Christelle Nguyen, MD, PhD; Isabelle Boutron, MD, PhD; Gabriel Baron, PhD; Katherine Sanchez, MD; Clémence Palazzo, MD, PhD; Raphaël Benchimol, MD; Guillaume Paris, MD; Étienne James-Belin, MD; Marie-Martine Lefèvre-Colau, MD, PhD; Johann Beaudreuil, MD, PhD; Jean-Denis Laredo, MD, PhD; Anne Béra-Louville, MD; Anne Cotten, MD, PhD; Jean-Luc Drapé, MD, PhD; Antoine Feydy, MD, PhD; Philippe Ravaud, MD, PhD; François Rannou, MD, PhD; Serge Poiraudeau, MD, PhD
In this randomized, controlled trial conducted at 3 tertiary care centers in France, the authors sought to assess the efficacy of a single intradiscal glucocorticoid injection in patients with chronic low back pain with active discopathy.
Oluwaseun Falade-Nwulia, MBBS, MPH; Catalina Suarez-Cuervo, MD; David R. Nelson, MD; Michael W. Fried, MD; Jodi B. Segal, MD, MPH; Mark S. Sulkowski, MD
Multiple oral direct-acting antiviral regimens are approved for the treatment of chronic hepatitis C virus infection. This systematic review of 42 trials examines the efficacy and safety of those agents.
Alex P. Salam, MBChB, MSc; Amanda Rojek, MBBS, MSc; Jake Dunning, MBBS, PhD; Peter W. Horby, MBBS PhD
Zika virus infection in pregnancy causes adverse fetal outcomes, and treatments to prevent these effects are sorely needed. This report examines the scientific, ethical, and logistical challenges of conducting trials of therapies aimed at preventing congenital Zika virus disease.
Jay H. Hoofnagle, MD; Averell H. Sherker, MD
Within the past 4 years, orally available antiviral drugs have received U.S. Food and Drug Administration approval as therapy for chronic hepatitis C virus (HCV) infection. Falade-Nwulia and colleagues provide a systematic review of 42 published clinical trials of these agents in all 6 HCV genotypes and in cohorts with and without cirrhosis, previous treatment, HIV co-infection, and liver transplantation. The new antiviral regimens have transformed management of chronic HCV infection. Amid the optimism about HCV therapy, the editorialists note several caveats.
David J. Kennedy, MD; Byron J. Schneider, MD
Nguyen and colleagues report a randomized trial of glucocorticoid intradiscal injection for patients with chronic low back pain associated with active discopathy. The editorialists commend the authors for avoiding common pitfalls of low back pain research and discuss explanations for the lack of long-term improvement in pain.
Julia Schoen, MS
Mr. B had his own agenda for our conversation. I asked him about his shortness of breath. Instead, he told me stories about his favorite dog.
Jiena Sun, PhD
Neha J. Pagidipati, MD, MPH; Christopher B. Granger, MD
Calvin Hirsch, MD
Eric R. Bates, MD
Shamir R. Mehta, MD, MSc, FRCPC, FACC
Susan R. Kahn, MD, MSc, FRCPC
Patricia F. Harris, MD, MS
Justin Lee, BScPhm, MD; Anne Holbrook, MD, PharmD
Aaron J. Ruberto, MD; Heather Murray, MD, FRCPC
KoKo Aung, MD, MPH; Thwe Htay, MD
Flavia Kessler Borges, MD, PhD; P.J. Devereaux, MD, PhD
Geno J. Merli, MD; Howard H. Weitz, MD
Annals Consult Guys brings a new perspective to the art and science of medicine with lively discussion and analysis of real-world cases and situations.
Darren B. Taichman, MD, PhD
David H. Wesorick, MD; Vineet Chopra, MD, MSc
Payal K. Patel, MD, MPH; Sanjay Saint, MD, MPH
Anne L. Stephenson, MD, PhD; Jenna Sykes, MMath; Sanja Stanojevic, PhD; Bradley S. Quon, MD, MSc; Bruce C. Marshall, MD; Kristofer Petren, BA, BSc; Josh Ostrenga, MSc; Aliza K. Fink, DSc; Alexander Elbert, PhD; Christopher H. Goss, MD, MSc
Previous studies suggested important differences in survival between patients with cystic fibrosis in Canada and those in the United States but were limited by discrepancies in the way national databases have been assembled. This study used comparable data from large Canadian and U.S. registries to better assess differences in survival and variables that might be associated with them.
James J. Chamberlain, MD; William H. Herman, MD, MPH; Sandra Leal, PharmD; Andrew S. Rhinehart, MD; Jay H. Shubrook, DO; Neil Skolnik, MD; Rita Rastogi Kalyani, MD, MHS
The American Diabetes Association annually updates the Standards of Medical Care in Diabetes. This synopsis focuses on the recommendations from the 2017 Standards about pharmacologic approaches to glycemic treatment for type 2 diabetes.
