Marc R. Larochelle, MD, MPH; Dana Bernson, MPH; Thomas Land, PhD; Thomas J. Stopka, PhD, MHS; Na Wang, MA; Ziming Xuan, ScD, SM; Sarah M. Bagley, MD, MSc; Jane M. Liebschutz, MD, MPH; Alexander Y. Walley, MD, MSc
Patients who survive an opioid overdose are at increased risk for subsequent nonfatal and fatal events. This study evaluated overdose survivors to determine whether use of medications for opioid use disorder was associated with reduced mortality.
Elizabeth Selvin, PhD, MPH; Dan Wang, MS; Kunihiro Matsushita, MD, PhD; Morgan E. Grams, MD, PhD, MHS; Josef Coresh, MD, PhD, MHS
Current clinical guidelines require repeated testing (“2-sample testing”) to confirm an elevated fasting glucose or hemoglobin A1c level and reduce the possibility of a false-positive diagnosis of diabetes mellitus. In this study, the authors examined the prognostic performance of a single-sample confirmatory definition of undiagnosed diabetes in identifying persons who subsequently developed diabetes or related complications.
Nora D. Volkow, MD; Eric M. Wargo, PhD
In their article, Larochelle and colleagues provide convincing evidence of the benefits of methadone and buprenorphine in preventing opioid-related deaths in patients with a history of nonfatal opioid overdose. The editorialists discuss the findings and what they reveal about the challenges of overcoming barriers to broader use of medication-assisted treatment of opioid use disorder.
K.M. Venkat Narayan, MD, MSc, MBA; Ram Jagannathan, PhD
In this issue, Selvin and colleagues report the prognostic capability of “single-sample” definitions of confirmed (elevated levels of both fasting glucose and hemoglobin A1c) and unconfirmed (elevated fasting glucose level or elevated hemoglobin A1c level) undiagnosed diabetes to identify future risk for diagnosed diabetes and its complications. The editorialists discuss the promise of these findings (if they are confirmed in other populations) to improve the timing and efficiency of diabetes diagnosis.
Rosalind D. Kaplan, MD
I have run out of ideas. I have no plans. No new potions or lotions or patches or pills.
Faith T. Fitzgerald, MD
Acronyms have multiplied in unprecedented numbers. I often don't know what they mean—how can I know how I feel about their meaning?
Phoebe Prioleau, MD, MPH
Mat Rose, MD, CCFP
Adam G. Kelly, MD; Robert G. Holloway, MD, MPH
Brian Budenholzer, MD
Diego J. Maselli, MD; Jay I. Peters, MD
Eric R. Bates, MD
Brent A. Duran, DO; Robert G. Badgett, MD; Steven Q. Simpson, MD
Roland Staud, MD
Fergal J. O’Donoghue, MB, BCh, PhD, FRACP; Christine F. McDonald, MBBS, PhD, FRACP
Geno J. Merli, MD; Howard H. Weitz, MD
Drs. Merli and Weiss (the Consult Guys) and their expert guess address the questions of a viewer who wants to help his patients' risks for firearm-related harms but is not sure how to talk about firearms or whether it is legal.
Darren B. Taichman, MD, PhD
David H. Wesorick, MD; Vineet Chopra, MD, MSc
Charlie M. Wray, DO, MS; Hyung J. Cho, MD
Guideline recommendations do not cover the range of decisions that hospitalists make on a daily basis, leaving large areas of uncertainty that are often filled with unnecessary care. This commentary discusses why hospitalists are positioned to lead in acknowledging and confronting these “gray zones” of uncertainty and their contribution to overuse.
Lesley S. Park, PhD, MPH; Janet P. Tate, ScD, MPH; Keith Sigel, MD, MPH; Sheldon T. Brown, MD; Kristina Crothers, MD; Cynthia Gibert, MD; Matthew Bidwell Goetz, MD; David Rimland, MD; Maria C. Rodriguez-Barradas, MD; Roger J. Bedimo, MD; Amy C. Justice, MD, PhD; Robert Dubrow, MD, PhD
Patients with HIV infection have an excess risk for cancer. A large prospective cohort from the Veterans Affairs database was used to examine whether long-term HIV suppression resulting from sustained antiretroviral therapy reduced the incidence of AIDS-defining and non-AIDS-defining cancer.
