DOCSLIB.ORG

Documentation and Diagnosis of Overweight and Obesity In

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Documentation and Diagnosis of Overweight and Obesity In Letters intervention, residents were aware that albuterol neb treat- Analysis and interpretation of data: Moriates, Novelero, Khanna, Mourad. ments were more expensive than albuterol MDIs (82%, pre- Drafting of the manuscript: Moriates, Novelero. Critical revision of the manuscript for important intellectual content: Quinn, test; 94%, postintervention [P = .11]). Prior to the interven- Khanna, Mourad. tion 13 of the residents (26%) answered incorrectly that neb Statistical analysis: Khanna. treatments were more efficacious than MDIs, in contrast to only Obtained funding: Novelero. 1 resident (3%) following exposure to our intervention (P < .01). Administrative, technical, and material support: Novelero, Quinn, Mourad. Study supervision: Khanna, Mourad. At baseline, none of the residents agreed that “patients re- Published Online: July 22, 2013. ceive adequate inpatient MDI teaching”; however, this rate im- doi:10.1001/jamainternmed.2013.9002. proved to 16% after the first 2 months of implementation Conflict of Interest Disclosures: None reported. (P < .01). Additional Contributions: Theodore Omachi, MD, MBA (Department of Medicine, University of California, San Francisco), and Sumant Ranji, MD Discussion | Our multifaceted intervention was associated (Department of Medicine, University of California, San Francisco), contributed with a simultaneous decrease in unnecessary neb treat- to the design and implementation of this project. They did not receive compensation. ments, an increase in evidence-based resident physician 1. Turner MO, Patel A, Ginsburg S, FitzGerald JM. Bronchodilator delivery in knowledge, and potentially an improvement in MDI patient acute airflow obstruction: a meta-analysis. Arch Intern Med. 1997;157(15):1736- education. This concurrent improvement in quality of care 1744. with a decrease in cost maximizes the “value equation” 2. Dolovich MB, Ahrens RC, Hess DR, et al; American College (defined as quality divided by costs). The approximately of Chest Physicians; American College of Asthma, Allergy, and 50% decrease in nebs following our intervention highlights Immunology. Device selection and outcomes of aerosol therapy: evidence-based guidelines: American College of Chest the degree of wasteful usage of this resource-intensive Physicians/American College of Asthma, Allergy, and Immunology. Chest. therapy previously on our pilot medical ward. Reducing 2005;127(1):335-371. inappropriate nebs represents a straightforward way for 3. Mandelberg A, Chen E, Noviski N, Priel IE. Nebulized wet aerosol treatment institutions to reduce health care costs through a simple in emergency department: is it essential? comparison with large spacer device intervention. for metered-dose inhaler. Chest. 1997;112(6):1501-1505. Our study has some limitations. Owing to the nature of 4. Press VG, Arora VM, Shah LM, et al. Misuse of respiratory inhalers in hospitalized patients with asthma or COPD. J Gen Intern Med. our intervention and the significant crossover of our physi- 2011;26(6):635-642. cians, RTs, and nurses, it was not possible to create a control group at our medical center during this pilot study. Also, our financial model may overestimate our cost savings since RT Documentation and Diagnosis of Overweight time is a semifixed cost and our intervention has not yet led and Obesity in Electronic Health Records to a decrease in actual RT full-time equivalents. However, of