RSS Medical Articles

Consider Quality of Life to Improve Quality of Cancer Guidelines
Κύριακη, 10.01.2017, 03:00am
To the EditorWe read with interest the Original Investigation by Merkow et al in a recent issue ofJAMA Internal Medicinethat analyzed clinical practice guidelines for cancer survivorship surveillance. The authors identified 41 English-language national guidelines that addressed posttreatment care for survivors of 9 adult-onset cancers. They found that the guidelines included inconsistent and ambiguous recommendations for surveillance testing and advised that more definitive recommendations are needed. They emphasized that clear guidance is particularly important as primary care providers are more often charged with caring for cancer survivors and have limited knowledge of appropriate cancer surveillance strategies.
Consider Quality of Life to Improve Quality of Cancer Guidelines—Reply
Κύριακη, 10.01.2017, 03:00am
In ReplyWe appreciate the letters from Schepisi et al and Nekhlyudov et al, both of which highlight the need for a definition of cancer survivorship care that goes beyond surveillance for recurrent disease. In our study, we reported on the inconsistency and lack of clarity among national guidelines regarding posttreatment surveillance in patients with common adult cancers and recommended a more systematic guideline development process. These letters make an additional point about the appropriate scope of survivorship care.
Current Shortcomings of Camera Screening
Κύριακη, 10.01.2017, 03:00am
To the EditorIn an Original Investigation published in a recent issue ofJAMA Internal Medicine, Daskivich et al show that primary care–based digital camera–enabled telemedicine screening for diabetic retinopathy increases the rate and decreases the wait time of such screening for the underserved diabetic population of the largest county public health system in the United States. Camera-based retinal screening in nonophthalmic settings is certainly a powerful disruptive innovation that will alter best practices in the way eye care is delivered across populations.
Current Shortcomings of Camera Screening—Reply
Κύριακη, 10.01.2017, 03:00am
In ReplyOur teleretinal diabetic retinopathy screening (TDRS) program was implemented to address the large backlog of persons with diabetes in Los Angeles County waiting for diabetic retinopathy (DR) screening examinations. As stated in our article, our TDRS program is intended solely for DR screening; it is not intended to replace a comprehensive eye examination to rule out the presence of conditions such as glaucoma. However, it is clear that the highest risk of blindness posed to our patient population is from diabetic retinopathy. Although the pre-TDRS mean wait time for screening of 158 days may be acceptable for lower levels of diabetic retinopathy, it is not an acceptable wait time for a screening examination to determine who falls into that category. As evidenced by our historically low screening rate and long wait times for DR screening examinations, many of these patients were not getting adequate eye care, or any eye care at all, prior to the implementation of our TDRS program. This is a major challenge for the US safety net.
Effects of Reminder Devices on Medication Adherence
Κύριακη, 10.01.2017, 03:00am
To the EditorIn an Original Investigation in a recent issue ofJAMA Internal Medicine, Dr Choudhry and colleagues evaluated the effectiveness of 3 low-cost reminder devices on medication adherence. While the study is highly rational when viewed from the medical model of disability, at its core this study is about the effectiveness of assistive technology intervention. From this perspective, the study loses its coherence.
Open VA Data Sets to Non-VA Researchers
Κύριακη, 10.01.2017, 03:00am
To the EditorThere is debate about whether patient outcomes at Department of Veterans Affairs (VA) facilities are comparable to those at other facilities; such information may inform what role VA should have in US health care.
Cytomegalovirus in Patients in the Intensive Care Unit
Κύριακη, 10.01.2017, 03:00am
To the EditorWe read with interest the Original Investigation by Cowley and colleagues on antiviral therapy to prevent cytomegalovirus (CMV) reactivation in patients who are immunocompetent and in the intensive care unit (ICU). The strategy to suppress CMV replication has been studied in solid organ transplants, in which both prophylaxis and preemptive treatment is accepted as standard of care. In patients in the ICU, CMV reactivation occurs in 35% of patients who are seropositive and has been associated with worse outcomes: a longer stay in the ICU and/or hospital, longer need for organ support, higher risk for bacterial infections, and increased mortality. Cowley and colleagues mention a direct correlation between CMV viral load and mortality but this association has not been shown. There is a correlation between CMV viral load and a combined end point of mortality and continued hospitalization at day 30, but the correlation between viral load and mortality as such has not been evaluated.
Cytomegalovirus in Patients in the Intensive Care Unit
Κύριακη, 10.01.2017, 03:00am
To the EditorWe read with interest the Original Investigation by Cowley and colleagues in a recent issue ofJAMA Internal Medicineon a randomized clinical trial evaluating the efficacy and safety of antiviral therapy for prevention of cytomegalovirus (CMV) reactivation in patients in the intensive care unit (ICU).
Cytomegalovirus in Patients in the Intensive Care Unit—Reply
Κύριακη, 10.01.2017, 03:00am
In ReplyWe appreciate the interest shown in our Original Investigation. Drs Navarro and Aguilar are correct to note that the small numbers of patients in whom we could obtain repeat bronchiolar lavage specimens makes conclusions on viral suppression in the lung difficult. We agree that the effective suppression of viremia may not necessarily exclude end organ disease.
β-Blockers and Diltiazem Combination
Κύριακη, 10.01.2017, 03:00am
To the EditorI read with interest the Teachable Moment by Carroll and Hassanin published in a recent issue ofJAMA Internal Medicineand concerning the worrisome issue of polypharmacy in the elderly. I fully agree with Carroll and Hassanin about the opportunity of considering medication reconciliation and of containing the number of comedications in the elderly to a minimum. The strategies proposed by Carroll and Hassanin (ie, use of established prescribing tools such as Beers criteria and STOPP criteria and/or discontinuation of medications without a clear indication) are robust and may surely concur in reducing polypharmacy. Likewise, they may be helpful in effectively preventing avoidable drug-drug interactions leading to unintentional hospital admission.
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