Joshua M. Liao, MD; Catharine B. Stack, PhD; Michael E. Griswold, PhD; A. Russell Localio, PhD
A randomized trial aims to reduce bias in comparing 2 or more treatments. An intention-to-treat (ITT) analysis theoretically evaluates all participants within their original randomized group in an attempt to fulfill this primary aim. In practice, however, a true ITT analysis often is difficult when not all patients complete the trial or fully adhere to randomized treatments. Despite the challenges of dropout and nonadherence, investigators routinely report that “ITT analyses were conducted” without further explanation. This brief tutorial aims to help clinicians assess the clinical relevance of results from ITT analyses and decide whether results from additional analyses may be helpful.
Patrick A. Flume, MD; Donald R. VanDevanter, PhD
In this issue, Stephenson and colleagues report a sobering comparison of cystic fibrosis survival between Canada and the United States that shows a marked advantage for Canadians beginning around 1995 and increasing to the current gap of approximately 10 years. The editorialists discuss possible explanations for the survival gap and conclude that differences in the health care systems between the 2 countries are the most likely contributor.
Megan E. Roerink, MD; Sebastian J.H. Bredie, MD, PhD; Michael Heijnen; Charles A. Dinarello, MD; Hans Knoop, PhD; Jos W.M. Van der Meer, MD, PhD
Few proven effective treatments exist for chronic fatigue syndrome (CFS). This randomized, placebo-controlled trial evaluated the benefits and harms of anakinra, an interleukin-1 receptor antagonist, for women with CFS and severe fatigue leading to functional impairment.
Kirsten Bibbins-Domingo, PhD, MD, MAS; Evelyn Whitlock, MD, MPH; Tracy Wolff, MD, MPH; Quyen Ngo-Metzger, MD, MPH; William R. Phillips, MD, MPH; Karina W. Davidson, PhD, MASc; Alex H. Krist, MD, MPH; Jennifer S. Lin, MD, MCR; Carol M. Mangione, MD, MSPH; Ann E. Kurth, PhD, CNM, MSN, MPH; Francisco A.R. García, MD, MPH; Susan J. Curry, PhD; David C. Grossman, MD, MPH; C. Seth Landefeld, MD; John W. Epling, Jr., MD, MSEd; Albert L. Siu, MD, MSPH
This paper describes the principles and considerations that the U.S. Preventive Services Task Force uses to develop recommendations for specific U.S. populations.
Marian E. Betz, MD, MPH; Megan L. Ranney, MD, MPH; Garen J. Wintemute, MD, MPH
The recent overturning of a Florida law that sought to limit discussions of firearm safety reassures physicians and patients that these conversations are protected. The authors discuss factors that motivated the law, why it was struck down, and the implications for patient safety.
William W. Pinsky, MD
The future supply of physicians in the United States will not be adequate to meet the country's health care needs. Internationally educated physicians currently account for approximately one fourth of the practicing physician workforce and will continue to play a critical role in the delivery of health care services. This commentary discusses the current vetting process for international medical graduates and outlines their importance to quality health care delivery in the United States and their subsequent contribution to the safety of the country.
Jonathan D. Moreno, PhD
The release of the National Academies of Sciences, Engineering, and Medicine report on human gene editing signifies an effort to establish responsible policies and practices in a fast-moving new field of science. This commentary notes that from publication to moratorium to self-governance, the community's response to the emergence of CRISPR/Cas9 has followed a pattern remarkably similar to the recombinant DNA story. Whether the postscript for genome editing will also resemble the largely favorable reviews given the recombinant DNA tale is now the outstanding question.
Joshua M. Liao, MD; Catharine B. Stack, PhD
This article aims to help clinicians understand the implications of missing data due to dropout, a common problem that can affect the validity of clinical trial findings. Several analytic methods exist to handle this problem. Understanding the assumptions behind these methods can help clinicians decide whether and how to incorporate clinical trial findings into their own practice.
Kim L. Bennell, BAppSci(Physio), PhD; Rachel Nelligan, BPhysio; Fiona Dobson, BAppSci(Physio), PhD; Christine Rini, PhD; Francis Keefe, BA, MS, PhD; Jessica Kasza, BSc(Hons), PhD; Simon French, BAppSc(Chiro), MPH, PhD; Christina Bryant, MA(Clin Psych), PhD; Andrew Dalwood, BAppSci(Physio), GradDipManipTherapy; J. Haxby Abbott, PhD, DPT; Rana S. Hinman, BPhysio(Hons), PhD
Effective and accessible biopsychosocial treatments are needed to manage chronic knee pain on a population level. In this parallel-group randomized, controlled trial, the authors evaluated the effectiveness of an Internet-based intervention combining physiotherapist-prescribed home exercise delivered via videoconferencing and automated pain-coping skills training in addition to educational material in persons with chronic knee pain.
