JAMA Internal Medicine Research Articles

IntroductionCase reports are perceived as having diminished value relative to other study designs. It has been said that medical toxicology (MT) is based largely upon case report literature and thought to be unique in this regard. We sought to quantify recent MT publication of case reports compared with top periodicals from emergency medicine (EM) and internal medicine (IM) journals.MethodsA retrospective review examined 5 years of articles in 6 U.S.-based medical journals–MT (Journal of Medical Toxicology, Clinical Toxicology), EM (Annals of Emergency Medicine, Journal of Emergency Medicine), and IM (JAMA Internal Medicine, New England Journal of Medicine) was performed using on-line resources. Every article in each issue was categorized into Case report vs. Research and Analysis articles vs. Excluded. “Case report” was defined as one (or ≤ 5) individual patients, one patient’s data, etc. Total articles per issue were reported after removing Excluded items.ResultsBetween 2018 and 2022, these 6 periodicals published 522 issues; with 2644 case reports; and 8246 total included articles. Comparison of MT case reports vs. EM revealed a significant difference and odds (Odds Ratio = 1.7, (95% CI: [1.49, 2.03], p < 0.001); MT compared with IM was not significantly different (Odds Ratio = 1.1, (95% CI: [0.96, 1.30], p = 0.150). The percent of case reports increased in the IM and EM journals compared with a relative decrease in the MT journals. Cumulative case report precents were consistently greater in EM and IM than in MT.Conclusion In the past 5 years, MT journals published fewer and had a declining trend of case reports compared with leading EM and IM journals. Future research is needed to determine the effect on MT practice resulting from the diminished body of case report literature.

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A cohort study that looked at Canadian province British Columbia's Safer Opioid Supply policy, instituted two years ago, found that there was a moderate increase in the number of individuals with at least one opioid prescription, a large increase in the number of opioid prescriptions dispensed, and a substantial increase in hospitalizations related to opioid poisoning. According to the study, “British Columbia's Safer Opioid Supply Policy and Opioid Outcomes” published online in JAMA Internal Medicine on Jan. 16, there were no statistically significant changes in deaths from opioid overdoses and no significant change in the number of prescribers. Rather, those prescribers who were there before prescribed a significantly greater amount of opioids. And the opioid‐related poisoning hospitalization rate increased by 3.2 per 100,000 population. The study, by Hai V. Nguyen, Ph.D. and colleagues, was funded by the Canadian Institutes of Health Research. The study used quarterly data from 2016 to 2022 from British Columbia, where the Safer Opioid Supply policy was implemented, then compared that data to Canada's Manitoba and Saskatchewan provinces where the policy was not implemented. The main outcomes were rates of prescriptions, claimants, and prescribers of opioids targeted by the Safer Opioid Supply policy (hydromorphone, morphine, oxycodone, and fentanyl); opioid‐related poisoning hospitalizations; and deaths from apparent opioid toxicity. The researchers concluded that while the Safer Opioid Supply policy was associated with higher rates of safer (prescription) supply, it was also associated with a significant increase in opioid‐related poisoning hospitalizations. “These findings will help inform ongoing debates about this policy not only in British Columbia, but also in other jurisdictions that are contemplating it,” the researchers concluded.

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JAMA Internal Medicine Research Articles

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