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 Showing 61-80 of 101 Articles
Research Letter 
Joseph A. Lin, MPH; Joseph K. Canner, MHS; Eric B. Schneider, PhD

This study examines the traumatic brain injury–related factors associated with accelerated change in health insurance coverage and the differences in time to coverage change among individuals with employer-provided private insurance.

Original Investigation 
Aslam Ejaz, MD, MPH; Andrew A. Gonzalez, MD, JD, MPH; Faiz Gani, MD; Timothy M. Pawlik, MD, MPH, PhD
Includes: Supplemental Content

Importance  Reduction of postoperative readmissions has been identified as an opportunity for containment of health care costs. To date, the effect of index hospitalization costs on subsequent readmissions, however, has not been examined.

Objectives  To identify the effect of index admission costs on readmission rates and ...

Invited Commentary: Targeting Future Health Care Expenditure Reductions; Alexander C. Schwed, MD; Christian de Virgilio, MD
Original Investigation 
Yi Li, MD, PhD; Luca Stocchi, MD; Deepa Cherla, MD; Xiaobo Liu, MS; Feza H. Remzi, MD

Importance  The use of narcotics among patients with Crohn disease (CD) is endemic.

Objective  To evaluate the association between preoperative use of narcotics and postoperative outcomes in patients with CD.

Design, Setting, and Participants  Patients undergoing abdominal surgery for CD at a tertiary referral center ...

Invited Commentary 
Alexander C. Schwed, MD; Christian de Virgilio, MD

A commonly held belief states that paying more for a product is an assurance of higher quality. The adage “you get what you pay for” has been the conventional wisdom for many prospective buyers, whether they are debating buying a new vs a used vehicle, buying an index ...

Research Letter 
Anne P. Ehlers, MD; Giana H. Davidson, MD, MPH; Bonnie J. Bizzell, MBA, MEd; Mary K. Guiden; Elliott Skopin; David R. Flum, MD, MPH; Danielle C. Lavallee, PharmD, PhD

This study describes the development of a pragmatic clinical trial to address questions regarding the use of antibiotics vs appendectomy to treat acute appendicitis.

Comment & Response 
Devin S. Zarkowsky, MD; Caitlin W. Hicks, MD, MS; Mahmoud B. Malas, MD, MHS

To the Editor We appreciate Dr Onuigbo’s letter1 regarding our recent study2; it is humbling to read that the nephrology community at large is interested in our findings. We agree, in principle, that “renoprevention,” as Dr Onuigbo counsels, is wise. However, to target a syndrome ...

Original Investigation 
Jason D. Wright, MD; Ana I. Tergas, MD; June Y. Hou, MD; William M. Burke, MD; Ling Chen, MD, MPH; Jim C. Hu, MD, MPH; Alfred I. Neugut, MD, PhD; Cande V. Ananth, PhD, MPH; Dawn L. Hershman, MD
Includes: Supplemental Content

Importance  Despite the lack of efficacy data, robotic-assisted surgery has diffused rapidly into practice. Marketing to physicians, hospitals, and patients has been widespread, but how this marketing has contributed to the diffusion of the technology remains unknown.

Objective  To examine the effect of regional hospital competition ...

Invited Commentary: Implications of Market Competition, Technology, and Cost; Joel T. Adler, MD, MPH; David C. Chang, PhD, MBA, MPH
Original Investigation 
Abby J. Isaacs, MS; Mary L. Gemignani, MD, MPH; Andrea Pusic, MD, MHS, FRCSC; Art Sedrakyan, MD, PhD
Includes: Supplemental Content

Importance  For early-stage breast cancer, breast conservation surgery (BCS) is a conservative option for women and involves removing the tumor with a margin of surrounding breast tissue. If margins are not tumor free, patients undergo additional surgery to avoid local recurrence.

Objectives  To investigate the use ...

Invited Commentary: Reoperation for Margins After Breast Conservation Surgery; Uttara Nag, MD; E. Shelley Hwang, MD, MPH
Invited Commentary 
Joel T. Adler, MD, MPH; David C. Chang, PhD, MBA, MPH

Provision of health care is rapidly evolving in an era of cost consciousness and new treatments, making the evaluation of technology and its adoption important and necessary. Many of these rapidly shifting market conditions were precipitated by hospital mergers in light of incentives in the Affordable Care Act....

Invited Commentary 
Uttara Nag, MD; E. Shelley Hwang, MD, MPH

More than 30 years after demonstration that survival after breast conservation surgery (BCS) and adjuvant radiotherapy is equivalent to survival after mastectomy,1 significant variability in the implementation of BCS remains, particularly in the rates of reoperation for margins. Breast conservation surgery is the most common oncologic operation ...

