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Ensuring Access to Health Care for Patients With Disabilities

from ArchInte - 01 Feb 15

Patients with disabilities face barriers when they attempt to access health care. These barriers include physical barriers to entering health care establishments, lack of accessible equipment, lack of a safe method for transferring the patient to an examination table, and the lack of policies that facilitate access. The barriers persist despite 2 federal laws (the Americans With Disabilities Act [ADA] of 1990 and Section 504 of the Rehabilitation Act of 1973) that explicitly state that health ca



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Screening and Surveillance for Barrett Esophagus

from ArchInte - 01 Feb 15

When Norman Barrett described columnar metaplasia in the esophagus in 1950, he could not have predicted the controversies that would arise from the condition that now bears his name. In response to chronic injury from reflux esophagitis, the normally squamous-lined lower esophagus becomes reepithelialized with intestinal-type (mucus-secreting) columnar epithelium, giving rise to Barrett esophagus. In a minority of cases, this metaplastic epithelium develops dysplasia, which, in turn, can progres





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Why I’m Opting out of Mammography

from ArchInte - 01 Feb 15

At a routine appointment a few days after my 40th birthday, my gynecologist gave me a prescription for a mammogram. There was no discussion, no explanation. Just a slip of paper, handed to me without a word as I left the examination room. When I asked the doctor what she’d just given me, she told me it was an order for a mammogram. I could call the number to schedule an appointment.



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Unintended Influence When Our Words Mean More Than We Think

from ArchInte - 01 Feb 15

A family friend recently shared the experience of her 83-year-old mother, a relatively healthy woman who lives independently at home. She has 3 daughters who check in on her and support her. The only notable medical history was a stroke about a year and a half prior that resulted in challenges with decision making, but she has made considerable recovery.



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The Ongoing Debate of Who to Treat for Chronic Hepatitis C Virus

from ArchInte - 01 Feb 15

Chronic hepatitis C virus (HCV) infection accounts for approximately 30% of cases of cirrhosis and one-quarter of hepatocellular carcinomas worldwide and is the leading indication for liver transplant in the adult US population. Although the incidence of chronic HCV infection is declining in the United States, the number of deaths is projected to rise over the next decade because of complications among persons infected 30 to 40 years ago. Hence, the major reasons for treating chronic HCV infecti



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Statin Therapy and Risk of Fracture Results From the JUPITER Randomized Clinical Trial

from ArchInte - 01 Feb 15

ImportanceOsteoporosis and cardiovascular disease may share common biological pathways, with inflammation playing a role in the development of both. Although observational studies have suggested that statin use is associated with a lower risk of fractures, randomized trial data addressing this issue are scant.ObjectiveTo determine whether statin therapy reduces the risk of fracture and, in a secondary analysis, whether baseline levels of the inflammatory biomarker high-sensitivity C-reactive pro



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Liver Fibrosis Progression in Hepatitis C Virus Infection After Seroconversion

from ArchInte - 01 Feb 15

ImportanceKnowing the rate of liver fibrosis progression in hepatitis C virus (HCV)-infected persons can help inform patients and providers (clinicians, medical institutions or organizations, and third-party payers) in making treatment decisions.ObjectiveTo determine the rate and factors associated with liver fibrosis progression and hepatic decompensation in persons after acquiring HCV infection.Design, Setting, and ParticipantsSecondary data analysis of persons in the Electronically Retrieved



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Tramadol Use and the Risk of Hospitalization for Hypoglycemia in Patients With Noncancer Pain

from ArchInte - 01 Feb 15

ImportanceTramadol is a weak opioid analgesic whose use has increased rapidly, and it has been associated with adverse events of hypoglycemia.ObjectiveTo assess whether tramadol use, when compared with codeine use, is associated with an increased risk of hospitalization for hypoglycemia.Design, Setting, and ParticipantsA nested case-control analysis was conducted within the United Kingdom Clinical Practice Research Datalink linked to the Hospital Episodes Statistics database of all patients newl



