Karsten Juhl Jørgensen, MD, DrMedSci; Peter C. Gøtzsche, MD, MSc; Mette Kalager, MD, PhD; Per-Henrik Zahl, MD, DrMedSci
Effective breast cancer screening should detect early-stage cancer and prevent advanced disease. Using unique data from screening programs launched in Denmark from 1991 to 2007, the authors assessed the association between screening and the size of detected tumors. They estimated that a substantial proportion of tumors represents overdiagnosis—that is, tumors found during screening that would not become clinically relevant in a woman's lifetime.
Ann Intern Med. 2017;166(5):313-323. doi:10.7326/M16-0270
Jason H. Wasfy, MD, MPhil; Corwin Matthew Zigler, PhD; Christine Choirat, PhD; Yun Wang, PhD; Francesca Dominici, PhD; Robert W. Yeh, MD, MSc
In this pre–post analysis, the authors evaluated whether passage of the Medicare Hospital Readmissions Reduction Program helped to accelerate improvement in 30-day risk-standardized readmission rates after hospitalizations for acute myocardial infarction, congestive heart failure, or pneumonia and whether the lowest-performing hospitals had faster acceleration in improvement after passage of the law than higher-performing hospitals.
Ann Intern Med. 2017;166(5):324-331. doi:10.7326/M16-0185
Ching Li Chai-Coetzer, MBBS, PhD; Nick A. Antic, MBBS, PhD; Garun S. Hamilton, MBBS, PhD; Nigel McArdle, MBBS, MD; Keith Wong, MBBS, PhD; Brendon J. Yee, MBBS, PhD; Aeneas Yeo, MBBS; Rajeev Ratnavadivel, MBChB, PhD; Matthew T. Naughton, MBBS, MD; Teanau Roebuck, BAppSc(Hons); Richard Woodman, PhD; R. Doug McEvoy, MBBS, MD
Despite increased use in clinical practice, whether in-home sleep studies lead to similar diagnostic and therapeutic decisions and similar patient outcomes compared with full laboratory polysomnography (PSG) is not known. This randomized trial compared diagnoses made by physicians and their confidence in them as well as patient outcomes when physicians were presented with full PSG results with the more limited information available from in-home studies.
Ann Intern Med. 2017;166(5):332-340. doi:10.7326/M16-1301
Aaron Mendelson, BA; Karli Kondo, PhD; Cheryl Damberg, PhD; Allison Low, BA; Makalapua Motúapuaka, BA; Michele Freeman, MPH; Maya O'Neil, PhD; Rose Relevo, MLIS, MS; Devan Kansagara, MD, MCR
The effectiveness of pay-for-performance programs, which provide financial rewards or penalties to providers or institutions according to performance on measures of quality, is unclear. This review of 69 studies examines whether such programs positively influence processes of care and improve patient outcomes.
Ann Intern Med. 2017;166(5):341-353. doi:10.7326/M16-1881
Sanjay Basu, MD, PhD; Jeremy B. Sussman, MD, MS; Rod A. Hayward, MD
Two recent treat-to-target trials yielded discordant results about the effects of intensive blood pressure management. The authors aimed to determine whether heterogeneous treatment effects (HTEs) were hidden in these trials and could explain the observed differences. They also examined the ability of the SMART (sequential, multiple assignment, randomized trial) design to detect HTEs.
Ann Intern Med. 2017;166(5):354-360. doi:10.7326/M16-1756
Andrew J. Goodwin, MD; Russell A. Higgins, MD; Karen A. Moser, MD; Kristi J. Smock, MD; Wayne L. Chandler, MD; Kandice Kottke-Marchant, MD, PhD; Sarah K. Hartman, MD; Oksana Volod, MD; Alan F. Brown, MD; Vandita P. Johari, MD; Sharon Burr, MBA, MT; Nataliya Polyakov, MT; Dong Chen, MD, PhD
Use of age-adjusted D-dimer levels has been recommended for evaluating patients with suspected pulmonary embolism. The authors of this commentary caution that clinicians must understand important differences among laboratories in how D-dimer values are reported, as well as the limited knowledge of certain assays' performances as age-adjusted values, to avoid potentially dangerous misinterpretations that might harm patients.
Ann Intern Med. 2017;166(5):361-363. doi:10.7326/M16-2030
Otis W. Brawley, MD
Jørgensen and colleagues compared breast cancer incidence and death rates in areas of Denmark where screening was introduced at various times in the 1990s. They estimate that screen-detected breast tumors have an overdiagnosis rate of 14.7% to 38.6% (excluding ductal carcinoma in situ). The editorialist discusses the need to accept that overdiagnosis exists, urges recognition of the limitations of screening, and asserts that all elements of breast cancer control should be examined to optimize patient care.