To the Editor Jackson and colleagues1 described an opportunity for orthopedic surgeons to improve outcomes and reduce costs under Medicare’s new bundled payment plan for lower-extremity joint replacements. They identified transplant surgeons as role models because transplant surgeons “have learned to engage both traditional and nontraditional partners…in ...

Comment & Response 
Hannah Alphs Jackson, MD, MHSA; Brian Walsh, BS, CPA; Michael Abecassis, MD, MBA

In Reply We note and appreciate Dr Brown’s point that team-based care is essential for the deployment and success of managing episodes of care, especially in risk-based accountable payment models such as bundles. Indeed, Dr Brown is correct in stating that behavioral health professionals “have helped transplant surgeons ...

Original Investigation 
Vlad V. Simianu, MD, MPH; Alessandro Fichera, MD; Amir L. Bastawrous, MD, MBA; Giana H. Davidson, MD, MPH; Michael G. Florence, MD; Richard C. Thirlby, MD; David R. Flum, MD, MPH
Includes: Supplemental Content

Importance  Despite professional recommendations to delay elective colon resection for patients with uncomplicated diverticulitis, early surgery (after <3 preceding episodes) appears to be common. Several factors have been suggested to contribute to early surgery, including increasing numbers of younger patients, a lower threshold to operate laparoscopically, and ...

Invited Commentary: Improving Treatment of Uncomplicated Diverticulitis; James Fleshman, MD
Original Investigation 
Lance E. Davidson, PhD; Ted D. Adams, PhD, MPH; Jaewhan Kim, PhD; Jessica L. Jones, MD, MSPH; Mia Hashibe, PhD; David Taylor, PhD; Tapan Mehta, PhD; Rodrick McKinlay, MD; Steven C. Simper, MD; Sherman C. Smith, MD; Steven C. Hunt, PhD
Includes: Supplemental Content

Importance  Bariatric surgery is effective in reducing all-cause and cause-specific long-term mortality. Whether the long-term mortality benefit of surgery applies to all ages at which surgery is performed is not known.

Objective  To examine whether gastric bypass surgery is equally effective in reducing mortality in groups ...

Invited Commentary: Age-Related Mortality After Gastric Bypass Surgery; Malcolm K. Robinson, MD
Invited Commentary 
James Fleshman, MD

We continue to struggle with the perfect definition of the indication for an elective operation in the patient with diverticulitis. Simianu et al,1 in their review of the MarketScan Commercial Claims and Encounters Database, have attempted to determine the influences that drive early and late operation on ...

Invited Commentary 
Malcolm K. Robinson, MD

Young adults are generally thought to be the least risky operative candidates for elective surgery, whereas older individuals may be considered too risky. In this issue of JAMA Surgery, Davidson et al1 challenge these notions for patients undergoing gastric bypass surgery.

Research Letter 
Peter C. Minneci, MD, MHSc; Kristine M. Nacion, MPH; Daniel L. Lodwick, MD, MS; Jennifer N. Cooper, MS, PhD; Katherine J. Deans, MD, MHSc

This study discusses the effect of stakeholder involvement in an ongoing randomized clinical trial of pediatric appendicitis.

Comment & Response 
Vakhtang Tchantchaleishvili, MD; William Hallinan, RN, MS; H. Todd Massey, MD

In Reply In their comments on our recent Viewpoint,1 Garan et al and Fiedler et al have highlighted the institutional commitment needed to provide timely and comprehensive care for patients with acute myocardial infarction with cardiogenic shock (AMICS). Indeed, a 24/7 multidisciplinary “Shock Team” should be an ...

Comment & Response 
Arthur Reshad Garan, MD; Ajay Kirtane, MD, SM; Hiroo Takayama, MD, PhD

To the Editor We read with great interest the Viewpoint by Tchantchaleishvili et al1 calling for organized statewide networks for the management of acute myocardial infarction–related cardiogenic shock. We applaud the authors’ insights into one of the major current challenges in cardiovascular care. Despite advances in the ...

Comment & Response 
Amy G. Fiedler, MD; Tae H. Song, MD; David A. D’Alessandro, MD

To the Editor The Viewpoint by Tchantchaleishvili et al1 calling for organized statewide networks for the management of acute myocardial infarction–related cardiogenic shock brings to attention the critical need for multidisciplinary, multicenter, coordinated efforts to treat and manage patients presenting with cardiogenic shock. This is a timely ...

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