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Variation in Prices for Common Medical Tests and Procedures

from ArchInte - 01 Jan 15

This Viewpoint reports crowdsourced health care prices in California.



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Bundling Informed Consent and Advance Care Planning in Chronic Cardiovascular Disease We Need to Talk

from ArchInte - 01 Jan 15

Modern cardiovascular therapies offer unprecedented opportunities to improve survival and quality of life. Cardiovascular morbidity and mortality have significantly declined, owing in a large part to preventive therapies and technological advances such as coronary revascularization, implantable cardioverter defibrillators (ICDs), and ventricular assist devices (VADs). Newer therapies like transcatheter aortic valve replacement hold great promise. Nonetheless, cardiovascular disease remains a lea



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Public Health in the Age of Ebola in West Africa

from ArchInte - 01 Jan 15

This Viewpoint discusses several key public health lessons learned from the current West Africa Ebola epidemic that are changing the way we think about emerging infectious disease threats.



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Secondary Prevention of Cardiovascular Disease With Vorapaxar A New Era of 3-Drug Antiplatelet Therapy?

from ArchInte - 01 Jan 15

This Viewpoint questions the benefit-risk balance of vorapaxar use as a component of 3-drug antiplatelet therapy for cardiovascular disease.





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PSA Screening—I Finally Won!

from ArchInte - 01 Jan 15

I must have won. That is what everyone tells me. At the beginning there were a few telephone calls, followed by e-mails, and now every talk I give someone brings up how happy I must feel for winning. What I purportedly won was the new recommendations against routine checking for prostate-specific antigen (PSA). The new recommendations acknowledge the limitations of PSA after years of heated debate. I had written an essay about our malpractice system and evidence-based medicine (EBM) after being



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A Comparison of Diagnostic Imaging Ordering Patterns Between Advanced Practice Clinicians and Primary Care Physicians Following Office-Based Evaluation and Management Visits

from ArchInte - 01 Jan 15

ImportanceLittle is known about the use of diagnostic testing, such as medical imaging, by advanced practice clinicians (APCs), specifically, nurse practitioners and physician assistants.ObjectiveTo examine the use of diagnostic imaging ordered by APCs relative to that of primary care physicians (PCPs) following office-based encounters.Design, Setting, and ParticipantsUsing 2010-2011 Medicare claims for a 5% sample of beneficiaries, we compared diagnostic imaging ordering between APC and PCP epi



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Community Health Worker Home Visits for Adults With Uncontrolled Asthma The HomeBASE Trial Randomized Clinical Trial

from ArchInte - 01 Jan 15

ImportanceAsthma is often poorly controlled. Home visitation by community health workers (CHWs) to improve control among adults has not been adequately evaluated.ObjectiveTo test the hypothesis that CHW home visits for adults with uncontrolled asthma improve outcomes relative to usual care.Design, Setting, and ParticipantsRandomized parallel group study with 1-year follow-up, conducted 2008 through 2011 at homes of low-income adults aged 18 to 65 years with uncontrolled asthma living in King Cou



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Risk of Bleeding With Dabigatran in Atrial Fibrillation

from ArchInte - 01 Jan 15

ImportanceIt remains unclear whether dabigatran etexilate mesylate is associated with higher risk of bleeding than warfarin sodium in real-world clinical practice.ObjectiveTo compare the risk of bleeding associated with dabigatran and warfarin using Medicare data.Design, Setting, and ParticipantsIn this retrospective cohort study, we used pharmacy and medical claims in 2010 to 2011 from a 5% random sample of Medicare beneficiaries. We identified participants as those newly diagnosed as having at



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Dual Use of Department of Veterans Affairs and Medicare Benefits and Use of Test Strips in Veterans With Type 2 Diabetes Mellitus

from ArchInte - 01 Jan 15

ImportanceSelf-monitoring of blood glucose is a costly component of care for diabetes mellitus, with unclear benefits for patients not taking insulin. Veterans with dual Department of Veterans Affairs (VA) and Medicare benefits have access to test strips through both systems, raising the potential for overuse.ObjectivesTo examine the patterns of test strip receipt among older veterans with diabetes and determine whether receipt of strips from dual health care systems is associated with overuse.D



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Getting Maintenance of Certification to Work A Grounded Theory Study of Physicians' Perceptions

from ArchInte - 01 Jan 15

ImportanceDespite general support for the goals of maintenance of certification (MOC), concerns have been raised about its effectiveness, relevance, and value.ObjectiveTo identify barriers and enabling features associated with MOC and how MOC can be changed to better accomplish its intended purposes.Design, Setting, and ParticipantsGrounded theory focus group study of 50 board-certified primary care and subspecialist internal medicine and family medicine physicians in an academic medical center



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Effects of Hyperbaric Oxygen on Symptoms and Quality of Life Among Service Members With Persistent Postconcussion Symptoms A Randomized Clinical Trial

from ArchInte - 01 Jan 15

ImportanceImprovement has been anecdotally observed in patients with persistent postconcussion symptoms (PCS) after mild traumatic brain injury following treatment with hyperbaric oxygen (HBO). The effectiveness of HBO as an adjunctive treatment for PCS is unknown to date.ObjectivesTo compare the safety of and to estimate the efficacy for symptomatic outcomes from standard PCS care alone, care supplemented with HBO, or a sham procedure.Design, Setting, and ParticipantsMulticenter, double-blind,