Adult Primary Care Patients RT daily staffing is based on volume at our large hospital; Almost 69% of US adults are either overweight or obese thus, if the project is successfully scaled medical center– (body mass index [BMI], calculated as weight in kilograms wide, then it would likely result in a decrease in daily divided by height in meters squared, ≥25),1 yet clinicians RT staffing. Currently, this saved time is being repurposed often fail to diagnose overweight and obesity or discuss for our RTs to perform other important job duties at our weight management with their patients.2-6 Many clinicians hospital, such as MDI training and smoking cessation use electronic health records (EHRs), and adoption of EHRs counseling. has been increasing since the introduction of the Health In conclusion, our pilot study illustrates that a multifac- Information Technology for Economic and Clinical Health eted effort may be successful in dramatically decreasing the (HITECH) Act in 2009.7 Electronic recording of vital signs— overuse of neb therapies on an inpatient medicine service. Re- including height, weight, and BMI—is now one of the ducing utilization of these resource intensive and unneces- requirements for achieving “meaningful use” of EHRs,8 but sary treatments may provide an ideal target for improving few studies have examined rates of BMI documentation and health care value. diagnosis of overweight and obesity in EHR data. We con- ducted a retrospective study to examine these rates in the Christopher Moriates, MD EHRs of adult primary care patients before the passing of Maria Novelero, MA, MPA the HITECH Act in 2009. Kathryn Quinn, MPH Raman Khanna, MD Methods | We evaluated patients at 25 primary care practices Michelle Mourad, MD within a large academic care network in Boston, Massachu- setts. We included adult patients (≥18 years) who had at Author Affiliations: Department of Medicine, University of California, San least 2 visits with the same clinician between 2004 and Francisco, San Francisco (Moriates, Novelero, Quinn, Khanna, Mourad). 2008 and were not pregnant at the time of the visit. The Corresponding Author: Christopher Moriates, MD, Department of Medicine, study was approved by the Partners Human Research University of California, San Francisco, 505 Parnassus Ave, M1287, San Committee. Francisco, CA 94143-0131 ([email protected]). Data were extracted from coded fields in the EHR. The Author Contributions: Study concept and design: Moriates, Novelero, Quinn, Mourad. primary outcome was documentation of at least 1 BMI in the Acquisition of data: Moriates, Novelero. appropriate coded EHR field at any time during the study 1648 JAMA Internal Medicine September 23, 2013 Volume 173, Number 17 jamainternalmedicine.com Downloaded From: https://jamanetwork.com/ on 09/29/2021 Letters Table 1. Documentation of Body Mass Index (BMI) in the Electronic Health Records of 219 356 Adult Primary Care Patients No. in ≥1 BMI, Adjusted OR Characteristic Group No. (%) (95% CI) P Value Overall 144 522 (65.9) Patient Characteristics Age at first visit, y 18-29 42 170 27 934 (66.2) 1 [Reference] 30-39 46 382 29 851 (64.4) 0.93 (0.90-0.97) 40-49 45 156 30 427 (67.4) 1.04 (1.00-1.08) <.001 50-59 38 822 26 438 (68.1) 1.00 (0.96-1.04) 60-69 24 877 16 729 (67.3) 0.94 (0.89-0.99) ≥70 21 949 13 143 (59.9) 0.60 (0.56-0.63) Sex Male 81 742 48 233 (59.0) 1 [Reference] <.001 Female 137 614 96 289 (70.0) 1.45 (1.41-1.48) Race/ethnicity White 145 391 96 081 (66.1) 1 [Reference] Black 17 814 11 851 (66.5) 1.01 (0.97-1.05) Hispanic/Latino 29 432 19 935 (67.7) 1.05 (1.00-1.09) <.001 Asian 8885 6033 (67.9) 0.97 (0.92-1.03) Other or missing 17 834 10 622 (59.6) 0.84 (0.81-0.88) Primary insurance Private 167 479 111 906 (66.8) 1 [Reference] Medicare 36 734 23 759 (64.7) 0.94 (0.90-0.98) <.001 Medicaid 5764 3979 (69.0) 0.93 (0.87-1.00) No insurance or self-pay 9379 4878 (52.0) 0.64 (0.61-0.68) Visits, No. 2-5 75 868 41 572 (54.8) 1 [Reference] 6-9 52 940 35 002 (66.1) 1.87 (1.81-1.92) <.001 10-14 38 295 27 491 (71.8) 2.78 (2.68-2.87) ≥15 52 253 40 457 (77.4) 4.66 (4.50-4.83) Obesity-related comorbidities, No. 0 109 051 65 300 (59.9) 1 [Reference] 1 52 549 36 603 (69.7) 1.34 (1.30-1.38) <.001 2 30 213 21 844 (72.3) 1.48 (1.42-1.53) ≥3 27 543 20 775 (75.4) 1.73 (1.66-1.80) Clinician Characteristicsa Age, y <30 20 336 14 042 (69.1) 1 [Reference] 30-39 76 896 52 394 (68.1) 1.04 (0.88-1.24) 40-49 59 452 39 948 (67.2) 1.14 (0.91-1.41) .23 50-59 49 581 30 319 (61.2) 1.10 (0.88-1.37) ≥60 12 462 7475 (60.0) 0.77 (0.52-1.15) Sex Male 100 487 60 247 (60.0) 1 [Reference] .01 Female 118 869 84 275 (70.9) 1.20 (1.04-1.38) Abbreviations: NP, nurse practitioner; Type OR, odds ratio; PA, physician Staff physician 188 273 124 744 (66.3) 1 [Reference] assistant. a NP or PA 20 307 13 058 (64.3) 0.88 (0.84-0.92) <.001 Counts refer to the number of patients who had visits with clinicians Resident or fellow 10 776 6720 (62.4) 1.02 (0.95-1.08) with these characteristics. period. Body mass index is calculated if patients have both patients with at least 1 BMI of at least 25 (overweight) or at height and weight; once a height has been entered, it is car- least 30 (obese), we also examined whether they had a diag- ried forward and used in subsequent calculations. Among nosis of “overweight,” “obesity,” “weight gain,” or “weight jamainternalmedicine.com JAMA Internal Medicine September 23, 2013 Volume 173, Number 17 1649 Downloaded From: https://jamanetwork.com/ on 09/29/2021 Letters Table 2. Diagnosis of Overweight and Obesity Among 98 762 Adult Primary Care Patients With BMI of at Least 25 Diagnosis of Overweight/Obesity No. in on Problem List, Adjusted OR Characteristic Group No.
Load more

Recommended publications
  • Empowering General Internists to Lead Digital Innovation
    Health IT Empowering General Internists to Lead Digital Innovation PRELIMINARY PROGRAM This meeting is jointly sponsored by the University of Alabama School of Medicine (UASOM) Division of Continuing Medical Education and the Society of General Internal Medicine. The UASOM designates this live activity for a maximum of 16.5 AMA PRA Category 1 Credits™ and a maximum of 16.5 MOC points. connect.sgim.org/SGIM18 Schedule DAY TIME SESSION 8:00 am – 5:00 pm Leon Hess Management Training and Leadership Institute 8:00 am – 5:30 pm Invigorate Your Practice: Performance Improvement for Practice Redesign Course n TEACH Core Session 10:45 am – 4:00 pm TOUR 1: Deadly Medicine: Creating the Master Race 9:00 am –12:00 pm LEAHP 101 12:00 – 1:00 pm LEAHP 101 & 201 Luncheon 12:00 – 5:00 pm Informatics Pre-Course n LEAHP Session 12:00 – 3:00 pm Regional Leadership Retreat 1:00 – 4:00 pm LEAHP 201 1:00 – 4:30 pm TEACH 201 WEDNESDAY, APRIL 11 WEDNESDAY, 3:00 – 5:00 pm JGIM Deputy Editors Retreat 5:00 – 5:30 pm LEAD Orientation n ACLGIM Business Meeting n TEACH Reception Session A 5:30 – 7:00 pm Scientific Abstract Poster Session 1 7:00 – 9:00 pm ACLGIM Annual Dinner Breakfast 7:00 – 8:00 am Breakfast n Interest Groups n Committee Meetings 8:00 – 8:15 am 15-minute Break Session B 8:15 – 10:15 am Thursday Plenary Session | Malcolm L. Peterson Honor Lecture n Oral Presentations 10:15 – 10:30 am 15-minute Break Clinical Vignette Poster Session C 10:30 – 11:30 am Workshops n Special Symposium n Clinical Update n Oral Presentations Session 1 (10:15 – 11:45 am)
