2020 Category: Internal Medicine Source Type: research

Geriatrics and Palliative Care Principles for Chronic Obstructive Pulmonary Disease
This Viewpoint proposes that clinicians who routinely care for older patients with chronic obstructive pulmonary disease should proactively integrate geriatrics and palliative care principles into their daily practice. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - April 27, 2020 Category: Internal Medicine Source Type: research

Omitted Disclaimer
This article was corrected online. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - April 20, 2020 Category: Internal Medicine Source Type: research

The Life and Death of Mammograms in Patients 75 Years and Older —To Screen or Not to Screen?
Less is More (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - April 20, 2020 Category: Internal Medicine Source Type: research

Removing the Thyroid From Images, Not From Patients
In March 2011, a major earthquake and tsunami hit the Fukushima Daiichi nuclear plant in Japan, causing the reactor to melt down. Five years later, children living near the plant were reported to have rates of thyroid cancer 20 to 50 times that of other children in Japan. This finding, however, appeared to stem from a systematic thyroid ultrasonographic screening program —one that did not extend to the rest of Japan. Other investigators applying the same screening protocol to children in other Japanese regions found that the rate of thyroid cancer detected by screening did not differ meaningfully from that in the Fuk...
Source: JAMA Internal Medicine - April 20, 2020 Category: Internal Medicine Source Type: research

Trends in Utilization of Prescribed Controlled Substances in US Commercially Insured Adults, 2004-2019
This study examines the most commonly dispensed categories and individual substances of all prescribed controlled substances, including stimulants, benzodiazepines, and depressants, among US commercially insured adults. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - April 20, 2020 Category: Internal Medicine Source Type: research

Unexpected Heparin-Induced Thrombocytopenia While Bridging
To the Editor Kulkarni and Fang, in their engaging and instructive Teachable Moment, discuss the indications, merits, demerits, and dangers of bridging anticoagulation. However, they do not address the possibility that, in the present patient, the bleeding complication may have been, at least in part, due to heparin-induced thrombocytopenia (HIT) resulting in a bleeding diathesis. Heparin-induced thrombocytopenia occurs in 2 forms. Type 2 is the most injurious. This is an autoimmune-mediated activation of platelets triggered by heparin. It results in a generally prothrombotic state. Type 1 results from a direct activation ...
Source: JAMA Internal Medicine - April 20, 2020 Category: Internal Medicine Source Type: research

Unexpected Heparin-Induced Thrombocytopenia While Bridging —Reply
In Reply We thank Uzoigwe et al for their reply to our recent Teachable Moment. In the clinical case described, the patient ’s platelet count was 358 000/uL, and he did not exhibit any arterial or venous thromboses. Thus, there was low suspicion for heparin-induced thrombocytopenia (HIT), and workup for this condition was not pursued. Additionally, bleeding due to HIT is thought to be rare. However, we appreciate the reminder to remain mindful of the possibility of HIT in the appropriate clinical context for patients receiving heparin therapy. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - April 20, 2020 Category: Internal Medicine Source Type: research