When the Boards Fail Us —Structural Bias in Certification Examinations
This essay shines a light on structural bias inherent to the board certification examination process, sharing the author's experience preparing and sitting for the examination while contending with co-occurring challenging life events. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - February 12, 2024 Category: Internal Medicine Source Type: research
Patient Navigator Intervention for Palliative Care Outcomes in Hispanic Patients
This randomized clinical trial aims to determine the effectiveness of a lay patient navigator intervention in improving palliative care outcomes among Hispanic patients. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - February 12, 2024 Category: Internal Medicine Source Type: research
Outcomes of Various Classes of Oral Antidiabetic Drugs on Nonalcoholic Fatty Liver Disease
This cohort study investigates which oral antidiabetic drug was associated with the most advantageous outcomes in patients with nonalcoholic fatty liver disease and type 2 diabetes. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - February 12, 2024 Category: Internal Medicine Source Type: research
Hypothetical Assessments of Trial Emulations —Reply
In Reply We appreciate the comments from Schneeweiss and Wang, and the insights from the RCT-DUPLICATE Initiative. As noted, unlike their series of target trial emulations, ours was a hypothetical exercise intended to inform discussions and establish expectations for the role these data are likely to play in medical product evaluations. There is increasing interest in using data from routine clinical encounters to address postmarketing requirements for new medical product approvals, particularly to confirm efficacy or evaluate new clinical indications. While we remain hopeful for the future use of these data and methods, o...
Source: JAMA Internal Medicine - February 12, 2024 Category: Internal Medicine Source Type: research
Hypothetical Assessments of Trial Emulations
To the Editor We thank Janda et al for their hypothetical assessment of whether randomized clinical trials (RCTs) submitted to regulators for supplemental indications can be emulated with secondary health care data. While we see some value in their hypothetical exercise, the proof will be in attempting actual emulations of these trials. We have completed approximately 50 actual trial emulations, and these 4 principal remarks come from our experience. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - February 12, 2024 Category: Internal Medicine Source Type: research
Emergency Department Use Disparities Among Transgender and Cisgender Medicare Beneficiaries, 2011-2020
This cross-sectional study compares emergency department use among transgender and gender-diverse as well as cisgender Medicare beneficiaries. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - February 12, 2024 Category: Internal Medicine Source Type: research
Quantifying Use of Emergency Services by Transgender and Gender-Diverse Individuals
Transgender and gender-diverse (TGD) individuals are at a higher risk of developing physical and mental health conditions compared with their cisgender peers due to various reasons. These include avoiding health care (primary care and emergency care) due to persistent stigma, suboptimal access to high-quality mental health, lack of clinician knowledge and guidance to conduct appropriate evaluation and develop management plans, and lack of adequate documentation of TGD status in the ubiquitous electronic health records. Literature addressing the effects of these structural, process, and patient-level barriers has only start...
Source: JAMA Internal Medicine - February 12, 2024 Category: Internal Medicine Source Type: research
The Perils of Artificial Intelligence in a Clinical Landscape
Primary care in the US is in acute-on-chronic crisis. After decades of evidence-defying fiscal and structural neglect, changes to primary care practice —including shorter appointment times, increasing patient and management complexity, growing electronic medical record burden, staffing shortages, and crises involving COVID-19, opioid use disorder, and mental health disorders—have created a reality in which there are not enough hours in the day for primary care clinicians to do their jobs. This has led to burnout and clinician shortages, perpetuating a cycle of decline. In this issue of JAMA Internal Medicine, Sarkar an...
Source: JAMA Internal Medicine - February 12, 2024 Category: Internal Medicine Source Type: research
Transforming Value-Based Dementia Care
This Viewpoint reviews the Guiding an Improved Dementia Experience (GUIDE) Model to assess its suitability in providing equitable and cost-effective dementia care and to compare it with previously introduced specialty care payment models to identify opportunities for refining payment innovation in dementia care. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - February 5, 2024 Category: Internal Medicine Source Type: research
Officer-Involved Killings of Unarmed Black People and Racial Disparities in Sleep Health
This repeated cross-sectional study using difference-in-differences analyses assesses sleep duration changes in Black individuals after officer-involved killings of unarmed Black people. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - February 5, 2024 Category: Internal Medicine Source Type: research
Testosterone and Progression From Prediabetes to Diabetes in Men With Hypogonadism
This randomized clinical trial evaluates whether testosterone replacement therapy prevents progression from prediabetes to diabetes or induces glycemic remission in middle-aged and older men with hypogonadism. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - February 5, 2024 Category: Internal Medicine Source Type: research
ST-T Alternans as a Risk Predictor for Fatal Ventricular Arrhythmia —Reply
In Reply We express our gratitude to Zhao and Wang for their interest in our recent case report in which we detailed polymorphic ventricular tachycardia (PMVT) triggered by premature beats from Purkinje fibers. This occurred within the context of giant R-wave syndrome stemming from coronary artery disease (CAD). We wholeheartedly concur with the statement that ST-T −wave alternans (STTA), serving as an indicator of focal abnormalities in myocardial electrical repolarization, are associated with ventricular arrhythmias in CAD. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - February 5, 2024 Category: Internal Medicine Source Type: research
ST-T Alternans as a Risk Predictor for Fatal Ventricular Arrhythmia
To the Editor Xu et al present the electrocardiogram findings of a patient in their 50s with syncope and palpitation and amaurosis, followed by loss of consciousness for several minutes without preceding position change, cough, chest pain, or shortness of breath. The authors highlight that “giant R-wave syndrome is distinguished by delayed depolarization and repolarization of the myocardium, which is a predictor of the onset of ventricular fibrillation.” The authors focused only on giant R-wave syndrome as a predictive factor for ventricular arrhythmias in patients with acute myo cardial infarction and ignored the pres...
Source: JAMA Internal Medicine - February 5, 2024 Category: Internal Medicine Source Type: research
Injuries From Conducted Energy Devices
This cross-sectional study evaluates emergency department visits for physical injuries from use of conducted energy devices by police departments. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - February 5, 2024 Category: Internal Medicine Source Type: research
Testosterone Replacement Therapy and Diabetes in Men With Hypogonadism
In JAMA Internal Medicine, Bhasin et al evaluate whether testosterone replacement therapy (TRT) improves metabolic health in men with hypogonadism by (1) preventing progression from prediabetes to diabetes in men with prediabetes or (2) improved glycemic control among those with diabetes. The study involved 5204 participants with hypogonadism across 316 trial sites. Of the 1175 participants with prediabetes, 607 (51.7%) were randomized to testosterone and 568 (48.3%) to placebo, and of 3880 participants with diabetes, 1917 (49.4%) were randomized to testosterone and 1963 (50.6%) to placebo. The mean (SD) age of this cohort...
Source: JAMA Internal Medicine - February 5, 2024 Category: Internal Medicine Source Type: research
