RSS Medical Articles

The Experience of Undocumented Immigrants With End-stage Renal Disease
Σάβατο, 04.01.2017, 03:00am
This qualitative study analyzes the illness experience of undocumented immigrants with end-stage renal disease who lack access to scheduled hemodialysis.
Early Performance in Medicaid Accountable Care Organizations
Σάβατο, 04.01.2017, 03:00am
This population-based study compares the effects of Medicaid transformation in Oregon and Colorado on health care expenditures, utilization, and quality for Medicaid participants.
April 2017 Issue Highlights
Σάβατο, 04.01.2017, 03:00am
Copy Fees and Limitation of Patients’ Access to Their Medical Records
Σάβατο, 04.01.2017, 03:00am
This Viewpoint addresses fees that patients must pay for copies of their personal medical records and how the availability of digital medical records can improve this situation.
Potential Benefits of Testosterone Therapy in Older Men
Σάβατο, 04.01.2017, 03:00am
Testosterone levels decline with advancing age in men, and a number of symptoms and adverse outcomes may be associated with low testosterone levels in older men. Yet, the advantages of testosterone replacement in these men have been unclear. In 2003, an Institute of Medicine panel reviewed the evidence that testosterone supplementation is beneficial and considered it unsubstantial. It recommended a series of clinical trials to critically evaluate the usefulness of supplementation for several clinical indications. The T-Trials, a series of 7 linked, rigorously designed and well-executed studies, were performed to address these recommendations. The findings from 3 of these studies (addressing effects in men with symptoms related to sexual function, vigor, and physical performance) were recently published. The results of 2 more studies (addressing effects on bone and anemia) are reported in this issue ofJAMA Internal Medicine. Together, the T-Trials represent the most definitive assessments of the potential short-term advantages of testosterone replacement in older men, but were not intended to address the equally critical issue of whether there are important long-term adverse effects. To that end, also in this issue ofJAMA Internal Medicineis an article by Cheetham et al that reports the association of testosterone supplementation with cardiovascular events in a large, retrospective cohort study.
Addressing Ethical Lapses in Research
Σάβατο, 04.01.2017, 03:00am
The study “Association of Testosterone Levels With Anemia in Older Men,” published in this week’sJAMA Internal Medicine, contains an ethical error. Hemoglobin levels were measured in all 788 participants at baseline, and every 3 months during the 1-year duration of the trial. Blood obtained at baseline was stored until the end of the trial, when tests for the cause of anemia were performed. Participants with hemoglobin levels less than 10.0 g/dL at baseline were excluded from the trial and “referred to their primary care providers for evaluation of anemia.” However, the 126 participants (16%) with mild anemia (hemoglobin levels between 10.0 and 12.7 g/dL) were not told of this condition.
Screening for Obstructive Sleep Apnea
Σάβατο, 04.01.2017, 03:00am
The US Preventive Services Task Force (USPSTF) recommendation on screening for obstructive sleep apnea (OSA) was recently released along with its supporting evidence report and systematic review. The USPSTF concludes that “the current evidence is insufficient to assess the balance of benefits and harms of screening for OSA in asymptomatic adults (I statement),” including those with previously unrecognized symptoms. The I statement indicates that the evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined. With this statement, the USPSTF recommends that if the service is offered, patients should understand the uncertainty about the balance of benefits and harms. While screening for OSA is an important area to have considered, this recommendation leaves front-line clinicians who are trying to provide evidence-informed primary care wondering what is the right thing to do. In this Editorial, we outline why primary care physicians should identify OSA and other sleep disorders in symptomatic patients, but we caution that with the current level of evidence, screening for OSA in asymptomatic patients is likely to lead to unnecessary diagnostic testing and higher health care costs without clear evidence of benefit.
Comparative Effectiveness of Vancomycin and Metronidazole for C difficile Infection
Σάβατο, 04.01.2017, 03:00am
This propensity-matched cohort study evaluates the risk of recurrence and all-cause 30-day mortality in patients receiving metronidazole or vancomycin for mild to moderate and severeClostridium difficileinfection.
Lack of Statistical Support and Corroboration of Subgroup Claims in RCTs
Σάβατο, 04.01.2017, 03:00am
This meta-epidemiological survey evaluates how often subgroup claims reported in the abstracts of randomized clinical trials are actually supported by statistical evidence and corroborated by subsequent trials and meta-analyses.
Resumption of Warfarin Treatment After Hemorrhagic Stroke or ICH
Σάβατο, 04.01.2017, 03:00am
This cohort study uses data from 3 Danish national registries to investigate the prognosis associated with resuming warfarin treatment in patients with atrial firbrillation who sustain a hemorrhagic stroke or traumatic intracranial hemorrhage.
  » Acupuncture for Migraine Prevention
  » Moving Forward With Accountable Care Organizations
  » Undocumented Immigrants and Access to Health Care
  » The Challenges of Generating Evidence to Support Precision Medicine
  » The Tightrope of Resuming Anticoagulation Therapy After a Bleed
  » Gender Disparities in Sponsorship
  » Biotin-Induced Biochemical Graves Disease
  » A Patient With Hypertrophic Cardiomyopathy Presenting in Cardiac Arrest
  » Abnormal Electrocardiogram in a Woman With Atrial Fibrillation
  » Electrocardiography Nondiagnostic ST Elevations With Chest Pain