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Less Is More Collection - JAMA Network

Tamma PD. JAMA Intern Med. 2019;179(3):316-323.

In this multicenter cohort study of 1478 unique patients with Enterobacteriaceae bacteremia, no difference in 30-day mortality or recurrent bacteremia was observed between patients converted to early (within the first 5 days of treatment), oral step-down therapy and propensity score–matched patients who continued to receive intravenous antibiotics for the duration of therapy. The findings suggest that transitioning to oral step-down therapy may be an effective treatment approach for patients ...

Less Is More Collection - JAMA Network

Seib CD. JAMA Intern Med. 2019;179(3):391-393.

Over the past years, transcatheter aortic valve replacement (TAVR) has emerged as an alternative to surgical aortic valve replacement (SAVR) for severe aortic stenosis and is increasingly being used in older patients with a high burden of comorbidity. Although prior studies that focused on disease-specific outcomes contributed to the expansion of TAVR use, multi-institutional observational studies have demonstrated that patient frailty results in an increased risk of mortality and disability at ...

Less Is More Collection - JAMA Network

Christopher W. Goodman.JAMA Intern Med. 2019;179(5):695-701. doi:10.1001/jamainternmed.2019.0086 aut

This report summarizes the limited published evidence supporting the unauthorized use of gabapentinoids and the clinical issues associated with their use. Regardless of the limitations in their indications, gapentinoids are widely prescribed off-label for different syndromes. Clinicians who prescribe gabapentinoids off-label for pain should be aware of the limited evidence and should acknowledge to patients that potential benefits are uncertain for most off-label uses.

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John N. Mafi. JAMA Intern Med. 2019;179(5):648-657.

This study took place at 2 academic safety-net medical centers to compare pre- and postintervention vs control group low value care utilization and cost changes. This intervention was associated with sustained reductions in low-value preoperative testing among patients undergoing cataract surgery and modest cost savings for the health system. The findings suggest that reducing low-value care may be associated with cost savings for financially capitated health systems and society but also with ...

Less Is More Collection - JAMA Network

Pack QR. JAMA Intern Med. 2019;179(9):1176-1185.

It’s a restrospectives cohor study. Greater use of echocardiography did not appear to be associated with better patient outcomes in patients with acute myocardial infarction. In models that adjusted for hospital and patient characteristics, no difference was found in inpatient mortality or 3-month readmission between the highest and lowest quartiles of echocardiography use. In patients with AMI, hospitals in the quartile with the highest rates of echocardiography showed greater hospital ...