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from JAMA - 15 May 13

May 15, 2013

Addressing the Social Determinants of Health Within the Patient-Centered Medical Home Lessons From Pediatrics Social Determinants of Health in the Medical Home

from JAMA - 15 May 13

Socioeconomic disparities in health continue to exist, despite advances in medicine. Since the classic Whitehall studies, it has been well known that the social context in which an individual lives and works influences health. Mitigating the harmful consequences of social factors that contribute to health disparities has largely been left to the public health and policy communities, whereas clinical medicine has traditionally focused on identifying and reducing biological risk factors for an ind

Contraception Is a Fundamental Primary Care Service Contraception Is Fundamental in Primary Care

from JAMA - 15 May 13

Contraceptives and the Law A View From a Catholic Medical Institution Contraceptives and the Law

from JAMA - 15 May 13

Cost Consequences of the 340B Drug Discount Program Cost Consequences of the 340B Drug Discount Program

from JAMA - 15 May 13

Created in 1992, a little-known federal drug discount program called “340B” allowed a handful of hospitals that cared for the poor to obtain drugs for their patients at substantially reduced prices. Today, through a series of expansions, including some enumerated in the Affordable Care Act, numerous other types of entities such as community hospitals and cancer centers that serve both the poor and the well-insured can participate. Between 2009 and 2012 the number of enrolled hospitals doubled, a

Patient’s Sister, Seeking Job

from JAMA - 15 May 13

My brother was diagnosed with hepatoblastoma when I was 4 years old and he was just shy of 2. It wasn't until years (and several cancers) later that we learned he had Gardner syndrome. Over the last 26 years, Hans had dozens of operations and underwent many lifetime doses of radiation and chemotherapy. The disease and its treatments took a toll on his body, and he had a multivisceral transplant in 2007 that gave him a new stomach, small intestine, pancreas, and liver. Five years later, his liver

Association of Single- vs Dual-Chamber ICDs With Mortality, Readmissions, and Complications Among Patients Receiving an ICD for Primary Prevention Dual Chamber ICDs, Mortality, and Complications

from JAMA - 15 May 13

ImportanceRandomized trials of implantable cardioverter-defibrillators (ICDs) for primary prevention predominantly used single-chamber devices. In clinical practice, patients often receive dual-chamber ICDs, even without clear indications for pacing. The outcomes of dual- vs single-chamber devices are uncertain.ObjectiveTo compare outcomes of single- and dual-chamber ICDs for primary prevention of sudden cardiac death.Design, Setting, and ParticipantsRetrospective cohort study of admissions in t

Long-term Outcomes Following Abdominal Sacrocolpopexy for Pelvic Organ Prolapse Outcomes for Pelvic Organ Prolapse

from JAMA - 15 May 13

ImportanceMore than 225 000 surgeries are performed annually in the United States for pelvic organ prolapse (POP). Abdominal sacrocolpopexy is considered the most durable POP surgery, but little is known about safety and long-term effectiveness.ObjectivesTo describe anatomic and symptomatic outcomes up to 7 years after abdominal sacrocolpopexy, and to determine whether these are affected by concomitant anti-incontinence surgery (Burch urethropexy).Design, Setting, and ParticipantsLong-term follo

Lutein + Zeaxanthin and Omega-3 Fatty Acids for Age-Related Macular Degeneration The Age-Related Eye Disease Study 2 (AREDS2) Randomized Clinical Trial Supplements and Age-Related Macular Degenerati

from JAMA - 15 May 13

ImportanceOral supplementation with the Age-Related Eye Disease Study (AREDS) formulation (antioxidant vitamins C and E, beta carotene, and zinc) has been shown to reduce the risk of progression to advanced age-related macular degeneration (AMD). Observational data suggest that increased dietary intake of lutein + zeaxanthin (carotenoids), omega-3 long-chain polyunsaturated fatty acids (docosahexaenoic acid [DHA] + eicosapentaenoic acid [EPA]), or both might further reduce this risk.ObjectivesTo

Do Findings on Routine Examination Identify Patients at Risk for Primary Open-Angle Glaucoma? The Rational Clinical Examination Systematic Review Patients at Risk for Primary Open-Angle Glaucoma

from JAMA - 15 May 13

ImportanceGlaucoma is the second leading cause of blindness worldwide, and its insidious onset is often associated with diagnostic delay. Since glaucoma progression can often be effectively diminished when treated, identifying individuals at risk for glaucoma could potentially lead to earlier detection and prevent associated vision loss.ObjectiveTo quantify the diagnostic accuracy of examination findings and relevant risk factors in identifying individuals with primary open-angle glaucoma (POAG)

Pelvic Organ Prolapse Surgery Long-term Outcomes and Implications for Shared Decision Making Pelvic Organ Prolapse Surgery

from JAMA - 15 May 13

Pelvic floor disorders, including pelvic organ prolapse, urinary incontinence, fecal incontinence, and other sensory disorders of the gastrointestinal and genitourinary tract, are common with nearly 1 in 4 US women having at least 1 pelvic floor condition. In this issue of JAMA, Nygaard and colleagues present findings from the extended Colpopexy and Urinary Reduction Efforts (extended CARE) trial. The original CARE trial was a double-blind randomized trial of 322 women mostly with advanced (stag

