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Debunking Atypical Chest Pain in Women Comment on “Reconstructing Angina: Cardiac Symptoms Are the Same in Women and Men” Comment on “Reconstructing Angina”

from ArchInte - 13 May 13

Awareness campaigns for heart disease in women have led to increased recognition for women of the importance of preventing heart disease via healthy lifestyle choices and recognizing the symptoms of heart disease. There also has been focus on the idea that women somehow present differently than men with ischemic coronary artery disease (CAD). Kreatsoulas et al reassure us that women and men are more alike than we think in presentation of CAD, and both are most likely to experience chest pain, pr

Demand of Words Demand of Words

from ArchInte - 13 May 13

In medicine, there is a brittle demand of words—once spoken, they cannot be called back, for their footprint is forever—particularly at the end of life. They embed themselves in the hearts of patients and families and hold dominion over understanding or uncertainty, acceptance or denial. They can also hurt or heal, or harm or help, and bear witness to the suffering of disease—and the manner of the physician.

Is There a Role for Further Risk Stratification of Patients With Stable Coronary Artery Disease? Comment on “High-Sensitivity Cardiac Troponin T Levels and Secondary Events in Outpatients With Coronar

from ArchInte - 13 May 13

The article by Beatty et al demonstrated an independent association between high-sensitivity cardiac troponin T levels and recurrent events among patients with known stable coronary artery disease, even after controlling for important potential confounders, including structural and functional heart disease factors. This association implies that we have the capability to refine risk prediction further among such already high-risk patients. However, whether we should do so is another question, bec

Serious Adverse Effects Can Occur With Minor Procedures Comment on “Risk of Topical Anesthetic–Induced Methemoglobinemia” Serious Adverse Effects With Minor Procedures

from ArchInte - 13 May 13

Minor procedures can have serious adverse effects. The article by Chowdhary et al quantitates a serious but rare adverse effect, namely, methemoglobinemia associated with the use of topical oropharyngeal anesthetics for invasive procedures. The studies for which the topical anesthetics are used are common procedures that are typically thought to be safe, such as transesophageal echocardiography and upper gastrointestinal tract endoscopy. The association of methemoglobinemia with topical anesthet

Weighing Benefits and Risks Comment on “Use of Glucocorticoids and Risk of Venous Thromboembolism” Weighing Benefits and Risks

from ArchInte - 13 May 13

Glucocorticoids are one of the most widely prescribed medications. They are effective for a large and diverse set of illnesses ranging from asthma to systemic lupus erythematosus. Unfortunately, their efficacy is accompanied by many adverse effects, including increased infection risk, hyperglycemia, hypertension, and mania.

Womb to Grow Womb to Grow

from ArchInte - 13 May 13

I first met Emily during my third year of medical school, and she deeply impressed upon me that in matters of the womb, patient wishes define when less is more. Emily was a 33-year-old woman (gravida 0, para 0) admitted for fever and right flank pain lasting several weeks. Emily's diagnosis was initially elusive. She had received a full course of antibiotics to treat suspected pyelonephritis. However, when her pain, leukocytosis, and fever persisted, we searched for another source of infection.

About This Journal

from ArchInte - 13 May 13

Adult Mortality in a Randomized Trial of Mass Azithromycin for Trachoma

from ArchInte - 13 May 13

Annual mass azithromycin treatments are provided to entire communities to clear the ocular strains of Chlamydiatrachomatis that cause blinding trachoma. Mass treatments reduce the community burden of ocular chlamydia and have proven efficacious in community-randomized trials. Since 1999, more than 150 million doses of azithromycin have been distributed for trachoma worldwide.

Availability of Potassium on the Nutrition Facts Panel of US Packaged Foods

from ArchInte - 13 May 13

Studies have indicated that diets low in potassium and high in sodium are associated with increased risk for cardiovascular disease, the leading cause of death in the United States, whereas higher potassium intake is associated with reduced risk for both all-cause and cardiovascular disease–related mortality. Yet, the majority of US adults consume considerably less than the 4700 mg/d of potassium that is recommended by the 2010 Dietary Guidelines for Americans.

Can Participation in Mental and Physical Activity Protect Cognition in Old Age? Comment on “The Mental Activity and eXercise (MAX) Trial: A Randomized Controlled Trial to Enhance Cognitive Function

from ArchInte - 13 May 13

With many societies around the globe experiencing increasing longevity, one challenging research question of our times is how to reduce the risk of cognitive decline in old age. Modifiable risk or protective factors for Alzheimer disease (AD) are of specific interest, because probably up to half of AD cases worldwide are potentially attributable to modifiable factors. It has been estimated, for example, that up to 1 million AD cases could be prevented globally if a 25% reduction in physical inac

Causal Effect of Public Space Smoking Bans?

from ArchInte - 13 May 13

Hurt and colleagues present a careful before-and-after study of the association of a workplace smoking ban in Olmsted County, Minnesota, with myocardial infarction and sudden cardiac death rates. There is no doubt that environmental tobacco smoke is a serious and immediate health hazard. Yet the authors acknowledge that their before-and-after designs are not ideal and point to their lack of data on a control area without such smoking bans.

Disregard of Patients' Preferences Is a Medical Error Comment on “Failure to Engage Hospitalized Elderly Patients and Their Families in Advance Care Planning” Disregard of Patients' Preferences

from ArchInte - 13 May 13

To physicians, what is encompassed by the term medical error may seem self-evident. It is the surgery performed on the wrong limb, the medication given to the wrong patient, or the medical test that falls through the cracks. Medical errors involve acts of omission as well as commission. During the past decade, we have attempted to systematically address diagnostic, treatment, and equipment-related errors and improve patient safety in medicine. Public awareness of the health care system's efforts

Effect of the ACGME 16-Hour Rule on Efficiency and Quality of Care: Duty Hours 2.0

from ArchInte - 13 May 13

In July 2011, the Accreditation Council for Graduate Medical Education (ACGME) reduced the consecutive number of hours that postgraduate year-1 residents can work in a single shift, from 30 to 16. This rule was intended to improve patient safety by reducing residents' fatigue. Many worry that the new duty hour policy increases patient care handovers, which may cause patient harm. The net effect of the 16-hour duty limits on patient outcomes is uncertain.

