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US Department of Justice Investigations of ICDs and Quality Improvement in Health Care

Mar, 03/07/2018 - 02:00
The US Department of Justice (DOJ) created a firestorm of controversy when, in 2010, it began investigating hundreds of hospitals for fraud due to inappropriate placement of implantable cardioverter-defibrillators (ICDs). Even though individuals were not the focus of the investigation, many physicians sensed a new exposure to civil liability, if not criminal penalties, and felt accused of providing substandard care.

Screening With HPV Testing vs Cytology for Cervical Intraepithelial Neoplasia

Mar, 03/07/2018 - 02:00
This randomized clinical trial compares the effects of cervical HPV vs cytology (Pap smear) screening on the cumulative incidence of high-grade cervical intraepithelial neoplasia (CIN3+) detected at 48 months.

Association Between Basal Insulin Analog vs NPH Insulin Initiation and Hypoglycemic Events in Type 2 Diabetes

Mar, 03/07/2018 - 02:00
This pharmacoepidemiology study estimates the risk of hypoglycemia-related emergency department visits or hospital admissions associated with initiation of long-acting insulin analogs vs human neutral protamine Hagedorn (NPH) insulin in patients with type 2 diabetes.

US Department of Justice Investigation and ICDs Not Meeting the Medicare National Coverage Determination

Mar, 03/07/2018 - 02:00
This cross-sectional analysis uses data from the National Cardiovascular Data Registry to examine changes in the proportion of initial primary prevention implantable cardioverter-defibrillators placed that did not meet the CMS National Coverage Determination following the announcement of the US Department of Justice investigation at hospitals that did and did not reach settlements.

Management Considerations in Infective Endocarditis

Mar, 03/07/2018 - 02:00
This narrative review article considers the increasing numbers of patients who contract the infection from cardiac surgical implants, increased intravenous drug use, and poor dental hygiene and discusses ways to treat it prophylactically, surgically, and medically.

Odds Ratios—Current Best Practice and Use

Mar, 03/07/2018 - 02:00
This JAMA Guide to Statistics and Methods explains the correct usage of odds ratios in the clinical literature to report the strength of the association between binary outcomes.

Management of Patients With Acute Lower Gastrointestinal Tract Bleeding

Mar, 03/07/2018 - 02:00
This JAMA Clinical Guidelines Synopsis summarizes the American College of Gastroenterology’s 2016 guideline on management of patients with acute lower GI tract bleeding.

Maternal Type 1 Diabetes and Risk of Autism in Offspring

Mar, 03/07/2018 - 02:00
This cohort study uses electronic health record data to examine associations between maternal diabetes (preexisting type 1, type 2, and gestational) and autism spectrum disorder in children.

Professional Football Participation and Mortality

Mar, 03/07/2018 - 02:00
To the Editor The retrospective cohort study by Dr Venkataramani and colleagues found a hazard ratio (HR) for mortality in career National Football League (NFL) players compared with NFL replacement players following NFL retirement of 1.38 (95% CI, 0.95-1.99); P?=?.09.

Professional Football Participation and Mortality

Mar, 03/07/2018 - 02:00
To the Editor A well-defined exposure is essential for a cohort study to determine an association between the exposure and a specific outcome. A lower-dose exposure is only useful and statistically powerful when used to examine a dose-response relationship; used only as a control, it is likely to underestimate an association. An infamous example of misclassification of exposed and nonexposed groups and a subsequent null result was the Danish study assessing risk of brain tumors from mobile phones.

Professional Football Participation and Mortality—Reply

Mar, 03/07/2018 - 02:00
In Reply We agree with Drs Smith and Siddiqi that the estimated mortality hazard may be clinically meaningful, but because it is based on a small number of deaths, further follow-up is necessary. We would encourage this interpretation even if the P value had fallen below .05.

Conflicts of Interest in Nutrition Research

Mar, 03/07/2018 - 02:00
To the Editor Drs Ioannidis and Trepanowski argued that the complexity of nutrition research creates special vulnerability to bias. However, we are concerned that their remedy—researchers’ disclosure of personal beliefs and practices—distracts from the main problem, lacks objectivity, and may impede academic freedom.

Conflicts of Interest in Nutrition Research

Mar, 03/07/2018 - 02:00
To the Editor In a Viewpoint, Drs Ioannidis and Trepanowski stated that nutrition scientists must make “numerous choices about what to eat while not allowing those choices to affect their research.” They advocated for nutrition scientists to disclose nonfinancial conflicts of interest such as relevant dietary preferences and practices related to “extreme and committed behavioral stances” and “cultural or religious value judgments.”

Conflict of Interest in Nutrition Research—Reply

Mar, 03/07/2018 - 02:00
In Reply The letters by Dr Ludwig and colleagues and Drs Bero and Grundy offer an opportunity to discuss potential trade-offs and clarify potential misunderstandings regarding our proposal.

Moral Dilemmas for Physicians Treating Terminal Patients

Mar, 03/07/2018 - 02:00
To the Editor We are concerned about Dr Trappey’s actions in treating a patient with ascites described in his A Piece of My Mind article.

Moral Dilemmas for Physicians Treating Terminal Patients—Reply

Mar, 03/07/2018 - 02:00
In Reply I believe that a lot of the objections by Drs Taylor and Wu to how I handled the situation are a result of misunderstandings likely born of my attempts to create a terse and impactful narrative describing my immediate thoughts and reactions. In writing this narrative, I did not include the many other individuals with whom I spoke and consulted in caring for the patient. The letter is helpful in offering guidance about incorporating palliative care and ethics specialists when needed. By saying that the patient “has chosen comfort measures over life-sustaining ones” and “we have nothing left to offer him but our best efforts to ease his pain,” I was trying to let the reader know that palliative care was involved in the patient’s care, that he had chosen to be DNR, and that he had been an active participant in all of these decisions.

Incorrect Name and Degrees Listed for an Author

Mar, 03/07/2018 - 02:00
In the Original Investigation entitled “Effect of a Home-Based Exercise Intervention of Wearable Technology and Telephone Coaching on Walking Performance in Peripheral Artery Disease: The HONOR Randomized Clinical Trial” published in the April 24, 2018, issue of JAMA, an author’s name was misspelled and the incorrect degrees were listed. The author listed in the byline as “Debra Kohlman-Trighoff, PhD, RN” should have been “Debra Kohlman-Trigoboff, RN, MS, ACNP-BC, CVN.” In the “Acquisition, analysis, or interpretation of data” and “Critical revision of the manuscript for important intellectual content” sections in the author contributions section, “Kohlman-Trighoff” should have been “Kohlman-Trigoboff.” This article was corrected online.

Adam Gazzaley, MD, PhD: Developing Prescribable Video Games

Mar, 03/07/2018 - 02:00
This Medical News article discusses a video game-based therapy for pediatric attention-deficit/hyperactivity disorder.

Why Merkel Cell Cancer Is Garnering More Attention

Mar, 03/07/2018 - 02:00
This Medical News story discusses the growing incidence of basal cell carcinoma and promising treatments for the disease.

New Genetic Links to Depression May Pave the Way for Novel Treatment Strategies

Mar, 03/07/2018 - 02:00
Despite a revolution in depression awareness and treatment in the 1990s and the approval of more than 20 drugs for the condition, many individuals still struggle with the condition. However, the recent discovery of new regions in the human genome associated with susceptibility to major depressive disorder (MDD) could pave the way for novel therapeutic strategies and improved diagnostics.

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