Bradley Gray, PhD; Jonathan Vandergrift, MS; Bruce Landon, MD, MBA; James Reschovsky, PhD; Rebecca Lipner, PhD
Whether patient care is improved by physicians maintaining their American Board of Internal Medicine certification is not known. This study compared how often physicians who had maintained their certification met a group of performance measures compared with those who had not maintained their certification.
Lee Goldman, MD, MPH
In this issue, Gray and colleagues report that maintenance of certification is correlated with small improvements in performance on several Healthcare Effectiveness Data and Information Set (HEDIS) metrics. The editorialist discusses the findings, the most disturbing of which are the overall low rates at which HEDIS standards were met and the minimally better performance among physicians who maintained certification.
Steve Yadlowsky, MS; Rodney A. Hayward, MD; Jeremy B. Sussman, MD, MS; Robyn L. McClelland, PhD; Yuan-I Min, PhD; Sanjay Basu, MD, PhD
Current guidelines recommend aspirin, statins, and antihypertensive drugs to prevent coronary artery disease in high-risk persons. Deciding whether a person's risk is high enough to warrant these interventions requires calculating his or her 10-year risk for coronary artery disease using pooled cohort equations. These equations have been controversial since their release in 2013. This study describes similar equations that were developed using more modern patient cohorts and modified methods that avoid some statistical problems.
Sanket S. Dhruva, MD, MHS; Joseph S. Ross, MD, MHS; Wade L. Schulz, MD, PhD; Harlan M. Krumholz, MD, SM
Medical devices are required to have unique identifiers, which have the potential to provide data to improve patient safety. The authors discuss why this potential is not currently being realized and suggest ways to overcome the barriers.
Andrew Paul DeFilippis, MD, MSc; Patrick Trainor, MS, MA
In their article, Yadlowsky and colleagues evaluated 2 approaches for improving the pooled cohort equations to estimate cardiac risk. The editorialists discuss the findings and the need to develop increasingly accurate tools for cardiac risk estimation in specific patient populations.
Tanner J. Caverly, MD, MPH; Pianpian Cao, MPH; Rodney A. Hayward, MD; Rafael Meza, PhD
Although screening with low-dose computed tomography (LDCT) can reduce lung cancer mortality, the benefits may differ according to the balance of a patient's risk for lung cancer, his or her risk for dying of lung cancer or other causes, and his or her personal preferences with regard to screening. This study evaluated each of these variables to help guide physician–patient discussions about whether to pursue LDCT screening for lung cancer.
Benjamin L. Ebert, MD, PhD; Peter Libby, MD
The presence of a somatic mutation associated with hematologic cancer in the peripheral blood at a variant allele frequency of at least 2% in the absence of hematologic cancer defines clonal hematopoiesis of indeterminate potential (CHIP). CHIP is common, confers a risk for hematologic cancer of about 5% over 10 years, and is associated with a dramatic increase in cardiovascular risk independent of traditional risk factors. This commentary discusses CHIP's potential in cardiovascular risk assessment and as a biomarker for response to interventions to reduce cardiovascular risk.
Benjamin E. Berkman, JD, MPH; Wynter K. Miller, JD; Christine Grady, RN, PhD
Information from online geneology services might be used in manners not anticipated by consumers, including as forensic evidence in crime solving. The authors discuss the informed consent, privacy, and justice issues involved in such use.
Laurence F. McMahon Jr., MD, MPH; Vineet Chopra, MD, MSc
News that the CEOs of Amazon, Berkshire Hathaway, and JPMorgan Chase are coming together to combat high health care costs has been met with anticipation and skepticism. This commentary speculates on how these business giants might apply a Six Sigma approach to achieve the cost containment that has so far eluded the U.S. health care system.