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Outcomes After Out-of-Hospital Cardiac Arrest Treated by Basic vs Advanced Life Support

from ArchInte - 01 Feb 15

ImportanceMost out-of-hospital cardiac arrests receiving emergency medical services in the United States are treated by ambulance service providers trained in advanced life support (ALS), but supporting evidence for the use of ALS over basic life support (BLS) is limited.ObjectiveTo compare the effects of BLS and ALS on outcomes after out-of-hospital cardiac arrest.Design, Setting, and ParticipantsObservational cohort study of a nationally representative sample of traditional Medicare beneficiar



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Fibrinolysis Use Among Patients Requiring Interhospital Transfer for ST-Segment Elevation Myocardial Infarction Care A Report From the US National Cardiovascular Data Registry

from ArchInte - 01 Feb 15

ImportanceGuidelines for patients with ST-segment elevation myocardial infarction (STEMI) recommend timely reperfusion with primary percutaneous coronary intervention (pPCI) or fibrinolysis. Among patients with STEMI who require interhospital transfer, it is unclear how reperfusion strategy selection and outcomes vary with interhospital drive times.ObjectiveTo assess the association of estimated interhospital drive times with reperfusion strategy selection among transferred patients with STEMI i



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Proactive Tobacco Cessation Outreach to Smokers of Low Socioeconomic Status A Randomized Clinical Trial

from ArchInte - 01 Feb 15

ImportanceWidening socioeconomic disparities in mortality in the United States are largely explained by slower declines in tobacco use among smokers of low socioeconomic status (SES) than among those of higher SES, which points to the need for targeted tobacco cessation interventions. Documentation of smoking status in electronic health records (EHRs) provides the tools for health systems to proactively offer tobacco treatment to socioeconomically disadvantaged smokers.ObjectiveTo evaluate a pro



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Association of Radiation Dose With Prevalence of Thyroid Nodules Among Atomic Bomb Survivors Exposed in Childhood (2007-2011)

from ArchInte - 01 Feb 15

ImportanceFew studies have evaluated the association of radiation dose with thyroid nodules among adults exposed to radiation in childhood.ObjectiveTo evaluate radiation dose responses on the prevalence of thyroid nodules in atomic bomb survivors exposed in childhood.Design, Setting, and ParticipantsThis survey study investigated 3087 Hiroshima and Nagasaki atomic bomb survivors who were younger than 10 years at exposure and participated in the thyroid study of the Adult Health Study at the Radi



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Mortality and Treatment Patterns Among Patients Hospitalized With Acute Cardiovascular Conditions During Dates of National Cardiology Meetings

from ArchInte - 01 Feb 15

ImportanceThousands of physicians attend scientific meetings annually. Although hospital physician staffing and composition may be affected by meetings, patient outcomes and treatment patterns during meeting dates are unknown.ObjectiveTo analyze mortality and treatment differences among patients admitted with acute cardiovascular conditions during dates of national cardiology meetings compared with nonmeeting dates.Design, Setting, and ParticipantsRetrospective analysis of 30-day mortality among



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Changes in Glomerular Kidney Function Among HIV-1 – Uninfected Men and Women Receiving Emtricitabine – Tenofovir Disoproxil Fumarate Preexposure Prophylaxis A Randomized Clinical Trial

from ArchInte - 01 Feb 15

ImportanceTenofovir disoproxil fumarate (TDF) use has been associated with declines in the estimated glomerular filtration rate (eGFR) when used as part of antiretroviral treatment by persons with human immunodeficiency virus (HIV) type 1, but limited data are available for risk when used as preexposure prophylaxis (PrEP) for HIV-1 prevention.ObjectiveTo determine whether TDF-based PrEP causes eGFR decline in HIV-1–uninfected adults.Design, Setting, and ParticipantsA per-protocol safety analysis