Cephalosporin Resistance in Neisseria gonorrhoeae Infections

from JAMA - 15 May 13

To the Editor: The emergence of extended-spectrum cephalosporin resistance in Neisseria gonorrhoeae infections in North America and worldwide is worrisome, as is the current US response to that problem. Authorities call for adherence to treatment recommendations, use of test of cure, risk-reduction counseling, increased condom use, clinician vigilance for treatment failure, and novel antimicrobial development. Even though these measures are reasonable, none has been shown to reduce the populatio

Cephalosporin Resistance in Neisseria gonorrhoeae Infections—Reply

from JAMA - 15 May 13

In Reply: We agree with Drs Klausner and Kerndt that antibiotic stewardship is an important component of controlling antibiotic resistance, and we support such efforts as sound clinical and public health practice. For many bacterial pathogens, antibiotic consumption appears to promote the emergence of resistance, and judicious antibiotic use may reduce the prevalence of resistance.

Cephalosporin Resistance in Neisseria gonorrhoeae Infections—Reply

from JAMA - 15 May 13

In Reply: Drs Klausner and Kerndt highlight the urgent need for innovative approaches to address the continued emergence of multidrug-resistant N gonorrhoeae. Specifically, by analogy to efforts successful at reducing macrolide-resistant group A streptococci, they suggest real-time detection and antimicrobial testing use may turn the tide of cephalosporin resistance in N gonorrhoeae.

Use of Administrative Data for Public Reporting of Outcomes

from JAMA - 15 May 13

To the Editor: In their Viewpoint regarding the use of administrative data (ie, International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM]) in public reporting of outcomes and pay for performance, Dr Farmer and colleagues argued for “a national, standardized system for outcome reporting” separate from administrative data that is “minimally affected by the incentives to alter coding created by public reporting.” Count us as skeptics.

Use of Administrative Data for Public Reporting of Outcomes—Reply

from JAMA - 15 May 13

In Reply: Drs Utter and Romano have made important contributions to society's ability to measure patient safety using patient safety indicators based on administrative (billing) data. But their response to our article is puzzling. Our central claim was that billing data cannot be relied on to simultaneously measure quality, publicly report quality, and pay for performance. If they are, the ability to measure true changes in quality will be lost.

Temporal Trends in Smokeless Tobacco Use Among US Middle and High School Students, 2000-2011

from JAMA - 15 May 13

To the Editor: Tobacco use remains the leading preventable cause of death and disease in the United States. Declines in smoking among youths were observed from the late 1990s, particularly after the Master Settlement Agreement in 1998. However, limited information exists on trends in smokeless tobacco use among US youths.

ACP, State Medical Boards Offer Advice on Online Professionalism for Physicians

from JAMA - 15 May 13

Physicians should pause before hitting Send on an e-mail, tweet, or other digital communication to ensure that the communication will uphold their professional obligations to patients and not mar the reputation of the profession, urges a new joint position paper (http: //annals.org/article.aspx?articleid =1675927) from the American College of Physicians (ACP) and the Federation of State Medical Boards (FSMB).

Volunteer Corps Aims to Improve Training for Clinicians in Developing Countries

from JAMA - 15 May 13

Like many developing countries, Malawi faces a shortage of clinicians to meet the demand for care. According to the World Health Organization, there are just 3 nurses per 10 000 Malawians (compared with approximately 100 nurses to 10 000 citizens in the United States and the United Kingdom) and even fewer physicians, with fewer than 1 per 10 000.

Selections From News@JAMA and JAMA Forum

from JAMA - 15 May 13

The Role of Medicaid and Medicare in Women's Health Care

from JAMA - 15 May 13

This month's Visualizing Health Policy provides information about the role of Medicaid and Medicare in women's health care: the proportion of US women who are covered by Medicaid and Medicare; how women comprise the majority of those covered by the Medicaid and Medicare programs and the majority of those receiving long-term services and supports (such as home health care); how women on Medicaid are poorer and sicker than women with private coverage; how Medicaid is a primary payer for women's re

Two or Three Things

from JAMA - 15 May 13

Just as fashions moved through the decades, from poodle skirts in the 1950s to go-go boots (1960s) and granny dresses (1970s), the abstract art of Elizabeth Murray (1940-2007) would also undergo changes in style, though always retaining a sense of her wink and a smile. Murray had moved from her birthplace of Chicago to Bloomington, Illinois, as a child, but her influence would someday extend far beyond the prairie horizon. The family had little, but movies brightened Murray's life, especially ca

The Spider

from JAMA - 15 May 13

The harvestman's diminutive braincontained in a quarter-inch bodyeasily moves eight Irishmaneyelashes rapidly upleaf or down,or as now, perfectly still,spread like the spokes of a leprechaun's fan—The neurons inside a squirreldo not add up to 100 billionand probably equal the few million starsin a dwarf galaxy, yet are,shall we say, spectacularly adequate—While waiting for ants in a shoethe six eyes of a recluse spiderdo not cause synapses behindto constitute a jealous mind;he bites a two-eyed c

NEW ANALYSES OF HOT SPRING WATERS

from JAMA - 15 May 13

May 17, 1913

Climate Change Linked With Increase in Diarrheal Disease

from JAMA - 15 May 13

Changes in climate that lead to an increase in temperature and a decrease in precipitation are associated with an increase in diarrheal disease in children in Botswana, a sub-Saharan country with distinct wet and dry seasons (Alexander KA et al. Int J Environ Res Public Health. 2013;10[4]:1202-1230).