In Reply We thank Guardiola and Baños for their comments on our article and for showing us the quote attributed to Joan Miró. It helps explain the process he used to create the triptych. But it still does not explain what the paintings mean, at least not to the artist. As we say in our essay, that’s part of the beauty of art: interpretation is subjective and cannot be imposed on others.
Tue Oct 01, 2019 03:00
This cross-sectional study uses Centers for Medicare & Medicaid Services data to evaluate the association between industry payments to physicians who prescribe gabapentinoids and gabapentinoid prescribing behavior.
Tue Oct 01, 2019 03:00
In Reply We thank Bliwise for his comments on our article and for highlighting the role of nocturia in disordered sleep. Routinely in hospital settings, diuretics such as furosemide may be unnecessarily dosed in the late evening (known as q 12 hours, or 9 am and 9 pm), contributing to nocturia, interrupted sleep, and increasing the risk of falls. Unnecessary continuous intravenous maintenance fluids that are not reassessed may also contribute and are important to address.
Tue Oct 01, 2019 03:00
Pancreatic cancer can be a devastating disease. Fewer than 9% of patients with ductal adenocarcinoma of the pancreas are living 5 years after diagnosis. It is estimated that in 2019, about 57 000 people will be diagnosed with pancreatic cancer in the United States and that it may soon overtake colon cancer to become the second-most common cause of cancer-related death. Based on recent progress in the treatment of colon cancer, the best hope for reducing the cancer-specific mortality of pancreatic...
Tue Oct 01, 2019 03:00
In Reply We would like to thank Gann for his important perspective on this topic and for his interest in our study. In his letter, Gann notes an important modeling article that takes the size of the prostate into account when determining the effect of use of a 5-α reductase inhibitor (5-ARI) on the development of low-grade and high-grade prostate cancers. There is extensive debate in the literature on whether 5-ARIs directly increase the risk of high-grade cancers through some biologic mechanism....
Tue Oct 01, 2019 03:00
This population-based cohort study evaluates the risk of cardiac arrhythmia and other cardiovascular events in patients 66 years or older receiving the β3-adrenoceptor agonist mirabegron.
Tue Oct 01, 2019 03:00
In Reply We appreciate the comments by Hill and colleagues concerning the way we categorized naloxone access laws (NALs) in our article. We acknowledge the oversimplification issue in our investigation of the effect of NALs on opioid overdose deaths. The fact is that all NALs are different in some manner, whether it is by statute or by implementation. It would be paralyzing to study every dimension of every state policy independently because it would be difficult to determine what common features...
Tue Oct 01, 2019 03:00
This cohort study evaluates the association of directly observed therapy with treatment adherencee in patients with apparent treatment-resistant hypertension.
Tue Oct 01, 2019 03:00
In Reply We would like to thank Medina and colleagues and Thompson Jr and colleagues for their interest and thoughtful comments on our article. We completely agree that the goal of observational studies is not to refute clinical trials, but rather to complement them through assessment of real-world practice. In the Prostate Cancer Prevention Trial, prostate-specific antigen (PSA) values for men being treated with finasteride (a 5-α reductase inhibitor [5-ARI]) were automatically adjusted for the...
Tue Oct 01, 2019 03:00
As the morbidity, mortality, and costs of diabetes grow nationwide, a new analysis by Kazemian and colleagues published in this issue of JAMA Internal Medicine shows that average-care goal achievement among adults with diabetes has remained stagnant over the past 12 to 15 years. Expanding on a previous report, this study used data from the 2005-2008, 2009-2012, and 2013-2016 cycles of the National Health and Nutrition Examinations Survey to describe the care continuum from diagnosis to combined achievement...
Tue Oct 01, 2019 03:00
To the Editor We read the article by Smyth et al with interest. The authors performed a large meta-analysis to determine whether participants in large, multicenter dialysis trials were similar to the general population undergoing dialysis in terms of age, comorbidities, and mortality rate. They concluded that participants in large, multicenter randomized clinical trials of patients with end-stage kidney disease undergoing dialysis are younger, have a different pattern of comorbidities, and have a...