    [Show full text]
  • Aacp Core List of Journals for Pharmacy Education
    AACP CORE LIST OF JOURNALS FOR PHARMACY EDUCATION 7th Edition, 2019 Prepared by: Robert D. Becketta, PharmD; Skye Bicketb, DHSc, MLIS; Kayce Gillc, MIS; Neyda Gilmand, MILS; Jason Guye, PharmD; Pam Hargwoodf, MLIS; Jennifer Hartmang, PharmD; Rebecca Hooverh; Tim Hutchersoni, PharmD; Jennifer Martinj, MIRLS; John Redwanskik, PharmD; Christina M. Seegerg, CPhT, MLS, AHIP Introduction The 7th edition of the AACP Core List of Journals for Pharmacy Education (Core Journals List) is a companion list to AACP Basic Resources for Pharmacy Education, and is an updated version of the 2016 Core Journals List. The update was conducted by an interdisciplinary task force of drug information specialists and pharmacy librarians. The goals for this update were to refine the previous list using similar, systematic collection methods. Similar to the previous update, the goal was to produce a final list containing 200 to 300 journals. The Core Journals List is a service project of the Library and Information Sciences Section of AACP. It is intended to provide information that assists with collection development as applied to the curriculum of the particular school or college of pharmacy for which it is being used. The Core Journals List is produced as a guide for those developing or maintaining the library collections that serve colleges and schools of pharmacy. While the recommended journals are suitable for all pharmacy college libraries, not all pharmacy college libraries should feel obligated to purchase every title on the list. Each pharmacy program has its own mission and program(s), so each college’s library’s collection must reflect that mission and support the college’s curricula.
    [Show full text]
  • Annual Report of the School of Medicine
    2019 Annual Report UNIVERSITY OF PITTSBURGH SCHOOL OF MEDICINE REFLECTION University of Pittsburgh School of Medicine 2019 ANNUAL REPORT REFLECTION 2 A Job Well Done 6 News & Achievements 14 Education & Training 26 Research Grants of Note, 27 Publications of Note, 30 42 Community 47 Donors 62 Administration, Departments, Institutes, & Leadership COVER: Alessandro Gottardo A shooting star is said to reap good fortune — and, in reflecting upon the past two decades, Arthur S. Levine, MD, was in many ways a shooting star for the University of Pittsburgh. n past years, annual report readers have been greeted on page one with a thoughtful column by Arthur S. Levine, MD, senior vice chancellor for the health sciences and John and Gertrude Petersen Dean of the School of Medicine. However, this year is not a typical year because Dr. Levine will step down from his leadership positions, once his successor arrives in June 2020 (see below). So, in lieu of his column, the annual report leads off with the story of Dr. Levine’s tenure, Iencapsulating quite a journey for him and for the University of Pittsburgh In addition, the report is packed with news emanating from the School of Medicine and the achievements of its students and faculty. All is worthy of reflection. Anticipation n January 7, 2020, Anantha Shekhar, MD, PhD, a nationally recognized educator, researcher, and entrepreneur with major contributions in medicine and life sciences, was named senior vice chancellor for the health sciences and John and Gertrude Petersen Dean of the School of Medicine. His start date is June 2020.
