JAMA internal medicine
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JAMA internal medicine · Jun 2019
Randomized Controlled TrialEffect of the Serious Illness Care Program in Outpatient Oncology: A Cluster Randomized Clinical Trial.
High-quality conversations between clinicians and seriously ill patients about values and goals are associated with improved outcomes but occur infrequently. ⋯ The results of this cluster randomized clinical trial were null with respect to the coprimary outcomes of goal-concordant care and peacefulness at the end of life. Methodologic challenges for the primary outcomes, including measure selection and sample size, limit the conclusions that can be drawn from the study. However, the significant reductions in anxiety and depression in the intervention group are clinically meaningful and require further study.
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JAMA internal medicine · Feb 2019
Randomized Controlled TrialEfficacy of Mobile Phone-Delivered Smoking Cessation Interventions for Socioeconomically Disadvantaged Individuals: A Randomized Clinical Trial.
Limited evidence supports mobile phone-delivered cessation interventions for socioeconomically disadvantaged individuals. ⋯ Findings indicate that assignment to an intervention consisting of text messaging alone may not increase cessation rates for socioeconomically disadvantaged smokers. However, text messaging plus proactive counseling may be an efficacious option.
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JAMA internal medicine · Jan 2019
Randomized Controlled TrialEffect of Exercise Intervention on Functional Decline in Very Elderly Patients During Acute Hospitalization: A Randomized Clinical Trial.
Functional decline is prevalent among acutely hospitalized older patients. Exercise and early rehabilitation protocols applied during acute hospitalization can prevent functional and cognitive decline in older patients. ⋯ The exercise intervention proved to be safe and effective to reverse the functional decline associated with acute hospitalization in very elderly patients.
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JAMA internal medicine · Dec 2018
Randomized Controlled TrialEngaging Diverse English- and Spanish-Speaking Older Adults in Advance Care Planning: The PREPARE Randomized Clinical Trial.
Advance care planning improves the receipt of medical care aligned with patients' values; however, it remains suboptimal among diverse patient populations. To mitigate literacy, cultural, and language barriers to advance care planning, easy-to-read advance directives and a patient-directed, online advance care planning program called PREPARE For Your Care (PREPARE) were created in English and Spanish. ⋯ The patient-facing PREPARE program and an easy-to-read advance directive, without clinician-level or system-level interventions, increased documentation of advance care planning and patient-reported engagement, with statistically higher gains for PREPARE vs advance directive alone. These tools may mitigate literacy and language barriers to advance care planning, allow patients to begin planning on their own, and could substantially improve the process for diverse English-speaking and Spanish-speaking populations.
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JAMA internal medicine · Nov 2018
Randomized Controlled TrialEfficacy of Low-Dose Amitriptyline for Chronic Low Back Pain: A Randomized Clinical Trial.
Antidepressants at low dose are commonly prescribed for the management of chronic low back pain and their use is recommended in international clinical guidelines. However, there is no evidence for their efficacy. ⋯ This trial suggests that amitriptyline may be an effective treatment for chronic low back pain. There were no significant improvements in outcomes at 6 months, but there was a reduction in disability at 3 months, an improvement in pain intensity that was nonsignificant at 6 months, and minimal adverse events reported with a low-dose, modest sample size and active comparator. Although large-scale clinical trials that include dose escalation are needed, it may be worth considering low-dose amitriptyline if the only alternative is an opioid.