Tue Oct 01, 2019 03:00
This qualitative study evaluates differences in design and implementation of rapid response teams at top-performing and non–top-performing sites for survival of in-hospital cardiac arrest.
Tue Oct 01, 2019 03:00
To the Editor In their extraordinarily important article, Soong and colleagues emphasize the significance of reducing sedative-hypnotic medication usage in noncritically ill inpatients. Falls and fractures represent major morbidities associated with the usage of such medications, and there can be little doubt that numerous nonpharmacologic approaches for poor sleep remain vastly underutilized in the inpatient setting. As the authors note, however, addressing the underlying cause(s) of such sleep...
Tue Oct 01, 2019 03:00
This cohort study uses MASS II trial data to assess the association of myocardial ischemia documented during exercise stress testing with major adverse cardiovascular events or changes in the ventricular function in patients with multivessel coronary artery disease.
Tue Oct 01, 2019 03:00
To the Editor We read with interest the recently published Perspective by Taran and Detsky that explored how diagnosing disease may be thought of in similar terms as interpreting modern art. The authors compared diagnosing with the experience of finding paintings’ meaning through the impressions that Catalan painter Joan Miró’s paintings Bleu I, Bleu II, and Bleu III transmit to the viewer. After different interpretations, they suggest the following question: What if the paintings were simply dots...
Tue Oct 01, 2019 03:00
This cross-sectional survey study assesses the self-reported prognostic expectations of patients undergoing dialysis and how these expectations relate to care planning, goals, and preferences.
Tue Oct 01, 2019 03:00
The Open Payments database at the Centers for Medicare & Medicaid Services continues to shine a bright light on the association between industry payments to physicians by drug and medical device companies and prescribing. In this issue of JAMA Internal Medicine, 2 Research Letters examine the association between these payments and physician prescribing in diverse fields—biologic medications for inflammatory bowel diseases and gabapentinoids for various conditions, including seizure disorders...
Tue Oct 01, 2019 03:00
To the Editor We read with great interest the recently published study by Abouk and colleagues that identified reduced opioid-related mortality in states granting pharmacists direct authority to dispense naloxone. We agree that empowering pharmacists to dispense naloxone can profoundly influence overdose risk and concur that the method of implementing such policies can greatly influence their effectiveness. However, categorizing naloxone access laws (NALs) as either providing pharmacists direct or...
Tue Oct 01, 2019 03:00
This survey study uses data from the Centers for Medicare and Medicaid Services, the American Hospital Association, and US News & World Report to compare services available in hospitals with and without 5-star patient experience summary ratings.
Tue Oct 01, 2019 03:00
To the Editor Interpretation of observational studies is challenging when results are different from randomized trials. The recently published report by Sarkar and colleagues illustrates this challenge. A retrospective cohort of patients diagnosed with prostate cancer between 2001 and 2005 was described, and it was found that the use of 5-α reductase inhibitors (5-ARIs) was associated with a delayed diagnosis and a 39% increase in prostate cancer mortality. Initially, this conclusion seems at variance...
Tue Oct 01, 2019 03:00
This population-based study examines the changes in care from 2005 to 2016 for patients with diabetes in the United States.
Tue Oct 01, 2019 03:00
This pilot randomized clinical trial explores the effect of individualized coaching on physician burnout, job satisfaction, and well-being.
Tue Oct 01, 2019 03:00
To the Editor I would like to offer 2 points to expand on the important analysis by Sarkar and colleagues. First, use of a single prostate-specific antigen (PSA) multiplier for all men using 5α-reductase inhibitors (5-ARIs) is probably not optimal. The goal is to estimate what each man’s PSA would have been in the absence of drug treatment. However, because 5-ARIs inhibit the common age-associated increase in gland volume and PSA, the PSA trajectory for a man being treated with a drug vs his counterfactual...
Tue Oct 01, 2019 03:00
This Teachable Moment describes the case of a man in his 40s with a history of opioid use disorder in remission taking buprenorphine/naloxone who presented with a fifth distal phalanx fracture and underwent surgery, but had postoperative difficulty securing a prescription for buprenorphine/naloxone.