    [Show full text]
  • Healthcare Specialty Journal Collections
    Journals@Ovid Healthcare Specialty Journal Collections 8 collections of peer-reviewed titles focused on Cardiology, Dermatology, Neurology, Oncology, Ophthalmology, Pediatrics, Psychiatry, and Surgery Choose from 8 collections, each focused on a specific medical or healthcare specialty You need a simple, cost-effective way to expand your electronic journal holdings. Choosing the right set of titles is tough. Ovid®’s 8 subject-focused Quickly and easily build your collections have been pre-selected for you! Each collection includes highly institution’s ejournals portfolio regarded, peer-reviewed journals in a particular discipline and published by the with premium titles from the world’s leading scientific world’s leading healthcare and medical publishers. publishers, including Lippincott No journals in these collections are under any embargoes so you always have Williams & Wilkins, Oxford University Press, the American the most current articles and information. Plus you can view the tables of Medical Association, and more contents of all of journals—more than 1,400 titles—on Ovid. Find articles quickly with OvidSP’s powerful journal browse and search functionality, as well as flexible, time-saving results management and refinement tools The 8 Subject Journal Collections Include: Take advantage of cost-effective collection pricing Ovid Cardiology Journal Collection (13 titles) Keep up on the latest research with automatic delivery of electronic Ovid Dermatology Journal Collection (10 titles) tables of contents via email alert Ovid Neurology Journal Collection (24 titles) or RSS feed Ovid Oncology Journal Collection (13 titles) Search journals simultaneously with book and bibliographic Ovid Ophthalmology Journal Collection (9 titles) resources Ovid Pediatrics Journal Collection (13 titles) Use natural language processing to Ovid Psychiatry Journal Collection (16 titles) generate relevance-ranked results Ovid Surgery Journal Collection (15 titles) See pages 2-4 for a complete list of journals in each collection.
    [Show full text]
  • JAMA Internal Medicine—The Year in Review, 2019 Rita F
    Editorial Opinion Services Task Force. Agency for Healthcare 12. Zelenev A, Li J, Mazhnaya A, Basu S, Altice FL. elimination in the United States. Aliment Pharmacol Research and Quality; 2019. Hepatitis C virus treatment as prevention in an Ther. 2019;50(1):66-74. doi:10.1111/apt.15291 9. European Association for the Study of the Liver. extended network of people who inject drugs in the 16. World Health Organization. Global health sector EASL Recommendations on Treatment of Hepatitis USA: a modelling study. Lancet Infect Dis. 2018;18 strategy on viral hepatitis 2016-2021. June 2016. C2018.J Hepatol. 2018;69(2):461-511. doi:10. (2):215-224. doi:10.1016/S1473-3099(17)30676-X Accessed February 23, 2020. https://www.who.int/ 1016/j.jhep.2018.03.026 13. Centers for Disease Control and Prevention. hepatitis/strategy2016-2021/ghss-hep/en/. 10. Dore GJ, Altice F, Litwin AH, et al; C-EDGE Surveillance for viral hepatitis—United States, 2017. 17. Barocas JA, Tasillo A, Eftekhari Yazdi G, et al. CO-STAR Study Group. Elbasvir-grazoprevir to treat November 14, 2019. Accessed February 23, 2020. Population-level outcomes and cost-effectiveness hepatitis C virus infection in persons receiving https://www.cdc.gov/hepatitis/statistics/ of expanding the recommendation for age-based opioid agonist therapy: a randomized trial. Ann 2017surveillance/index.htm. hepatitis C testing in the United States. Clin Infect Dis. Intern Med. 2016;165(9):625-634. doi:10.7326/ 14. Suryaprasad AG, White JZ, Xu F, et al. Emerging 2018;67(4):549-556. doi:10.1093/cid/ciy098 M16-0816 epidemic of hepatitis C virus infections among 18.