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Material Need Insecurities, Control of Diabetes Mellitus, and Use of Health Care Resources Results of the Measuring Economic Insecurity in Diabetes Study

from ArchInte - 01 Feb 15

ImportanceIncreasing access to care may be insufficient to improve the health of patients with diabetes mellitus and unmet basic needs (hereinafter referred to as material need insecurities). How specific material need insecurities relate to clinical outcomes and the use of health care resources in a setting of near-universal access to health care is unclear.ObjectiveTo determine the association of food insecurity, cost-related medication underuse, housing instability, and energy insecurity with



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Increasing Varenicline Dose in Smokers Who Do Not Respond to the Standard Dosage A Randomized Clinical Trial

from ArchInte - 01 Feb 15

ImportanceStandard varenicline tartrate dosing was formulated to avoid adverse effects (primarily nausea), but some patients may be underdosed. To our knowledge, no evidence-based guidance exists for physicians considering increasing varenicline dose if there is no response to the standard dosage.ObjectiveTo determine whether increasing varenicline dose in patients showing no response to the standard dosage improves treatment efficacy.Design, Setting, and ParticipantsIn a double-blind randomized



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Shared Decision-Making Easy to Evoke, Challenging to Implement

from ArchInte - 01 Feb 15

In this issue of JAMA Internal Medicine, 2 poignant accounts of experiences with breast cancer screening are presented: that of a 40-year-old trying to engage her physician in shared decision-making regarding mammography, which she ultimately decides to forgo, and the account of an 83-year-old who has the test, perhaps without realizing it was being offered and not necessarily recommended, and has an abnormal finding. In both, a central component of patient-centered care is missing: elicitation



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Tramadol and Hypoglycemia One More Thing to Worry About

from ArchInte - 01 Feb 15

Pain is one of the leading reasons why patients seek medical attention, and over the past 2 decades, clinicians, health care institutions, medical organizations, and regulators have become increasingly attentive to its management. Yet despite the importance of pain as a clinical entity, the well of approved pharmacologic options is shallow, consisting principally of acetaminophen, nonsteroidal anti-inflammatory drugs, and opioids, along with off-label alternatives including certain anticonvulsan



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Evidence in Support of a Back-to-Basics Approach in Out-of-Hospital Cardiopulmonary Resuscitation vs "Advanced" Treatment

from ArchInte - 01 Feb 15

A man clutches his chest and collapses on the sidewalk. Call 911. Surely we want the most advanced life support (ALS) available—paramedics capable of intubating, administering intravenous medications, and managing complex arrhythmias, as well as transport to the hospital. Or do we?



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Is Primary Percutaneous Coronary Intervention Still the Superior Reperfusion Strategy?

from ArchInte - 01 Feb 15

The current guidelines for the management of ST-segment elevation myocardial infarction (STEMI) recommend primary percutaneous coronary intervention (pPCI) as the preferred treatment strategy if it can be conducted in a timely fashion by an experienced catheterization team. Because of the restricted availability of hospitals providing pPCI support 24 hours 7 days a week, the concept of STEMI networks with prearranged rapid transfer protocols between community hospitals and PCI-capable centers ha



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Proactive Outreach Strategies to Connect Smokers With Tobacco Cessation Treatment

from ArchInte - 01 Feb 15

Most smokers want to quit smoking but try to stop without using tobacco cessation treatment. Because abundant evidence supports the efficacy of behavioral, pharmacologic, and combination treatment for tobacco dependence, it is important to increase the proportion of smokers who take advantage of therapy. Evidence confirms that current tobacco treatment models that rely on the patient or clinician to initiate treatment fail to reach all smokers interested in quitting. Proactive outreach strategie



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Preexposure Prophylaxis A Path Forward

from ArchInte - 01 Feb 15

Thirty years after the discovery of the human immunodeficiency virus (HIV), about 50?000 Americans and over 2 million persons worldwide are infected each year, most of them through sexual relations. This occurs despite detailed knowledge of how HIV is transmitted and the availability of a highly effective, cheap, safe method of HIV prevention, the condom, which in addition to its effectiveness in HIV prevention, also decreases the likelihood of other sexually transmitted diseases as well as unwa


 

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