1209jamainternalmedicine.com JAMA Internal Medicine August 2014 Volume 174, Number 8

JAMA Internal MedicineIn This Issue August 2014

Volume 174, Number 8 Pages 1209 - 1424

Research

Patient Preferences and Glycemic Control Outcomes 1227Because guidelines often fail to consider treatment burden, many patients with type 2 dia-betes mellitus may be overtreated. Vijan and coauthors used a Markov simulation model to estimate the effects of hemoglobin A1c level reduction on diabetes outcomes and over-all quality-adjusted life years. They found that for many patients, the burdens and adverse effects of treatment outweigh the benefits from reduction of diabetes complications. Patients and clinicians should consider this information when deciding on treatments to lower hemoglobin A1c, and health care organizations should reconsider how they define quality of care for diabetes, since current guidelines and quality measures may provide incentives to deliver care that causes more harm than benefit.

HEALTH CARE REFORMOutreach to Improve Colorectal Cancer Screening 1235Expanded use of fecal occult blood testing (FOBT) has been proposed as a strategy to re-duce disparities in colorectal cancer screening; however, it is unclear whether it is possible to achieve the high level of adherence to annual FOBT necessary to reduce colorectal cancer mortality. In a randomized comparative effectiveness study, Baker and coauthors assessed whether a multifaceted intervention could achieve higher adherence to annual FOBT com-pared with usual care in a network of community health centers. The intervention achieved high levels of adherence (82.2% completion within 6 months of the due date), which was much higher than that for usual care (37.3%). Green and Coronado consider the challenges of FOBT screening in underserved populations in an Invited Commentary.

Invited Commentary 1242

Anticoagulation Resumption Following Traumatic Brain Injury 1244The increased risk of hemorrhage associated with anticoagulant therapy following trau-matic brain injury (TBI) creates a dilemma for medical management of older patients with TBI: should anticoagulant therapy be resumed after injury, and if so, when? Albrecht and coauthors conducted a retrospective longitudinal analysis of 10 782 anticoagulated Medi-care beneficiaries hospitalized with TBI during 2006 through 2009 to estimate the risk of thrombotic and hemorrhagic events associated with resumption of warfarin therapy following hospital discharge. During the year following hospital discharge for TBI, warfarin resumption was associated with increased risk of hemorrhagic events and decreased risk of thrombotic events, regardless of timing of resumption. Resumption of warfarin therapy was associated with decreased risk of hemorrhagic and ischemic stroke.

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Statins and Physical Activity in Older Men 1263Muscle pain, fatigue, and weakness are common adverse effects of statin medications and may decrease physical activity in older men. In a prospective cohort study of community-dwelling men 65 years and older from the Osteoporotic Fractures in Men Study, Lee and coauthors studied the cross-sectional and longitudinal association between statin use and physical activity. Physical activity was measured by a validated self-administered ques-tionnaire at baseline, 4.6 years, and 6.9 years (n = 3039). At the last follow-up visit, physi-cal activity was also measured by an accelerometer worn by the participants (n = 3079). They found that statin use was associated with modestly less physical activity, even after accounting for medical history and other potentially confounding factors. In an Invited Commentary, Golomb sets the findings in clinical context.

Invited Commentary 1270

Opinion

Perspective1219 Antibiotic Overuse and Clostridium difficileT Sullivan

1221 Balancing the Benefits and Risks of Empirical Antibiotics for SinusitisA MacKenzie

1223 Evidence-Based Evaluation for Allergies to Avoid Inappropriate Testing, Diagnosis, and TreatmentDP Huston and LS Cox

1225 Waiting for WordsJH Davidson

Invited Commentary1242 "BeneFITs" to Increase Colorectal Cancer Screening in Priority PopulationsBB Green and GD Coronado

1261 Let's Prioritize the Right Care for the Right Patients With HypertensionPA James

1270 Statins and ActivityBA Golomb

1281 Hip Fracture: A Trigger for Palliative Care in Vulnerable Older AdultsFC Ko and RS Morrison

1290 Restricting Interactions With Industry to Promote Evidence-Based Prescribing JS Ross

1299 Engaging Patients and Clinicians in Treating Tobacco AddictionJJ Prochaska

1318 Physicians and PoliticsA Relman

1328 Preoperative β-Blockade in CABG SurgeryDM Shahian

1338 Warfarin, Genes, and the (Health Care) EnvironmentDS Kazi and MA Hlatky

1348 The Case for Sex- and Gender-Specific MedicineCN Bairey Merz and V Regitz-Zagrosek

1358 Not All (Medical) Homes Are Built AlikeRJ Baron

1367 The Whole Truth About Coronary StentsA Malhotra

1377 Improving Care for Hospitalized, Opioid-Dependent PatientsM Kushel

Editor's Note1396 On Board With the Choosing Wisely CampaignD Grady

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1211jamainternalmedicine.com JAMA Internal Medicine August 2014 Volume 174, Number 8

