When you hear the word orgasm, what’s the first thing that comes to mind? Odds are, you probably thought about pleasure because most of us tend to equate orgasms with positive feelings. However, it turns out that orgasms aren’t universally pleasurable experiences. In fact, according to a recent study published in the Archives of Sexual Behavior, many people report having experienced a “bad” orgasm at one time or...
Mon Mar 02, 2020 17:00
I’ve been getting a lot of questions lately about the difference between being bisexual versus being pansexual. There seems to be a lot of confusion about what these terms really mean and how they’re similar or different, so I thought it would be worth exploring this in a post. Let’s start with the term “bisexual.” Historically, this term has been used to refer to a sexual orientation that involves attraction to both men and women. It originated in a time when sex/gender was primarily seen as a binary...
Fri Feb 28, 2020 17:00
Abstract Purpose This study aimed to assess the reliability of rectal villous tumors staging between rectal MRI and histological examination used as the Gold Standard and to investigate causes for discrepancies. Methods The rectal 1.5 T MR scans of 40 patients followed for a histologically proven rectal villous adenoma were retrospectively included. Two independent...
Mon Mar 02, 2020 02:00
Abstract Purpose Although intra-arterial chemotherapy (IAC) is commonly used for treating intraocular retinoblastoma, it is not a systemic therapy. We aimed to investigate whether the addition of intravenous chemotherapy (IVC) before IAC administration had any effects (whether beneficial or adverse) on patient outcomes. Methods This multicenter retrospective...
Mon Mar 02, 2020 02:00
The call for quality measurement to focus on outcomes rather than care processes is loud and persistent. However, robust consideration of problems with the validity of outcome measures is often lacking. In this issue of JAMA Internal Medicine, Silva and colleagues make an important contribution to that discussion. They used data from the Veterans Health Administration to examine trends in mortality 30 days following hospital admission for veterans with heart failure or pneumonia. Risk-adjustment...
Sun Mar 01, 2020 02:00
This randomized clinical trial evaluates whether combining behavioral and drug therapies improves outcomes compared with each therapy alone for overactive bladder symptoms in men and compares 3 sequences for implementing combined therapy.
Sun Mar 01, 2020 02:00
In Reply We thank Bush et al for their comments on the Comparison of Depression Interventions After Acute Coronary Syndrome: Quality of Life randomized clinical trial. We provide a response to their concern that our recommendation to reconsider depression-screening guidelines was premature. First, they note that the prevalence of depression in our sample was lower than expected. The low prevalence of screening-detected depression (7% actual vs 20% expected) contributed to our recommendation to reconsider...
Sun Mar 01, 2020 02:00
Mission Statement: To promote the art and science of medicine and the betterment of human health by publishing manuscripts of interest and relevance to internists practicing as generalists or as medical subspecialists.
Sun Mar 01, 2020 02:00
Health Care Policy
Sun Mar 01, 2020 02:00
This cross-sectional study uses Minimum Data Set assessments to investigate the hospital transfer rates among nursing home residents in the United States with advanced illness between 2011 and 2017 after the introduction of national initiatives to reduce hospitalizations.
Sun Mar 01, 2020 02:00
In Reply We thank Stall et al for their thoughtful letter regarding our article, “Sharing the Care—A Patient and Her Caregivers.” We echo their assertion that family caregivers make important contributions to patient care, including assistance with personal and medical tasks. Indeed, the purpose of our article was to highlight that several different types of caregivers support patients at home and that clinicians may overlook caregivers’ perspectives and roles.
Sun Mar 01, 2020 02:00
This study examines the estimated cost of asthma inhalers for individuals treated under Medicare Part B compared with those treated under the Veterans Affairs Health System, taking into account separate approaches to price negotiation.
Sun Mar 01, 2020 02:00
In Reply In response to Morgan and Jones, consumption of e-liquids in volumes of more than 10 mL/d is not uncommon, especially for users tapering nicotine strength. Users of low nicotine strength (3-6 mg/mL) electronic cigarette (e-cigarette) liquids often vape more frequently to compensate for low nicotine concentrations, with some consuming large e-liquid volumes in the range of 15 to 30 mL/d. Surveys of vape shop customers found that users vaping low nicotine e-liquids (average, 3.3 mg/mL) consumed...
Sun Mar 01, 2020 02:00
As a cause of excess mortality, socioeconomic disadvantage rivals smoking, hypertension, cancer, and cardiovascular disease. At age 40 years, the poorest US women can expect to die about a decade sooner than the richest; for men the gap is 15 years. Socioeconomic inequalities are so pervasive that it is easy to assume they are immutable. Historical evidence demonstrates that tremendous progress toward narrowing inequalities is possible. Unfortunately, recent trends in the United States indicate that...
Sun Mar 01, 2020 02:00
In Reply Our group recently examined the pool of kidneys procured from deceased organ donors from 2004 to 2014 and estimated that 17 435 kidneys discarded in the United States would have been transplanted had they been procured in France. Compared with the United States, French transplant centers are much more likely to accept kidneys from deceased donors who are older (mean (SD) donor age, 50.9 (17.3) years in France vs 36.5 (17.0) years in the United States) or have comorbidities including hypertension...
Sun Mar 01, 2020 02:00
This qualitative study identifies sources of burnout and potential remedies after conducting focus group discussions and interviews among primary care practitioners at a large US academic medical center.
Sun Mar 01, 2020 02:00
To the Editor We write regarding the randomized clinical trial conducted by Kronish et al that evaluated screening for depression (with and without follow-up treatment) vs no screening on outcomes (quality-adjusted life-years and depression-free days) in patients who survived an acute coronary syndrome (ACS) event. The authors did not observe a difference in outcome between the 3 study groups and concluded that systematic screening may not be justified in this population. Their recommendation to...