Ann Intern Med. 2017;166(5):364-365. doi:10.7326/M16-2850
Lucas M. Donovan, MD; Sanjay R. Patel, MD, MS
Evidence has been lacking to compare the performance of laboratory-based and home-based testing for obstructive sleep apnea (OSA) in patients with low pretest probability for it or in selecting therapies other than continuous positive airway pressure. The editorialists discuss Chai-Coetzer and colleagues' findings and call for collaboration among professional medical societies, payers, and other stakeholders to ensure an economically viable strategy of replacing in-laboratory PSG with home testing for evaluation of OSA.
Ann Intern Med. 2017;166(5):366-367. doi:10.7326/M16-2902
Teryl K. Nuckols, MD, MSHS
Mendelson and colleagues examined 69 recent studies that evaluated pay-for-performance initiatives. The editorialist discusses new policies that require the Centers for Medicare & Medicaid Services to penalize or reward clinicians based on the quality of care they deliver and the insight existing research provides into the anticipated influence of those policies on health outcomes.
Ann Intern Med. 2017;166(5):368-369. doi:10.7326/M16-2947
Sanjay Kaul, MD
Basu and coworkers presented an innovative approach using microsimulation modeling to explore HTEs. This approach is used to explain the divergent results observed in 3 large, well-designed, rigorously conducted, randomized clinical trials examining blood pressure goals for hypertension treatment. The editorialist discusses how this approach will help to inform comparative effectiveness research and precision medicine.
Ann Intern Med. 2017;166(5):370-372. doi:10.7326/M16-2818
Michel Sauve, MD, MSc
Ann Intern Med. 2017;166(5):373-375. doi:10.7326/M16-1384
Ann Intern Med. 2017;166(5):376-377. doi:10.7326/L16-0624
Ann Intern Med. 2017;166(5):376. doi:10.7326/L16-0625
Ann Intern Med. 2017;166(5):376. doi:10.7326/L16-0626
Ann Intern Med. 2017;166(5):377-378. doi:10.7326/L16-0590
Ann Intern Med. 2017;166(5):378. doi:10.7326/L16-0589
Ann Intern Med. 2017;166(5):378-379. doi:10.7326/L16-0617
Ann Intern Med. 2017;166(5):379-380. doi:10.7326/L16-0038
Ann Intern Med. 2017;166(5):380. doi:10.7326/L16-0360
Jerome O. Cantor, BA, MD
Ann Intern Med. 2017;166(5):372. doi:10.7326/M16-2908
Fatima Z. Syed, MD, MSc
Ann Intern Med. 2017;166(5):375. doi:10.7326/M16-2632
Peter Zimetbaum, MD
Ann Intern Med. 2017;166(5):ITC33-ITC48. doi:10.7326/AITC201703070
Darren B. Taichman, MD, PhD
Ann Intern Med. 2017;166(5):ED5. doi:10.7326/AFED201703070
David Mayer Smith
Building on the popular Annals feature “On Being a Doctor,” storytellers share stories about the experience of doctoring on video.
Ann Intern Med. 2017;166(5):SS1. doi:10.7326/W17-0024
Anna Morgan, MD
Ann Intern Med. 2017;166(5):SS1. doi:10.7326/W17-0025
Ann Intern Med. 2017;166(5):SS1. doi:10.7326/W17-0026
Anita Ravi, MD, MPH
Ann Intern Med. 2017;166(5):SS1. doi:10.7326/W17-0027
Michael Bohannan-Calloway, PhD
Ann Intern Med. 2017;166(5):SS1. doi:10.7326/W17-0028
Lawrence I. Kaplan, MD
Ann Intern Med. 2017;166(5):SS1. doi:10.7326/W17-0029
Ann Intern Med. 2017;166(5):SS1. doi:10.7326/W17-0030
Benjamin Khazan, MD
Ann Intern Med. 2017;166(5):SS1. doi:10.7326/W17-0031
Navin Vij, MD
Ann Intern Med. 2017;166(5):SS1. doi:10.7326/W17-0032
Eliot Nierman, MD
Ann Intern Med. 2017;166(5):SS1. doi:10.7326/W17-0033
Lucia Briatore, MD, PhD; Ilaria Pozzi
Annals Graphic Medicine brings together original graphic narratives, comics, animation/video, and other creative forms by those who provide or receive health care. They address medically relevant topics—whether they be poignant, thought-provoking, or just plain entertaining.
Ann Intern Med. 2017;166(5):W5-W6. doi:10.7326/G16-0026
Ann Intern Med. 2017;166(5):I-20. doi:10.7326/P16-9027
Ann Intern Med. 2017;166(5):I-16. doi:10.7326/P16-9029
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