Tue Oct 01, 2019 03:00
This randomized clinical trial investigates the efficacy and safety of acupuncture as adjunctive therapy to antianginal therapies in reducing frequency of angina attacks in patients with chronic stable angina.
Tue Oct 01, 2019 03:00
With regard to the Original Investigation “Representativeness of Randomized Clinical Trial Cohorts in End-stage Kidney Disease: A Meta-analysis,” by Smyth et al, published online July 8, 2019, Jiang et al raised concerns about the inclusion of some of the trial cohorts in the meta-analysis and the possibility that some of these cohorts might be duplicates. Of the 6 pairs of cohorts identified by Jiang et al, 4 are clearly distinct cohorts. However, 2 pairs represent duplicated cohorts, of which 1...
Tue Oct 01, 2019 03:00
Hematuria is prevalent in up to a third of the US population. Approximately 2% to 5% of patients with microscopic hematuria and 12% of patients with macroscopic or gross hematuria will be diagnosed with urinary tract cancer, most cases of which are superficial bladder tumors detected through cystoscopy. Screening asymptomatic persons for bladder cancer with urinalysis to detect microscopic hematuria is not recommended by the US Preventive Services Task Force because of insufficient evidence of the...
Tue Oct 01, 2019 03:00
The Original Investigation by Budathoki et al published online August 26, 2019, had an incomplete title. The correct full title is “Association of Animal and Plant Protein Intake With All-Cause and Cause-Specific Mortality in a Japanese Cohort.” This article was corrected online.
Tue Oct 01, 2019 03:00
This systematic review and meta-analysis of prospective observational studies quantitatively synthesizes available evidence on the association between plant-based dietary patterns and risk of type 2 diabetes.
Tue Oct 01, 2019 03:00
This case report describes a man in his 80s with a VVI pacemaker who presented with left pleuritic chest pain.
Tue Oct 01, 2019 03:00
This population-based cohort study evaluated how often intramuscular vitamin B12 was prescribed to Canadian elderly patients when not medically necessary.
Tue Oct 01, 2019 03:00
This cohort study evaluates the number of kidney transplants that would have taken place in the United States if the US acceptance rate of deceased donor kidneys was as high as that of France and uses computer simulation algorithms to measure the potential gains in allograft survival years if US programs adopted less restrictive kidney acceptance practices.
Tue Oct 01, 2019 03:00
This meta-analysis of 189 studies involving 80 104 participants examines whether participants in large, multicenter dialysis trials were similar to the general population undergoing dialysis in terms of age, comorbidities, and mortality rate.
Tue Oct 01, 2019 03:00
Organ transplantation is lifesaving. Unfortunately, the need for organs exceeds the supply. For example, many patients wait for more than 5 years for a kidney transplant and many (approximately 20% of wait-listed patients on dialysis) will die before having had the opportunity to receive a transplant.
Tue Oct 01, 2019 03:00
This economic evaluation examines whether pharmaceutical industry payments to gastroenterologists are associated with how often they prescribe the pharmaceuticals’ drugs for inflammatory bowel disease.
Tue Oct 01, 2019 03:00
The Research Letter titled, “Prevalence of Inappropriateness of Parenteral Vitamin B12 Administration in Ontario, Canada,” published online July 15, 2019, contained an error in the Methods section regarding the dates of data analysis. The dates of data analysis were written to be from July 26, 2019, to November 22, 2019. The dates should be from July 26, 2018, to November 22, 2018. The dates have been corrected.
Tue Oct 01, 2019 03:00
It has been repeatedly demonstrated that participants in randomized clinical trials (RCTs) do not look like the patients we treat in our clinical practices. The inclusion and exclusion criteria of most RCTs exclude older adults and those with more severe disease, as well as those with conditions such as renal disease, liver disease, and cancer. The article by Smyth et al in this issue of JAMA Internal Medicine raises 2 noteworthy considerations. First, the study starkly contrasts the population of...
Tue Oct 01, 2019 03:00
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