Sun Mar 01, 2020 02:00
Pyrethroid pesticides are a large family of synthetic analogues of naturally occurring pyrethrins widely used for insect control in agricultural and numerous consumer products. Collectively, they are the second most–used insecticides in the world, totaling thousands of kilograms and billions of dollars in US sales.
Sun Mar 01, 2020 02:00
To the Editor We appreciate the work by Chen and colleagues that explores trends in graduate medical education (GME) payments and the provocative proposal to cap total government payments at a rate of $150 000 per resident. The striking variation in payments reflects the potential differences in costs to train residents but may also indicate differences in what programs provide trainees. To our knowledge, there is no document or contract that details minimum expectations of sponsoring institutions...
Sun Mar 01, 2020 02:00
This cohort study examines the relative and disease-specific survival rates for patients with 10 early-stage cancers.
Sun Mar 01, 2020 02:00
This cross-sectional study evaluates differences in intensity of care and mortality between homeless and nonhomeless individuals hospitalized for acute myocardial infarction, stroke, cardiac arrest, or heart failure.
Sun Mar 01, 2020 02:00
To the Editor We thank Drs Sterling and Shaw for their important work to raise the profile of caregiving and for their attempts to classify the types of caregivers assisting millions of Americans and the many more internationally receiving care in their homes. We oppose distinguishing unpaid family caregivers from paid care providers with the qualifiers informal and formal—these terms disrespectfully frame the family caregiving role, often with counterproductive consequences.
Sun Mar 01, 2020 02:00
This cross-sectional study uses county-level data to assess the association of social mobility with income-related differences in life expectancy of individuals at age 40 years in the United States.
Sun Mar 01, 2020 02:00
To the Editor In their recently published Teachable Moment, Pedley and Khalili underscore the perils of not obtaining a sexual history in older adults. Although their effort to remedy disparate sexual history–taking practices among the elderly is a step in the right direction, their proposed assessment may alienate at-risk patients and miss valuable screening opportunities.
Sun Mar 01, 2020 02:00
This cohort study compares the risk of major adverse coronary events (MACE) associated with use of ticagrelor vs clopidogrel in patients with acute coronary syndrome treated with percutaneous coronary intervention.
Sun Mar 01, 2020 02:00
To the Editor In response to the recently published Research Letter by Jabba and Jordt, we have concerns about the estimated volumes for consumption of fluid in electronic cigarette (e-cigarette) users. Traditional e-cigarette models with a single coil consume approximately 1 to 2 mL/d for light users and 5 to 6 mL/d for heavy users. The main exception to this is sub-ohm vapes, which use modified devices with low-ohm resistors to produce larger vapor clouds and more intense flavors, where use of...
Sun Mar 01, 2020 02:00
This case report presents the electrocardiographic findings of an apparently healthy man in his 40s.
Sun Mar 01, 2020 02:00
To the Editor Kidney transplantation is the most effective therapy for chronic kidney failure, yet there are about 100 000 patients waiting for a kidney in the United States. In their recently published study, Aubert and colleagues compared disparities in acceptance of deceased donor kidneys between the United States and France, finding that France is much more liberal in accepting kidneys from donors who are older and have more comorbidities. This results in a loss of approximately 3500 donated...
Sun Mar 01, 2020 02:00
Over the past decade, JAMA Internal Medicine has published 11 research articles on the subject of physician burnout, including 7 survey-based studies, 2 meta-analyses, and 2 pilot interventions. These studies have quantified the prevalence and predictors of burnout in various care settings and have piloted modest strategies, such as coaching and facilitated discussion groups for health care practitioners dealing with workplace stresses. To this body of work, this issue adds a qualitative study by...
Sun Mar 01, 2020 02:00
Courtesy of: Richard Wu, BS, The University of Texas at Dallas, 800 W Campbell Rd, MC17, Richardson, TX 75080 (richard.wu@utdallas.edu).
Sun Mar 01, 2020 02:00
Association Between Pyrethroid Insecticide Exposure and Risk of Mortality in the US Adult Population
This cohort study uses data from the National Health and Nutrition Examination Survey conducted from 1999 to 2002 to investigate whether exposure to pyrethroid insecticides is associated with the risk of all-cause, cardiovascular, and cancer mortality in the general US adult population.
Sun Mar 01, 2020 02:00
This survey study identifies changes in unmet need for physician services among insured and uninsured adults aged 18 to 64 years in the United States from the 1998 and 2017 Behavioral Risk Factor Surveillance System surveys.
Sun Mar 01, 2020 02:00
This observational time-trend study compares trends in 30-day mortality rates among veterans hospitalized with heart failure and pneumonia when claims-based vs clinical variables are used in risk-adjustment models.
Sun Mar 01, 2020 02:00
This cohort study quantifies whether proteinuria after hospital discharge is associated with future loss of renal function among patients who had acute kidney injury during hospitalization.
Sun Mar 01, 2020 02:00
This survey study assesses who has primary care in the United States and how this has changed over time.
Sun Mar 01, 2020 02:00
This quality improvement study assesses the potential consequences of systematic underreporting of alcohol use on the observed results in a recent, well-publicized study.
Sun Mar 01, 2020 02:00
This systematic review and meta-analysis of randomized clinical trials assesses the effectiveness and safety of aspirin for venous thromboembolism prophylaxis after total hip replacement and total knee replacement.
Sun Mar 01, 2020 02:00
This study examines a rise in telephone calls to the Rape, Abuse, and Incest National Network rape crisis hotline in the wake of an episode of the television show Grey’s Anatomy focused on rape and ending with the hotline number.
Sun Mar 01, 2020 02:00
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