JAMA Internal MedicineIn This Issue August 2014

Volume 174, Number 8 Pages 1209 - 1424

Research (continued)

Hip Fracture Outcomes Among Nursing Home Residents 1273Outcomes after hip fracture among long-term nursing home residents are not well studied. In a retrospective cohort study of 60 111 US long-term nursing home residents between 2005 and 2009, Neuman and coauthors found increased mortality and decreased indepen-dence after hospitalization for hip fracture. In adjusted analyses, marked increases in the risk of adverse outcomes after hip fracture were seen among nursing home residents who received nonoperative hip fracture care, patients older than 90 years, patients with multiple comorbidities, and patients with severe cognitive impairment. In an Invited Commentary, Ko and Morrison examine the implications of the findings for the practice of palliative care.

Invited Commentary 1281

Drug-Marketing Effect on Trainees’ Prescribing 1283Little is known about how pharmaceutical sales representatives affect trainees’ knowl-edge about pharmaceutical prescribing. To determine whether there is an association be-tween medical trainees’ interactions with pharmaceutical promotion and their medication use preferences, Austad and coauthors conducted a national survey of medical students and residents from all US-based allopathic medical schools. The authors developed an “in-dustry relations index” that graded trainees’ perceptions of the value of pharmaceutical promotion and frequency of accepting gifts and free meals from industry marketing rep-resentatives. In common clinical scenarios involving drug prescribing, respondents with higher industry relations scores were less likely to make evidence-based prescribing rec-ommendations and more likely to pick brand-name drugs over equally effective generic alternatives. Ross provides pedagogical context in an Editor’s Note.

Editor’s Note 1290

5α-Reductase Inhibitors and Prostate Cancer Risk 1301An increased risk of high-grade disease among users of 5α-reductase inhibitors (5ARIs) has been detected, leading to a Food and Drug Administration warning about using 5ARIs for chemoprevention of prostate cancer. To investigate whether 5ARI use was associated with high-grade or lethal prostate cancer, Preston and coauthors conducted a prospective cohort study of 38 058 men in the Health Professional’s Follow-up Study, assessing their exposure to 5ARIs every 2 years. They found that 5ARI use was not associated with risk of high-grade or lethal prostate cancer, while it was associated with a significant reduction in risk of low-grade, Gleason sum 7, and overall prostate cancer. However, the study can-not exclude the possibility of an increased risk of high-grade or lethal disease because the number of exposed cases was low and confidence intervals were wide.

Political Polarization of Physicians in the United States 1308Bonica and coauthors conducted multiple regression analyses of campaign contributions from 1991 through 2012 to explore the partisan differences in contributions by women compared with men, by those practicing in for-profit compared with nonprofit health care organizations, and by medical specialization. They found that physicians’ political prefer-ences are increasingly polarized by sex, specialty, and nonprofit vs for-profit employment. Physician contributors have shifted from majority Republican to majority Democratic, less because of changes in individual physicians than new physician contributors, especially women and practitioners not in solo or small group practices. The gaps, sharply increas-ing over time, are large compared with similar distinctions among general voters. Relman contributes an Invited Commentary.

Invited Commentary 1318 Author Audio Interview jamainternalmedicine.com

Departments1212 Staff Listing1244, 1369 CME Articles1421 Classified Advertising1421 Journal Advertiser Index1423 Contact Information1424 CME Questions

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LETTERSResearch Letter 1397 Prevalence and Characteristics of Systolic Blood Pressure Thresholds in Individuals 60 Years or OlderD Shimbo and Coauthors

1400 Chronic Pain and Opioid Use in US Soldiers After Combat DeploymentRL Toblin and Coauthors

1403 Effects of Ranolazine on Quality of Life Among Patients With Diabetes Mellitus and Stable AnginaSV Arnold and Coauthors

1405 Decreased Red Blood Cell Use and Mortality in Hospitalized PatientsNH Roubinian and Coauthors for the NHLBI Recipient Epidemiology and Donor Evaluation Study (REDS-III)

1407 The Portrait of an Adult Liver Transplant Recipient in the United States From 1987 to 2013M Stepanova

1409 Variation in Inpatient Costs of Hematopoietic Cell Transplantation Among Transplant Centers in the United StatesV Thao and Coauthors

Comment & Response 1412 What Is a "Nonprofit" Hospital?

1413 Improving Evidence-Based Practices Through Health Literacy

1414 Drug Treatment of Obesity

1416 Real-World Evidence About Potential Psychosocial Harms of Lung Cancer Screening

1417 In Defense of Screening for Breast Cancer With MRI

1418 Patient Satisfaction as a Quality Metric Promotes Bad Medicine

Invited Commentary1402 Pain and Opioids in the MilitaryWB Jonas and EB Schoomaker

1419 Correction

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