Failure to Engage Hospitalized Elderly Patients and Their Families in Advance Care Planning Advance Care Planning Between Patient and Families

from ArchInte - 13 May 13

ImportanceAdvance care planning can improve patient-centered care and potentially reduce intensification of care at the end of life.ObjectivesTo inquire about patients' advance care planning activities before hospitalization and preferences for care from the perspectives of patients and family members, as well as to measure real-time concordance between expressed preferences for care and documentation of those preferences in the medical record.DesignProspective study.SettingTwelve acute care hos

Firearm Legislation and Firearm-Related Fatalities in the United States US Firearm Laws and Firearm-Related Fatalities

from ArchInte - 13 May 13

ImportanceOver 30 000 people die annually in the United States from injuries caused by firearms. Although most firearm laws are enacted by states, whether the laws are associated with rates of firearm deaths is uncertain.ObjectiveTo evaluate whether more firearm laws in a state are associated with fewer firearm fatalities.DesignUsing an ecological and cross-sectional method, we retrospectively analyzed all firearm-related deaths reported to the Centers for Disease Control and Prevention Web-base

Forced Smoking Abstinence Not Enough for Smoking Cessation Forced Abstinence and Smoking Cessation

from ArchInte - 13 May 13

ImportanceMillions of Americans are forced to quit smoking as they enter tobacco-free prisons and jails, but most return to smoking within days of release. Interventions are needed to sustain tobacco abstinence after release from incarceration.ObjectiveTo evaluate the extent to which the WISE intervention (Working Inside for Smoking Elimination), based on motivational interviewing (MI) and cognitive behavioral therapy (CBT), decreases relapse to smoking after release from a smoke-free prison.Des

High-Sensitivity Cardiac Troponin T Levels and Secondary Events in Outpatients With Coronary Heart Disease From the Heart and Soul Study High-Sensitivity Cardiac Troponin T Levels

from ArchInte - 13 May 13

ImportanceLevels of high-sensitivity cardiac troponin T (hs-cTnT) predict secondary cardiovascular events in patients with stable coronary heart disease.ObjectivesTo determine the association of hs-cTnT levels with structural and functional measures of heart disease and the extent to which these measures explain the relationship between hs-cTnT and secondary events.DesignWe measured serum concentrations of hs-cTnT and performed exercise treadmill testing with stress echocardiography in a prospec

Improving Health Care After Prison Comment on “Forced Smoking Abstinence: Not Enough for Smoking Cessation” Improving Health Care After Prison

from ArchInte - 13 May 13

About 2.3 million people are incarcerated in federal and state prisons and local jails. Annually, 700 000 are discharged from state and federal prisons, and almost 12 million are discharged from local jails. Although prisoners have a constitutional right to medical care, no such right exists once they are discharged. Given that prisoners have a high rate of mental illness, substance abuse, and disease infections, including with human immunodeficiency virus (HIV), hepatitis C, and tuberculosis, t

In This Issue of JAMA Internal Medicine

from ArchInte - 13 May 13

New Oral Anticoagulants in Acute Coronary Syndromes: What Does a Meta-analysis Tell Us?

from ArchInte - 13 May 13

We read with interest the meta-analysis by Komócsi et al, which reported that the use of factor Xa and direct thrombin inhibitors in patients receiving antiplatelet therapy after an acute coronary syndrome (ACS) was associated with a substantial increase in major bleeding and moderate reduction in ischemic events. However, there are a few issues we would like to highlight.

New Oral Anticoagulants in Acute Coronary Syndromes: What Does a Meta-analysis Tell Us?—Reply

from ArchInte - 13 May 13

In reply

Nonbenzodiazepine Sleep Medication Use and Hip Fractures in Nursing Home Residents Sleep Medication Use and Nursing Home Hip Fracture

from ArchInte - 13 May 13

ImportanceIt is important to understand the relationship between sleep medication use and injurious falls in nursing home residents.ObjectiveTo conduct a case-crossover study to estimate the association between nonbenzodiazepine hypnotic drug use (zolpidem tartrate, eszopiclone, or zaleplon) and the risk for hip fracture among a nationwide sample of long-stay nursing home residents, overall and stratified by individual and facility-level characteristics.Design and SettingCase-crossover study per

Not Just Words Caring for the Patient by Caring About Language

from ArchInte - 13 May 13

Outcomes of Screening Mammography by Frequency, Breast Density, and Postmenopausal Hormone Therapy Outcomes of Screening Mammography

from ArchInte - 13 May 13

ImportanceControversy exists about the frequency women should undergo screening mammography and whether screening interval should vary according to risk factors beyond age.ObjectiveTo compare the benefits and harms of screening mammography frequencies according to age, breast density, and postmenopausal hormone therapy (HT) use.DesignProspective cohort.SettingData collected January 1994 to December 2008 from mammography facilities in community practice that participate in the Breast Cancer Surve

Overuse of Magnetic Resonance Imaging

from ArchInte - 13 May 13

Overuse of health care services such as magnetic resonance imaging (MRI) has become an increasingly recognized problem. We studied the appropriateness of requests for outpatient MRI of the lumbar spine and of the head for headache, as these are common indications and might be frequently inappropriate.