Potential of Large Language Models as Tools Against Medical Disinformation —Reply
In Reply We express our gratitude to Zhu et al for engaging with our work. Zhu et al correctly point out that malevolent individuals have historically used manual methods to create and disseminate health disinformation. However, the emergence of sophisticated large language models (LLMs) represents a potential tipping point. These tools possess unprecedented capabilities to personalize content targeted at individuals from diverse backgrounds. If their safeguards are inadequate, their ability to facilitate rapid, scalable, and cost-effective generation of health disinformation presents a unique and substantial challenge tha...
Source: JAMA Internal Medicine - February 26, 2024 Category: Internal Medicine Source Type: research
Potential of Large Language Models as Tools Against Medical Disinformation
To the Editor Menz et al highlight a concerning aspect of large language models (LLMs), emphasizing the urgent need for immediate attention and action in preventing the rapid generation of convincing but false medical information at scale. Although we agree with them, it is crucial to recognize that the spread of medical disinformation on the internet predates the advent of LLMs. Even if these artificial intelligence (AI) tools restrict their capacity to generate such content, malevolent individuals can still resort to other ways to make and spread falsehoods. Therefore, a more pressing need may be finding constructive sol...
Source: JAMA Internal Medicine - February 26, 2024 Category: Internal Medicine Source Type: research
Individualizing Care for Older Adults With Diabetes Amid the Revolution in Pharmacotherapy
This JAMA Network Insights reassesses the approach to caring for older adults with diabetes in the context of newly available pharmacologic agents. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - February 26, 2024 Category: Internal Medicine Source Type: research
Unusual Tachycardia in a Patient With Chest Pain and Bradycardia
This case report describes a patient in their 50s who presented with squeezing chest pain for 4 hours and an initial electrocardiogram showing acute inferior wall and right ventricular infarction with third-degree atrioventricular block. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - February 26, 2024 Category: Internal Medicine Source Type: research
Body Composition in Anti-Obesity Medication Trials
This Viewpoint contends that focusing only on weight loss as the primary weight medication end point is an inaccurate measure of medication efficacy for both patients and clinicians. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - February 19, 2024 Category: Internal Medicine Source Type: research
Why Wonder Why?
This essay describes how a physician ’s encounter with a patient with repeated intensive care unit admissions illuminated the value of wonder in clinical care and medical education. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - February 19, 2024 Category: Internal Medicine Source Type: research
Neighborhood Segregation and Access to Live Donor Kidney Transplantation
This cohort study assesses how neighborhood segregation is associated with racial disparities in access to live donor kidney transplantation, examining both the candidates ’ residential and transplant center neighborhoods. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - February 19, 2024 Category: Internal Medicine Source Type: research
Age-Related Fall Risk and Opioid Analgesic Use
This cohort study examines the age-related risk of serious fall events among Australian adults prescribed opioids by opioid exposure, time from initiation, and daily dose. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - February 19, 2024 Category: Internal Medicine Source Type: research
Ethics and Terminology for Opting In and Out —In Reply
This study was carried out as a collaboration between research and clinical teams in a learning health system model. The clinical team recognized that a major barrier to BCS is that practitioners must both identify a patient who is due for screening and order the test when the patient is due. They decided to support the primary care teams by testing 2 strategies that could possibly reduce these barriers: (1) opt out, meaning to automatically order the test when it is due; and (2) opt in, meaning to send an automated telephone reminder to the patient who is due for screening. It was recognized by the clinical team that in e...
Source: JAMA Internal Medicine - February 19, 2024 Category: Internal Medicine Source Type: research
Pitfalls of Cuff Size and Blood Pressure Measurement —Reply
In Reply Accurate measurement of blood pressure (BP) is central to the diagnosis and treatment of hypertension. Hypertension guidelines detail the procedural steps that are essential to obtaining accurate BP measurements, including implementing the appropriate rest time prior to measurement; back, arm, and feet support; cuff placement at heart level; and use of an appropriate cuff size. In our study, we rigorously tested the effects on BP accuracy of not adhering to 1 of these recommended steps, namely, the use of an appropriately sized cuff. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - February 19, 2024 Category: Internal Medicine Source Type: research
Ethics and Terminology for Opting In and Out
To the Editor The article by Marcotte et al of a trial comparing opt-out vs opt-in patient outreach strategies for breast cancer screening left me bewildered. Indeed, our first duty: shared decision-making, a demanding process that requires 4 steps, has been bypassed. An audiocare message requiring a veteran to confirm that they would like to participate in screening and have consult sent or a consult automatically sent and the veteran called to schedule screening precludes (1) the first step, reassuring by indicating that both options, participating or not, are equally valuable according to personal values; and (2) the se...
Source: JAMA Internal Medicine - February 19, 2024 Category: Internal Medicine Source Type: research
Pitfalls of Cuff Size and Blood Pressure Measurement
To the Editor We read with great interest the article by Ishigami et al investigating the association of miscuffing with blood pressure (BP) measurement using automated BP devices. Although these findings are interesting and further contribute to the current knowledge on BP measurement, in the presented analysis the authors did not consider the troncoconical shape of the upper arm, which is frequently observed in the general population, especially in patients with overweight and obesity. The degree of troncoconicity can be mathematically described calculating the conicity index. Indeed, high conicity indices imply the exis...
Source: JAMA Internal Medicine - February 19, 2024 Category: Internal Medicine Source Type: research
Ethics and Terminology for Opting In and Out
To the Editor In their pragmatic randomized clinical trial comparing the efficacy of opt-in vs opt-out methods for guideline-recommended breast cancer screening, Marcotte et al reported no differences in primary and secondary outcomes determined by a combination of completed and scheduled mammogram procedures at 100 days. Due to the higher empirical effort, cost, and clinician concerns, the authors recommended against routine implementation of an opt-out process for breast cancer screening. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - February 19, 2024 Category: Internal Medicine Source Type: research
Pitfalls of Cuff Size and Blood Pressure Measurement
To the Editor We commend Ishigami et al on their study to quantify the effects of inappropriately sized cuffs on blood pressure (BP) measurement using an automated oscillometric device. The authors indicate that, for the sake of uniformity, they measured BP in the right arm for all patients unless there was a compelling reason to use the left arm (eg, an open sore). (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - February 19, 2024 Category: Internal Medicine Source Type: research
Pitfalls of Cuff Size and Blood Pressure Measurement
To the Editor Using cuffs and bladders of inappropriate dimensions can be a serious source of error during auscultatory BP measurement. However, this concern may not apply to oscillometric BP measurement in which the role of the cuff is not only to compress the artery but also to act as a signal sensor. The issue of miscuffing with the use of oscillometric BP devices has been addressed by Ishigami et al in a recent article of JAMA Internal Medicine. These authors showed that using bladders that were too narrow or too large was associated with over- or underestimation, respectively, of oscillometric BP. These results were o...
Source: JAMA Internal Medicine - February 19, 2024 Category: Internal Medicine Source Type: research
