Archives of internal medicine最新文献

{"title":"Repeat testing among Medicare beneficiaries.","authors":"H Gilbert Welch,&nbsp;Kevin J Hayes,&nbsp;Carol Frost","doi":"10.1001/2013.jamainternmed.727","DOIUrl":"https://doi.org/10.1001/2013.jamainternmed.727","url":null,"abstract":"<p><strong>Background: </strong>Although the tendency to repeat examinations is a major determinant of the capacity to serve new patients and of the ability to contain health care costs, little research has described the patterns observed in actual practice.</p><p><strong>Methods: </strong>We investigated patterns of repeat testing in a longitudinal study of a 5% random sample of Medicare beneficiaries, restricted to 743,478 fee-for-service patients who were alive for a 3-year period after their index test between January 1, 2004, and December 31, 2006. Using the 50 largest metropolitan statistical areas as the unit of analysis, we examined the relationship between the proportion of the population tested and the proportion of tests repeated among those tested.</p><p><strong>Results: </strong>Among beneficiaries undergoing echocardiography, 55% had a second test within 3 years. Repeat testing following other examinations was also common: 44% of imaging stress tests were repeated within 3 years, as were 49% of pulmonary function tests, 46% of chest computed tomography, 41% of cystoscopies, and 35% of upper endoscopies. The proportion of the population tested and the proportion of tests repeated varied across metropolitan statistical areas. The proportion who underwent echocardiography was highest in Miami, Florida (48%, among whom 66% of examinations were repeated in 3 years), and was lowest in Portland, Oregon (18%, among whom 47% of examinations were repeated in 3 years). Across 50 metropolitan statistical areas, the proportion of the population tested was consistently positively correlated with the proportion of tests repeated for echocardiography (Spearman r = 0.87, P < .001), imaging stress test (r = 0.65, P < .001), pulmonary function test (r = 0.62, P < .001), chest computed tomography (r = 0.66, P < .001), cystoscopy (r = 0.21, P = .13), and upper endoscopy (r = 0.59, P < .001).</p><p><strong>Conclusions: </strong>Repeat testing is common among Medicare beneficiaries. Patients residing in metropolitan statistical areas with high rates of population testing are more likely to be tested and are more likely to have their test repeated.</p>","PeriodicalId":8290,"journal":{"name":"Archives of internal medicine","volume":"172 22","pages":"1745-51"},"PeriodicalIF":0.0,"publicationDate":"2012-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1001/2013.jamainternmed.727","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31327250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Grief in health care professionals: when screening for major depression is needed.","authors":"Emmanuelle Corruble,&nbsp;Ronald Pies,&nbsp;Sidney Zisook","doi":"10.1001/2013.jamainternmed.90","DOIUrl":"https://doi.org/10.1001/2013.jamainternmed.90","url":null,"abstract":"","PeriodicalId":8290,"journal":{"name":"Archives of internal medicine","volume":"172 22","pages":"1768; author reply 1768-9"},"PeriodicalIF":0.0,"publicationDate":"2012-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1001/2013.jamainternmed.90","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31115442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The burden of hospitalization for atrial fibrillation-reply.","authors":"Christopher X Wong,&nbsp;Kurt C Roberts-Thomson,&nbsp;Prashanthan Sanders","doi":"10.1001/2013.jamainternmed.320","DOIUrl":"https://doi.org/10.1001/2013.jamainternmed.320","url":null,"abstract":"","PeriodicalId":8290,"journal":{"name":"Archives of internal medicine","volume":"172 22","pages":"1770"},"PeriodicalIF":0.0,"publicationDate":"2012-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1001/2013.jamainternmed.320","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31494082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acupuncture for dyspnea on exertion in chronic obstructive pulmonary disease: no blindness.","authors":"Jean-Luc Mommaerts,&nbsp;Jan Vandevoorde,&nbsp;Dirk Devroey","doi":"10.1001/2013.jamainternmed.453","DOIUrl":"https://doi.org/10.1001/2013.jamainternmed.453","url":null,"abstract":"should not be used to modify clinical practice. However, although mortality is objective and important, most patients withCAPdonotdie.BecausenewinterventionsforCAPare likely to result in only small