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Errors Resulting From Standard Order Sets—In Reply

Mar, 28/08/2018 - 02:00
In Reply We agree with Dr Schreiber that poor physician judgment and a suboptimal handoff process were the proximal causes of an inappropriate ?-blocker prescription to a patient in acute heart failure and that there are additional opportunities other than the ones discussed to improve patient safety. Schreiber’s suggestion that we use hold orders and call orders is well taken. These types of orders are routinely used at our institution and, we suspect, at most others. They were not specifically mentioned in our initial report because of space limitations.

Comparing Spending on Medical Care in the United States and Other Countries

Mar, 28/08/2018 - 02:00
To the Editor The study by Dr Papanicolas and colleagues examined health care and social spending in the United States and other high-income countries in the Organisation for Economic Co-operation and Development (OECD). They concluded that US social spending and health care utilization were similar to these countries and that underinvestment in social spending did not appear to be a driver of increased US health care spending. One way this could be interpreted by policy makers is that health care and social spending should not be adjusted. We believe this interpretation would be unfortunate for 3 reasons.

Comparing Spending on Medical Care in the United States and Other Countries

Mar, 28/08/2018 - 02:00
To the Editor Health care in the United States has an undeniable pricing problem, highlighted in the Special Communication by Dr Papanicolas and colleagues. We disagree, however, with statements in the article about whether relatively higher US spending might partially be explained by low primary care to specialist mix.

Comparing Spending on Medical Care in the United States and Other Countries—In Reply

Mar, 28/08/2018 - 02:00
In Reply Drs Goodman and Valenti raise the important issue that social spending likely affects health outcomes, and we agree. While the somewhat lower-than-average investment in social spending in the United States may not be driving higher health care spending, it is likely a driver of worse health outcomes. As their letter notes, although many poor individuals in the United States may have access to excellent health care, they cannot easily access food or safe housing, factors that have a profound effect on health. Given that the United States has a much higher poverty rate than many of the other countries we studied, its lower-than-average social spending is particularly problematic for population health. Instead of justifying social spending as a way to reduce health care spending, social spending should be invested in for the most important reason of all: it likely improves health and well-being.

Data Misinterpretation

Mar, 28/08/2018 - 02:00
In the Editorial entitled “Digital Media and Symptoms of Attention-Deficit/Hyperactivity Disorders in Adolescents” published in the July 17, 2018, issue of JAMA, data from the original article were misinterpreted. The last words in the last sentence of the third paragraph should have read, “this magnitude of increase is clinically significant on an individual and population scale.” The last sentence in the seventh paragraph should have read, “Future studies should include effect modification analyses examining whether associations between media use and ADHD symptoms are stronger in adolescents with poorer emotion regulation.” The Editorial was corrected online.

Error in 95% CI Limit

Mar, 28/08/2018 - 02:00
In the Research Letter entitled “Use of Death Counts From Vital Statistics to Calculate Excess Deaths in Puerto Rico Following Hurricane Maria,” published online August 2, 2018, there was an error in an upper limit of a 95% CI reported in the Results section and Table. The number (95% CI) of excess deaths in September 2017 should have been: 459 (95% CI, 425-493). This article was corrected online.

Synapsed

Mar, 28/08/2018 - 02:00
A love can lapse;loosening ties that bind,widening the gapsin the sulci of the mind.We no longer touch,you’re beyond my grasp.What remains is a question:How wide is the cleaved space?Could I reach out and touch your face?Or has there been a complete rescission?Is the chasm too wide?Will it take a blind running leap,a flinging of self across a great divide?Or is it just a synapse,a nano-slit between fixed dendritesgone fallow, unfired, the silent nightsof atrophied flesh erringly eulogized?Who will first awaken, ignite, depolarizeand bathe the array in fluids that seepinto the spaces that get decreedwhen our hearts break,when our fingertips get prickedand start to bleed?

Letter: The Redundant Ritual

Mar, 28/08/2018 - 02:00
To the Editor:—Every year, from late May to the middle of June, American institutions of learning inflict on their faculty, their graduating students, and the latter’s relatives a series of protracted ordeals, viz, the commencement address, the precommencement address, the graduation oration, and sundry other forms of prolonged but exquisite verbal torture. Aside from the orgy of rhetoric at commencement itself, various faculties and schools, in particular those of medicine, nursing, dentistry, and law, pile on the agony by holding their own masochistic ceremonies. Since there are more than 2,000 colleges and universities in the United States, if these occasions are to be worthwhile it presupposes that there must be a thousand itinerant orators, all of whom have something worthwhile to say. This makes allowance for the fact that some speakers are invited—and inevitably acquiesce—to give forth twice or more.

Injury to the Eye

Mar, 28/08/2018 - 02:00
This JAMA Patient Page describes types of injury to the eye and practices for preventing eye injury.

JAMA

Mar, 28/08/2018 - 02:00