    [Show full text]
  • Richard H. White, M.D
    Richard H. White, M.D. Philosophy of Care To provide patients with all the knowledge necessary to understand and take responsibility for their medical condition. Clinical Interests Dr. White's clinical interests include: Deep vein thrombosis, pulmonary embolism, prevention, treatment, epidemiology, rheumatology, and anticoagulation therapy. Research/Academic Interests Dr. White's research centers on diagnosis, treatment and prevention of deep vein thrombosis and pulmonary embolism, which collectively is called venous thromboembolism. He runs a 3000 patient anticoagulation clinic and direct a thrombosis specialty clinic. Where they conduct clinical research and to clinical epidemiology studies using large data bases. Title Chief of General Medicine Professor of Medicine Specialty Internal Medicine, Thrombosis, Anticoagulation, Rheumatology, Allergy and Clinical Immunology Department Internal Medicine Division General Medicine Center/Program Affiliation Center for Healthcare Policy and Research Address/Phone Patient Support Services Building, 4150 V St. Suite 2400 Sacramento, CA 95817 UC Davis Medical Group - Rocklin, 550 West Ranch View Dr. Suite 2005 Rocklin, CA 95765 Phone: 916-295-5700 Additional Phone Phone: 916-734-7005 Fax: 916-734-2732 Physician Referrals: 800-4-UCDAVIS (800-482-3284) Education M.D., Washington University School of Medicine, St. Louis MO 1973 B.A., UC Santa Barbara, Santa Barbara CA 1968 Residency University of California, San Francisco, San Francisco CA 1973-1975 Fellowships University of California, San Francisco, San Francisco CA 1976-1979 Board Certifications American Board of Internal Medicine, 1976 American Board of Internal Medicine, Rheumatology, 1980 Professional Memberships American College of Physicians Richard H. White, M.D. Anticoagulation Forum International Society of Thrombosis Haemostasis Honors and Awards Outstanding Clinical Instructor, 1991 Outstanding Faculty Teacher, 1982 Select Recent Publications Sadeghi B, White RH, Maynard G, Zrelak P, Strater A, Hensley L, et al.
    [Show full text]
  • Physician Suicide: a Scoping Literature Review to Highlight Opportunities for Prevention
    GLOBAL PSYCHIATRY — Vol 3 | Issue 2 | 2020 Tiffany I. Leung, MD, MPH, FACP, FAMIA1*, Rebecca Snyder, MSIS2, Sima S. Pendharkar, MD, MPH, FACP3‡, Chwen-Yuen Angie Chen, MD, FACP, FASAM4‡ Physician Suicide: A Scoping Literature Review to Highlight Opportunities for Prevention 1Faculty of Health, Medicine, and Life Sciences, Department of Internal Medicine, Maastricht University, Maastricht, The Netherlands 2Library Services, University of Texas Southwestern Medical Center, Dallas, TX, USA 3Division of Hospital Medicine, The Brooklyn Hospital Center, Icahn School of Medicine Mt. Sinai, Brooklyn, NY, USA 4Department of Primary Care and Population Health, Stanford University, Palo Alto, CA, USA *email: [email protected] ‡Indicates equal contributions as last authors to the production of this manuscript. DOI: 10.2478/gp-2020-0014 Received: 27 February 2020; Accepted: 12 May 2020 Abstract Objective: The aim of this scoping review is to map the current landscape of published research and perspectives on physician suicide. Findings could serve as a roadmap for further investigations and potentially inform efforts to prevent physician suicide. Methods: Ovid MEDLINE, PsycINFO, and Scopus were searched for English-language publications from August 21, 2017 through April 28, 2018. Inclusion criteria were a primary outcome or thesis focused on suicide (including suicide completion, attempts, and thoughts or ideation) among medical students, postgraduate trainees, or attending physicians. Opinion articles were included. Studies that were non-English or those that only mentioned physician burnout, mental health, or substance use disorders were excluded. Data extraction was performed by two authors. Results: The search yielded 1,596 articles, of which 347 articles passed to the full-text review round.