changes in mortality, large sample sizes are required to detect clinically important changes. Therefore, it has been suggested that mortality is an insensitive measure of quality of care or treatment failure in CAP. 3 In our article, 1 we clearly pointed out that our study was not powered to detect a survival difference. Nevertheless, we found that only 4 of 200 patients (2%) in the 3-step group and 2 of 201 patients (1%) in the usual care group died. Importantly, no patient died during the 30-day follow-upperiodafterdischarge.However,itshouldbenoted that patients receiving usual care were more likely to experience adverse drug reactions, mainly phlebitis, probably related to the longer duration of intravenous antibiotic therapy in this group. Webelievethatapplyingthe3-stepcriticalpathway(early mobilizationanduseofobjectivecriteriaforswitchingtooral antibiotics and for deciding on hospital discharge) to the selected population analyzed is safe and effective and may allowcostsavings.Inthisregard,themostrecentInfectiousDiseasesSocietyofAmerica/AmericanThoracicSocietyConsensus","PeriodicalId":8290,"journal":{"name":"Archives of internal medicine","volume":"172 22","pages":"1772-3; author reply 1773"},"PeriodicalIF":0.0,"publicationDate":"2012-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1001/2013.jamainternmed.453","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31115447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moderate renal impairment and risk of bleeding with anticoagulation.","authors":"Tracy Minichiello","doi":"10.1001/2013.jamainternmed.456","DOIUrl":"https://doi.org/10.1001/2013.jamainternmed.456","url":null,"abstract":"","PeriodicalId":8290,"journal":{"name":"Archives of internal medicine","volume":"172 22","pages":"1718-20"},"PeriodicalIF":0.0,"publicationDate":"2012-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1001/2013.jamainternmed.456","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31027305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The value of community health workers.","authors":"Mitchell H Katz","doi":"10.1001/2013.jamainternmed.105","DOIUrl":"https://doi.org/10.1001/2013.jamainternmed.105","url":null,"abstract":"T he vignette about Mr Alberts is familiar to all of us working in safety-net hospitals. “Frequent flyer” patients may be young or old, male or female, and of any ethnicity. What they have in common is that their problems are not solvable by hospitals or medical systems. Yes, we can treat their pneumonias, skin abscesses, and in Mr Alberts’s case their chronic obstructive pulmonary disorder exacerbations, but we are ill-equipped to treat poverty, homelessness, addictions, and loneliness. We spend large sums of money on medical care, including expensive diagnostic tests, and then shake our heads at the inability of our society to pay relatively small sums to provide food, housing, and transportation to medical visits. What the editors found particularly moving about this vignette is the illustration of a potentially powerful intervention for patients like Mr Alberts: a community health worker drawn from the same community as the patient. We agree with the authors’ assertion that sending highly trained clinical personnel to the homes (or streets) of such patients will not necessarily improve their lives or decrease their medical expenses because it is not clinical services that they need. They need help with their social problems, connections to available resources in the community, transportation to medical visits, and translation of the increasingly complex language of medicine into terms they can understand and follow. We look forward to the results of trials on the use of community health workers in improving the care and decreasing the cost of patients like Mr Alberts.","PeriodicalId":8290,"journal":{"name":"Archives of internal medicine","volume":"172 22","pages":"1758"},"PeriodicalIF":0.0,"publicationDate":"2012-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1001/2013.jamainternmed.105","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31029336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fasting for lipid testing: Is it worth the trouble?","authors":"Amit V Khera,&nbsp;Samia Mora","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":8290,"journal":{"name":"Archives of internal medicine","volume":"172 22","pages":"1710-2"},"PeriodicalIF":0.0,"publicationDate":"2012-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31327252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of