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Clinical Effectiveness of Integrating Depression Care Management Into Medicare Home Health The Depression CAREPATH Randomized Trial

from ArchInte - 01 Jan 15

ImportanceAmong older home health care patients, depression is highly prevalent, is often inadequately treated, and contributes to hospitalization and other poor outcomes. Feasible and effective interventions are needed to reduce this burden of depression.ObjectiveTo determine whether, among older Medicare Home Health recipients who screen positive for depression, patients of nurses receiving randomization to an intervention have greater improvement in depressive symptoms during 1 year than pati



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Use of Cardiac Biomarker Testing in the Emergency Department

from ArchInte - 01 Jan 15

ImportanceCardiac biomarker testing is not routinely indicated in the emergency department (ED) because of low utility and potential downstream harms from false-positive results. However, current rates of testing are unknown.ObjectiveTo determine the use of cardiac biomarker testing overall, as well as stratified by disposition status and selected characteristics.Design, Setting, and ParticipantsRetrospective study of ED visits by adults (=18 years old) selected from the 2009 and 2010 National H



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Medication Therapy Management Interventions in Outpatient Settings A Systematic Review and Meta-analysis

from ArchInte - 01 Jan 15

ImportanceMedication therapy management (MTM) services (also called clinical pharmacy services) aim to reduce medication-related problems and their downstream outcomes.ObjectiveTo assess the effect of MTM interventions among outpatients with chronic illnesses.Data SourcesMEDLINE, Cochrane Library, and International Pharmaceutical Abstracts through January 9, 2014.Study SelectionTwo reviewers selected studies with comparators and eligible outcomes of ambulatory adults.Data Extraction and Synthesi



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Influence of the Timing of Antiretroviral Therapy on the Potential for Normalization of Immune Status in Human Immunodeficiency Virus 1–Infected Individuals

from ArchInte - 01 Jan 15

ImportanceIn individuals with human immunodeficiency virus 1 (HIV-1) infection who are receiving antiretroviral therapy (ART), factors that promote full immune recovery are not well characterized. ObjectiveTo investigate the influence of the timing of ART relative to HIV-1 infection on normalization of CD4+ T-cell counts, AIDS risk, and immune function.Design, Setting, and ParticipantsParticipants in the observational US Military HIV Natural History Study with documented estimated dates of seroc



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Finding Value in Medicine

from ArchInte - 01 Jan 15

“The medical care system in the United States is being restructured, with the goal of containing rising health care expenditures. Cost-containment strategies…have as their major purpose restraining the use of high-cost medical services. Yet little attention has been paid to how patients’ health and level of functioning in everyday activities are affected by these and other strategies.”(p925)



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Learning to Act on Secondhand Tobacco Smoke Exposure to Limit Risk for Coronary Heart Disease

from ArchInte - 01 Jan 15

Secondhand tobacco smoke (SHS) consists of a combination of mainstream smoke that is exhaled from a smoker and sidestream smoke that is given off by a burning cigarette. There is no known safe level of SHS exposure, and it is associated with multiple health risks including sinorespiratory disease, cancer, and cardiovascular disease. In children, SHS increases the risk of pneumonia, bronchitis, severe asthma, and sudden infant death syndrome, and in adults SHS increases the risk of chronic obstru



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The Ritual of Hyperbaric Oxygen and Lessons for the Treatment of Persistent Postconcussion Symptoms in Military Personnel

from ArchInte - 01 Jan 15

During the past decade, unprecedented clinical and research resources have been directed toward addressing 2 conditions considered “silent” and “signature injuries” of the Iraq and Afghanistan wars, namely, posttraumatic stress disorder (PTSD) and concussion (mild traumatic brain injury). This investment is increasingly paying dividends in knowledge and interventions that are changing the standards of clinical practice. Notable examples include emerging trauma-focused psychotherapies and the ant



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Now Is the Time for True Reform of Mental Health Services

from ArchInte - 01 Jan 15

The rapid aging of the population is accompanied by commensurate growth in the number of individuals who have complex chronic medical conditions (diabetes mellitus, heart disease, lung disease, etc). These people are increasingly less able to interact with health care services outside of their homes. At the same time, those caring for older adults are increasingly stretched in their ability to deliver care. This is especially true in providing care for mental disorders associated with chronic di



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Defining Success With Antiretroviral Therapy

from ArchInte - 01 Jan 15

Two critically important issues in human immunodeficiency virus (HIV) therapeutics are when to start antiretroviral therapy and how well these medications restore immunity. In this issue of JAMA Internal Medicine, Okulicz et al describe a prospective cohort study of 1119 US military service persons with known seroconversion dates who were monitored for several years. Because the dates of seroconversion were known for these individuals and their immunologic status was well characterized, the data



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The Right Care by the Right Clinician

from ArchInte - 01 Jan 15

Increased demand for primary care has resulted in the increased use of advanced practice clinicians (nurse practitioners and physician assistants) to supplement the physician workforce. It is natural to ask how the care delivered by these advanced practice clinicians differs from the care provided by physicians.



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A New Program for Sharing Medical Cost Information

from ArchInte - 01 Jan 15

The assumption that market principles apply to the choices consumers (that is, patients) make about their medical care is an important part of health care policy and regulations in the United States. This assumption, however, belies the facts that health care is mostly not paid for out of pocket, that consumers cannot really evaluate their care (there are minimal or no ratings of the type provided by Consumer Reports for physicians and hospitals), and that consumers are purchasing goods and serv


 

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