    [Show full text]
  • Jeroan J. Allison, MD, MS CURRICULUM VITAE PERSONAL
    Jeroan J. Allison, MD, MS CURRICULUM VITAE PERSONAL INFORMATION Place of Birth: Montgomery, Alabama Citizenship: USA Institution: University of Massachusetts Medical School Rank/title: Vice Chair and Professor, Department of Quantitative Health Sciences (Primary) Department of Medicine (Secondary) Associate Vice Provost for Health Disparities Research Professional Address: University of Massachusetts Medical Center Department of Quantitative Health Sciences 368 Plantation Street Worcester, MA 01605 EDUCATION March 1997 Master of Science in Harvard School of Public Health, Epidemiology with Boston, MA Concentration in Clinical Epidemiology July 1985- June 1989 Doctor of Medicine. University of Alabama at Cum Laude Birmingham, AL May 1985 Bachelor of Science, Samford University, Major in Chemistry and Birmingham, AL Biology, Summa Cum Laude CURRICULUM VITAE Jeroan J. Allison, M.D. Page 2 PERSONAL STATEMENT As the founding Vice Chair of the Department of Quantitative Health Sciences at the University of Massachusetts Medical School (http://www.umassmed.edu/qhs/), it has been an extraordinarily rewarding experience to work with Dr. Kiefe as Chair in establishing and nurturing this new academic venture. Beginning in June, 2009, with only Dr. Kiefe and myself, we have grown over the subsequent years to a broad-based department that includes 34 primary faculty and 31 doctoral and post-doctoral students. Our departmental vision is that, “We will be leaders in the science of moving from discovery to improving individual and population health by transforming healthcare delivery through methodological innovation.” Our core values include: social justice through improved health, collective creativity, scientific integrity and excellence, diversity and mutual respect, and science that makes a difference.
    [Show full text]
  • Analysis of Gender Equity in Leadership of Physician-Focused
    Letters 5. Centers for Medicare & Medicaid Services. Medicare Part D drug spending cialty groupings listed in the 2016 Physician Specialty Data Re- dashboard & data. https://www.cms.gov/Research-Statistics-Data-and- port (Table).1 We generally selected the largest and/or most in- Systems/Statistics-Trends-and-Reports/Information-on-Prescription-Drugs/ MedicarePartD.html. Accessed May 20, 2018. fluential society in the field. Groupings for internal medicine/ pediatrics, neonatal-perinatal medicine, pediatric cardiology, 6. Lieberman SM, Ginsburg PB. Would price transparency for generic drugs lower costs for payers and patients? https://www.brookings.edu/wp-content/ and pediatric hematology/oncology (4 of 43 groupings) were uploads/2017/06/es_20170613_genericdrugpricing.pdf. Published June 2017. then excluded because physicians in these specialties gener- Accessed May 20, 2018. ally belong to the American Academy of Pediatrics (AAP). The primary outcome measures were years of presidential leader- PHYSICIAN WORK ENVIRONMENT AND WELL-BEING ship attributed to men and women. To minimize some lack of Analysis of Gender Equity in Leadership independence across years, which is even greater for soci- of Physician-Focused Medical Specialty Societies, eties using 2-year presidential terms (4 of 39 societies; Table), 2008-2017 data were collected for a 10-year period (2008-2017), allow- The long-standing underrepresentation of women among ing for a minimum of 5 election cycles. For 38 societies, presi- medical academic leaders (deans, chairs, and professors) is well dents’ names were assigned to the year of election. For the AAP, documented. However, little is known about trends in medi- which changed the start of its presidential term from fall to cal society leadership.
    [Show full text]
  • Association of SARS-Cov-2 Seropositive Antibody Test with Risk of Future Infection
    Research JAMA Internal Medicine | Original Investigation Association of SARS-CoV-2 Seropositive Antibody Test With Risk of Future Infection Raymond A. Harvey, MPH; Jeremy A. Rassen, ScD; Carly A. Kabelac, BS; Wendy Turenne, MS; Sandy Leonard, MPH; Reyna Klesh, MS; William A. Meyer III, PhD, D(ABMM), MLS(ASCP)CM; Harvey W. Kaufman, MD, MBA; Steve Anderson, PhD; Oren Cohen, MD; Valentina I. Petkov, MD, MPH; Kathy A. Cronin, PhD; Alison L. Van Dyke, MD, PhD; Douglas R. Lowy, MD; Norman E. Sharpless, MD; Lynne T. Penberthy, MD, MPH Editor's Note page 679 IMPORTANCE Understanding the effect of serum antibodies to severe acute respiratory Supplemental content syndrome coronavirus 2 (SARS-CoV-2) on susceptibility to infection is important for identifying at-risk populations and could have implications for vaccine deployment. CME Quiz at jamacmelookup.com OBJECTIVE The study purpose was to evaluate evidence of SARS-CoV-2 infection based on diagnostic nucleic acid amplification test (NAAT) among patients with positive vs negative test results for antibodies in an observational descriptive cohort study of clinical laboratory and linked claims data. DESIGN, SETTING, AND PARTICIPANTS The study created cohorts from a deidentified data set composed of commercial laboratory tests, medical and pharmacy claims, electronic health records, and hospital chargemaster data. Patients were categorized as antibody-positive or antibody-negative according to their first SARS-CoV-2 antibody test in the database. MAIN OUTCOMES AND MEASURES Primary end points were post-index diagnostic NAAT results, with infection defined as a positive diagnostic test post-index, measured in 30-day intervals (0-30, 31-60, 61-90, >90 days).
