RSS Medical Articles

Text Messaging and Medication Adherence
Δευτέρα, 08.01.2016, 03:00am
To the EditorWe read the Original Investigation by Thakkar et al and the Invited Commentary by Nieuwlaat et al in a recent issue ofJAMA Internal Medicinewith great enthusiasm. Focusing on the second largest unsolved gap in health care and showing promisingly positive effects of short message service (SMS)-based interventions in improving the odds of medication adherence are important aspects of this research.
Text Messaging and Medication Adherence
Δευτέρα, 08.01.2016, 03:00am
In ReplyIt is well known that nonadherence to therapies in chronic diseases is associated with increased morbidity, mortality, and health care costs. Poor adherence is known to result from an interplay of multiple factors related to patient, therapy, and health care system. Key factors affecting adherence include motivation, forgetfulness, adverse effects, cost of therapy, complexity of regimen, and patient beliefs about disease or therapy.
Toxic Alcohol Calculations and Misinterpretation of Laboratory Results
Δευτέρα, 08.01.2016, 03:00am
To the EditorWe read with interest the Teachable Moment in a recent issue ofJAMA Internal Medicineby Himmel and colleagues and commend them on sharing this experience of medical error and disclosure. Regarding the clinical aspects of toxic alcohol poisoning, a few points merit discussion.
Toxic Alcohol Calculations and Misinterpretation of Laboratory Results
Δευτέρα, 08.01.2016, 03:00am
To the EditorWe read with interest the article by Himmel and colleagues that discussed the institution of hemodialysis for an erroneous laboratory result and would like to add some additional points. We wish to empathize with the authors, because we reported 3 cases in which a 10-fold misinterpretation of salicylate concentrations produced similar cognitive errors. As in the case reported by Himmel and colleagues, there was an intellectual disconnect between the clinical findings of poisoning and the laboratory result that would have been easily solved by a seasoned clinician.
Toxic Alcohol Calculations and Misinterpretation of Laboratory Results
Δευτέρα, 08.01.2016, 03:00am
To the EditorWe read with interest the Teachable Moment by Himmel et al in a recent issue ofJAMA Internal Medicinedescribing the case of a female patient inappropriately treated with hemodialysis for an erroneous value of serum methanol. Although we would agree that ordering appropriate investigations and considering an unexpected laboratory value in the context of the patient’s clinical signs and symptoms are essential to prevent inappropriate patient management and safeguard patient safety, we also wish to express mindful considerations about this case.
Toxic Alcohol Calculations and Misinterpretation Of Laboratory Results
Δευτέρα, 08.01.2016, 03:00am
In ReplyWe appreciate the interest and comments provided by Su and Hoffman, Lippi and Plebani, and Wu and Sivilotti in regards to our Teachable Moment “Hemodialysis in a Healthy Patient—A Case of an Erroneous Laboratory Result.”
Syncope While Driving in Denmark
Δευτέρα, 08.01.2016, 03:00am
To the EditorThe recent study by Numé et al in a recent issue ofJAMA Internal Medicinereports an association between prior hospitalization for syncope and increased risk of motor vehicle crashes, with subsequent recommendations for including syncope in the assessment of fitness to drive. This study differs significantly from previous studies in that the patients in this Danish nationwide cohort study were older (median age, 66 years), with a higher incidence of cardiovascular disease (34.8%). Thus, while the cause of syncope was not reported, this group possibly had syncope owing to another cause besides vasovagal syncope (VVS). In a study of highly symptomatic patients with VVS (mean [SD] age 38 [17] years), there was a low incidence of VVS while driving (2 of 174 cases), with a low estimated risk of serious harm or death (
Syncope While Driving in Denmark
Δευτέρα, 08.01.2016, 03:00am
In ReplyWe thank Chen-Scarabelli and Scarabelli for their interest in our study. We acknowledge that our study lacks data on the causes of syncope and cannot estimate risk attributable to specific causes of syncope. Our study was based on hospital International Classification of Diseases diagnosis codes, which do not specify the etiology of syncope. Many cases of syncope remain of unknown origin, however, and clinicians will still need to evaluate patient fitness to drive after an episode of syncope. Our study of a nationwide cohort of 41 039 adult patients with a primary discharge diagnosis of syncope is representative of the most common clinical presentations of syncope.
End-of-Life Experiences and Left Ventricular Assist Devices
Δευτέρα, 08.01.2016, 03:00am
To the EditorIn an article published in a recent issue ofJAMA Internal Medicine, McIlvennan et al found that the bereaved caregivers of patients with left ventricular assist devices (LVADs) reported feelings of confusion and abandonment. How to support patients with LVADs and their caregivers in end-of-life issues in an era of increasing destination therapy (DT) is a crucial issue.
End-of-Life Experiences and Left Ventricular Assist Devices
Δευτέρα, 08.01.2016, 03:00am
In ReplyWe appreciate the thoughtful response to our work from Drs Nakada and Arakawa. We agree that the informed consent process should be robust and ongoing when discussing left ventricular assist device (LVAD) therapy with patients and their caregivers. We also wholeheartedly agree that discussions around dying with an LVAD—especially when patients are being implanted under the destination therapy (DT) indication—should be discussed prior to implant or as medical realities allow. However, going beyond stating this should occur, we believe the real challenge is how to have these conversations with patients and caregivers. This is true not just for LVADs but for all complicated technological therapies that alter the dying process.
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