substance use disorders in ambulatory care in the United States, 2001-2009.","authors":"Joseph W Frank,&nbsp;John Z Ayanian,&nbsp;Jeffrey A Linder","doi":"10.1001/archinternmed.2012.4504","DOIUrl":"https://doi.org/10.1001/archinternmed.2012.4504","url":null,"abstract":"A n estimated 22.5 million Americans meet criteria for a substance use disorder diagnosis. Opioid use, in particular, has attracted attention recently because overdose deaths due to opioid analgesics have increased nearly 4-fold in the past decade. Effective treatment options have also increased during this period. The impact of these developments on the delivery of substance abuse treatment in traditional ambulatory care settings is not known. Further change is expected as recent federal legislation is implemented. Therefore, we sought to describe the prevalence and management of substance use disorders in ambulatory care in a nationally representative sample.","PeriodicalId":8290,"journal":{"name":"Archives of internal medicine","volume":"172 22","pages":"1759-60"},"PeriodicalIF":0.0,"publicationDate":"2012-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1001/archinternmed.2012.4504","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30994203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enoxaparin outcomes in patients with moderate renal impairment.","authors":"Douglas D DeCarolis,&nbsp;Joey G Thorson,&nbsp;Megan A Clairmont,&nbsp;Amy M Leuthner,&nbsp;Thomas S Rector,&nbsp;Gerhard J Johnson","doi":"10.1001/2013.jamainternmed.369","DOIUrl":"https://doi.org/10.1001/2013.jamainternmed.369","url":null,"abstract":"<p><strong>Background: </strong>Enoxaparin sodium has predictable pharmacokinetics that allow for simplified dosing without laboratory monitoring. Reliance on renal function for excretion may lead to accumulation of enoxaparin in patients with moderate renal impairment. However, there is no dose adjustment recommended for these patients. We conducted a review to compare bleeding events in patients with moderate renal impairment compared with those with normal renal function.</p><p><strong>Methods: </strong>Patients received enoxaparin sodium, 1 mg/kg, every 12 hours or 1.5 mg/kg once daily between June 1 and November 30, 2009. Moderate renal impairment was defined as creatinine clearance (CrCl) of 30 to 50 mL/min. Normal renal function was defined as CrCl greater than 80 mL/min. The primary outcome was major bleeding, defined as any bleeding resulting in death, hospital admission, lengthened hospital stay, or an emergency department visit. The secondary outcome was thromboembolism.</p><p><strong>Results: </strong>A total of 164 patients met the inclusion criteria: 105 with normal renal function and 59 with moderate renal impairment. The primary outcome occurred in 6 of 105 patients (5.7%) with normal renal function vs 13 of 59 patients (22.0%) with moderate renal impairment, representing an unadjusted odds ratio of 4.7 (95% CI, 1.7-13.0; P = .002). The odds ratio using multivariable logistic regression adjusting for differences in risk was 3.9 (95% CI, 0.97-15.6; P = .055). There was no recurrent thromboembolism in either group.</p><p><strong>Conclusions: </strong>Our results suggest an increased risk of major bleeding in patients with moderate renal impairment who receive enoxaparin. Because enoxaparin is frequently used and outcomes can be life saving or life threatening, we encourage further study of the appropriate dose in patients with moderate renal impairment.</p>","PeriodicalId":8290,"journal":{"name":"Archives of internal medicine","volume":"172 22","pages":"1713-8"},"PeriodicalIF":0.0,"publicationDate":"2012-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1001/2013.jamainternmed.369","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31029146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telemedicine and retinal imaging for improving diabetic retinopathy evaluation.","authors":"Seema Garg,&nbsp;Pooja D Jani,&nbsp;Abhijit V Kshirsagar,&nbsp;Bradley King,&nbsp;Edward Chaum","doi":"10.1001/archinternmed.2012.4372","DOIUrl":"https://doi.org/10.1001/archinternmed.2012.4372","url":null,"abstract":"","PeriodicalId":8290,"journal":{"name":"Archives of internal medicine","volume":"172 21","pages":"1677-8"},"PeriodicalIF":0.0,"publicationDate":"2012-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1001/archinternmed.2012.4372","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30946858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}