    [Show full text]
  • Announcing JAMA Network Open—A New Journal from the JAMA Network Frederick P
    Opinion EDITORIAL Announcing JAMA Network Open—A New Journal From The JAMA Network Frederick P. Rivara, MD, MPH; Thomas J. Easley; Annette Flanagin, RN, MA; Howard Bauchner, MD We are pleased to announce that in early , The JAMA Figure. Numbers of Major Articles Published in Web of Science and Network will launch a new journal—JAMA Network Open. Research Articles Submitted and Accepted for JAMA Network Journals, Our editorial goal is to publish the very best clinical re- 2008-2016 search across all disciplines, serving the worldwide commu- nity of investigators and clinicians and meeting the evolving A Major articles indexed in Web of Science needs and requirements of authors and funders. With the 1400 launch of JAMA Network Open, we simultaneously assert 1200 our editorial commitment to excellence and to the author- ship community regardless of requirements of funders. 1000 This will be a fully open access journal and follows the 800 launch of JAMA Oncology in and JAMA Cardiology in , which are hybrid journals offering open access 600 options for research articles., Frederick P. Rivara, MD, No. in Thousands No. MPH, current editor in chief of JAMA Pediatrics, will be the 400 editor in chief of JAMA Network Open. 200 Medical journals and publishing have changed substan- 0 tially during the past decades following the emergence 2008 2012 2016 and ascendance of the internet and the mobilization of Year journal content. Journals have gone “digital”—virtually all journals release content online ahead of or instead of B Submissions and acceptances of research articles in The JAMA Network journals print, and connect with their readers via electronic table of 15 contents and through social media.
    [Show full text]
  • Association Between Penicillin Allergy Documentation and Antibiotic
    Letters that legalization of recreational marijuana is associated with in- Association Between Penicillin Allergy creased traffic fatality rates. Applying these results to national driv- Documentation and Antibiotic Use ing statistics, nationwide legalization would be associated with Approximately half of hospitalized patients receive antibiot- 6800 (95% CI, 4200-9700) excess roadway deaths each year. De- ics, and more than 10% of these patients have a penicillin spite certain methodological differences, we found an increase allergy documented in the medical record.1 Hospitalized similar to that reported by Aydelotte et al.4 They reported an in- patients with ongoing crease of 1.8 fatal crashes (equivalent to 2.0 fatalities) per BVMT. infections who report an We concur with their opinion that changes may not be detected Supplemental content allergy to penicillin have an immediately after legalization but only after a longer time period increased risk of adverse or after commercial sales begin. CME Quiz at drug events, including Clos- We chose a control group consisting of all states with nei- jamacmelookup.com tridioides difficile infection, ther legal recreational nor medical marijuana to isolate the ef- when not treated with a fects of marijuana. We did not require that control states have β-lactam antibiotic.2 Allergy assessment with or without baseline attributes similar to the experimental states because diagnostic testing disproves more than 90% of documented the difference-in-difference technique removes biases in com- penicillin allergies.1 parisons between experimental and control groups that re- sult from permanent differences between those groups. Our Table. Multivariable Assessment of the Association of Documented conclusions, nonetheless, are limited by adjusting for only 3 Penicillin Allergies With Inpatient Antibiotic Use state-specific factors that may have changed during the study a period.
    [Show full text]