Michael K. Gould, MD, MS
In this issue, Caverly and colleagues present the results of a sophisticated modeling analysis that explores the importance of disutilities in the lung cancer screening decision. The editorialist discusses the unavoidable tensions among the various goals of screening, the role of patient preferences, and how physicians can incorporate Caverly and colleagues' findings into their discussions with patients about lung cancer screening.
Lilia Cervantes, MD; Sara Richardson, RN; Rajeev Raghavan, MD; Nova Hou; Romana Hasnain-Wynia, PhD; Matthew K. Wynia, MD; Catherine Kleiner, PhD, RN; Michel Chonchol, MD; Allison Tong, PhD
In the United States, nearly half of undocumented immigrants with end-stage kidney disease receive hemodialysis only when they are evaluated in an emergency department and are found to have life-threatening renal failure (“emergency-only hemodialysis” [EOHD]). Little is known about how providing EOHD affects the clinicians involved. In this qualitative study, the authors used semistructured interviews to understand the experiences and perspectives of interdisciplinary clinicians providing direct care for undocumented patients who rely on EOHD.
Boris Draznin, MD, PhD; David M. Nathan, MD; Mary T. Korytkowski, MD; Marie E. McDonnell, MD; Sherita Hill Golden, MD, MHS; Mark H. Schutta, MD; William T. Cefalu, MD
This commentary by expert clinicians counters some of the recommendations regarding hemoglobin A1c targets for type 2 diabetes that were proposed in a recent American College of Physicians guideline.
Ashwini R. Sehgal, MD
The study by Cervantes and colleagues in this issue is the first to provide empirical evidence about the effects of emergency-only hemodialysis (EOHD) on professionalism. The editorialist discusses the findings, draws parallels between providing standard dialysis to undocumented immigrants and providing universal health coverage to U.S. citizens, and proposes an approach to address the problem of EOHD.
Hormuzd A. Katki, PhD; Stephanie A. Kovalchik, PhD; Lucia C. Petito, PhD; Li C. Cheung, PhD; Eric Jacobs, PhD; Ahmedin Jemal, PhD; Christine D. Berg, MD; Anil K. Chaturvedi, PhD
Guidelines recommend the use of individualized risk models to refer ever-smokers for lung cancer screening, but the performance of different models in selecting ever-smokers for screening is unknown. In this study, the authors compared the U.S. screening populations selected by 9 lung cancer risk models and examined the predictive performance of the models in 2 large, population-based U.S. cohorts.
Neeraj Sood, PhD; Diane Ung, JD; Anil Shankar, JD; Brian L. Strom, MD, MPH
This commentary proposes a novel strategy for increasing access to treatment for hepatitis C virus infection for Medicaid beneficiaries. It posits a drug purchasing strategy that encourages competition among drug manufacturers that could save money for states and vastly expand treatment.
Martin C. Tammemägi, DVM, MSc, PhD
In this issue, Katki and colleagues compare the performance of 9 lung cancer risk models in a representative sample of the U.S. population and investigate the similarities and differences in the populations of ever-smokers selected for screening by each model. The editorialist discusses issues that will require attention if the models are to be implemented in routine clinical practice.
Marian E. Betz, MD, MPH; Alexander D. McCourt, JD, MPH; Jon S. Vernick, JD, MPH; Megan L. Ranney, MD, MPH; Donovan T. Maust, MD, MS; Garen J. Wintemute, MD, MPH
Many persons in the United States support limiting firearm access for those whose mental illness would place them or others at heightened risk, but less attention has been paid to progressive cognitive impairment and firearm access. For persons with dementia, their family members, and their health care providers, discussions about firearm access strongly parallel discussions about driving. This commentary discusses when persons with dementia need to “give up the keys,” be they to a gun safe or a car, and how to do so.
N. Lance Downing, MD; David W. Bates, MD, MSc; Christopher A. Longhurst, MD, MS
The widespread adoption of electronic health records (EHRs) has been perceived as driving physician dissatisfaction and burnout. The authors of this essay present data comparing EHR use in other countries with that in the United States and offer a possible explanation of, and solutions to, a root cause of dissatisfaction with the EHR.
Ian A. Scott, MBBS, MHA, MEd
This commentary discusses intersections between machine learning and evidence-based medicine.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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