JAMA internal medicine
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JAMA internal medicine · Mar 2014
Randomized Controlled TrialNudging guideline-concordant antibiotic prescribing: a randomized clinical trial.
"Nudges" that influence decision making through subtle cognitive mechanisms have been shown to be highly effective in a wide range of applications, but there have been few experiments to improve clinical practice. ⋯ Displaying poster-sized commitment letters in examination rooms decreased inappropriate antibiotic prescribing for ARIs. The effect of this simple, low-cost intervention is comparable in magnitude to costlier, more intensive quality-improvement efforts.
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JAMA internal medicine · Feb 2014
Randomized Controlled Trial Multicenter StudyMultifaceted intervention to improve medication adherence and secondary prevention measures after acute coronary syndrome hospital discharge: a randomized clinical trial.
Adherence to cardioprotective medication regimens in the year after hospitalization for acute coronary syndrome (ACS) is poor. ⋯ A multifaceted intervention comprising pharmacist-led medication reconciliation and tailoring, patient education, collaborative care between pharmacist and patients' primary care clinician and/or cardiologist, and voice messaging increased adherence to medication regimens in the year after ACS hospital discharge without improving BP and LDL-C levels. Understanding the impact of such improvement in adherence on clinical outcomes is needed prior to broader dissemination of the program.
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JAMA internal medicine · Feb 2014
Randomized Controlled Trial Multicenter Study Comparative StudyOverdiagnosis in low-dose computed tomography screening for lung cancer.
Screening for lung cancer has the potential to reduce mortality, but in addition to detecting aggressive tumors, screening will also detect indolent tumors that otherwise may not cause clinical symptoms. These overdiagnosis cases represent an important potential harm of screening because they incur additional cost, anxiety, and morbidity associated with cancer treatment. ⋯ More than 18% of all lung cancers detected by LDCT in the NLST seem to be indolent, and overdiagnosis should be considered when describing the risks of LDCT screening for lung cancer.
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JAMA internal medicine · Jan 2014
Randomized Controlled TrialGabapentin treatment for alcohol dependence: a randomized clinical trial.
Approved medications for alcohol dependence are prescribed for less than 9% of US alcoholics. ⋯ Gabapentin (particularly the 1800-mg dosage) was effective in treating alcohol dependence and relapse-related symptoms of insomnia, dysphoria, and craving, with a favorable safety profile. Increased implementation of pharmacological treatment of alcohol dependence in primary care may be a major benefit of gabapentin as a treatment option for alcohol dependence.
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JAMA internal medicine · Jan 2014
Randomized Controlled TrialA 2-hour diagnostic protocol for possible cardiac chest pain in the emergency department: a randomized clinical trial.
Patients with chest pain represent a high health care burden, but it may be possible to identify a patient group with a low short-term risk of adverse cardiac events who are suitable for early discharge. ⋯ Using the accelerated diagnostic protocol in the experimental pathway almost doubled the proportion of patients with chest pain discharged early. Clinicians could discharge approximately 1 of 5 patients with chest pain to outpatient follow-up monitoring in less than 6 hours. This diagnostic strategy could be easily replicated in other centers because no extra resources are required.