Corrine I. Voils, PhD; Maren K. Olsen, PhD; Jennifer M. Gierisch, PhD; Megan A. McVay, PhD; Janet M. Grubber, MSPH; Leslie Gaillard, MPH, RD; Jamiyla Bolton, MS; Matthew L. Maciejewski, PhD; Elizabeth Strawbridge, MPH, RD; William S. Yancy, Jr., MD, MHS
Weight regain after intentional weight loss is a common problem. In this randomized, usual care–controlled trial, investigators examined the efficacy of a low-cost intervention for maintaining weight loss.
Khameer K. Kidia, MPhil
As he prepares his match list, an international medical student reflects on how possible changes in U.S. immigration policy and the Patient Protection and Affordable Care Act could affect his own future as well as the flow of medical knowledge and talent in and out of the United States.
Steffie Woolhandler, MD, MPH; David U. Himmelstein, MD
President Trump and congressional Republicans have vowed to repeal and replace the Patient Protection and Affordable Care Act. The president has promised universal coverage and reduced deductibles and copayments, all within tight budgetary constraints. That is a tall order, unlikely to be filled by proposals that Republicans have offered thus far. Although these proposals would probably not achieve President Trump's triple aim—more coverage, better benefits, and lower costs—single-payer reform could.
Lisa A. Mandl, MD, MPH
Bennell and colleagues present the results from a randomized, controlled trial evaluating whether delivering nonpharmacologic therapy via the Internet can improve pain and decrease disability in persons with knee pain. The editorialist discusses the results of the study and the promise of telemedicine interventions for persons with chronic osteoarthritis.
Roger Chou, MD; Richard Deyo, MD, MPH; Janna Friedly, MD; Andrea Skelly, PhD, MPH; Robin Hashimoto, PhD; Melissa Weimer, DO, MCR; Rochelle Fu, PhD; Tracy Dana, MLS; Paul Kraegel, MSW; Jessica Griffin, MS; Sara Grusing, BA; Erika D. Brodt, BS
This systematic review for a clinical practice guideline by the American College of Physicians summarizes evidence about the benefits and harms of nonpharmacologic therapies, including acupuncture, exercise, tai chi, yoga, massage, mindfulness-based stress reduction, psychological therapies, and spinal manipulation, for adults with acute or chronic low back pain.
Roger Chou, MD; Richard Deyo, MD, MPH; Janna Friedly, MD; Andrea Skelly, PhD, MPH; Melissa Weimer, DO, MCR; Rochelle Fu, PhD; Tracy Dana, MLS; Paul Kraegel, MSW; Jessica Griffin, MS; Sara Grusing, BA
This systematic review for a clinical practice guideline by the American College of Physicians summarizes evidence about the benefits and harms of systemic pharmacologic therapies, including acetaminophen, benzodiazepines and antidepressants, corticosteroids, nonsteroidal anti-inflammatory drugs, opioids, skeletal muscle relaxants, and such antiseizure medications as gabapentin, for adults with acute or chronic low back pain.
Amir Qaseem, MD, PhD, MHA; Timothy J. Wilt, MD, MPH; Robert M. McLean, MD; Mary Ann Forciea, MD; for the Clinical Guidelines Committee of the American College of Physicians
This guideline from the American College of Physicians provides clinical recommendations about noninvasive pharmacologic and nonpharmacologic treatment of low back pain.
Steven J. Atlas, MD, MPH
This issue includes systematic reviews of noninvasive pharmacologic and nonpharmacologic therapies for low back pain and accompanying practice recommendations from the American College of Physicians. The editorialist discusses how increased use of effective treatments, whether for acute symptoms or chronic, disabling pain, would benefit patients, clinicians, and insurers. He discusses the need for pragmatic studies to fill evidence gaps and strategies to reduce the use of low-value services, such as payer coverage policies based on guideline recommendations, patient engagement, and pressure on insurers to cover nonpharmacologic, noninvasive therapies with demonstrated benefit.
Nathalie Wenger, MD; Marie Méan, MD; Julien Castioni, MD; Pedro Marques-Vidal, MD, PhD; Gérard Waeber, MD; Antoine Garnier, MD, MBA
Little current evidence documents how internal medicine residents spend their time at work. This study recorded internal medicine residents' activities at a Swiss teaching hospital and found that they spend more time at work than scheduled. Activities indirectly related to patients predominated, with direct patient care coming in second, and about half the workday was spent using a computer.
Hugo Torres, MD, MPH; Elisabeth Poorman, MD, MPH; Uma Tadepalli, MD; Cynthia Schoettler, MD, MPH; Chin Ho Fung, MD; Nicole Mushero, MD, PhD; Lauren Campbell, MD, MPH; Gaurab Basu, MD, MPH; Danny McCormick, MD MPH
Persons who have a chronic disease need more medical care than most others. As a result, they might benefit more from expanded insurance coverage and sign up early for coverage. Torres and colleagues studied a nationally representative, noninstitutionalized sample of U.S. adults aged 18 to 64 years who had a chronic disease before and after implementation of the Patient Protection and Affordable Care Act. The investigators kept track of the following self-reported outcomes: having insurance, having a personal physician, having a checkup, and not having to miss a physician visit because of cost.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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