Olvert A. Berkhemer, MD, PhD; Jordi Borst, MD, PhD; Manon Kappelhof, MSc; Albert J. Yoo, MD, PhD; Lucie A. van den Berg, MD; Puck S.S. Fransen, MD; Debbie Beumer, MD; Wouter J. Schonewille, MD, PhD; Paul J. Nederkoorn, MD, PhD; Marieke J.H. Wermer, MD, PhD; Henk A. Marquering, PhD; Hester F. Lingsma, PhD; Yvo B.W.E.M. Roos, MD, PhD; Robert J. van Oostenbrugge, MD, PhD; Diederik W.J. Dippel, MD, PhD; Wim H. van Zwam, MD, PhD; Charles B.L.M. Majoie, MD, PhD; Bart J. Emmer, MD, PhD; Aad van der Lugt, MD, PhD; on behalf of the MR CLEAN investigators
Randomized clinical trials for patients with acute ischemic stroke from an intracranial occlusion of the anterior circulation have found benefit from intra-arterial therapies, such as thrombectomy followed by a retrievable stent. These trials have usually excluded patients who also had extracranial disease in the carotid arteries. However, the Multicenter Randomized Clinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands (MR CLEAN) included patients with extracranial occlusion of the internal carotid artery. This article reports whether therapy in the MR CLEAN trial was as effective for patients with extracranial disease as it was for patients who had only intracranial disease.
Stacey A. Fedewa, PhD, MPH; W. Dana Flanders, MD, DSc; Kevin C. Ward, PhD, MPH; Chun Chieh Lin, PhD; Ahmedin Jemal, DVM, PhD; Ann Goding Sauer, MSPH; Chyke A. Doubeni, MD, MPH; Michael Goodman, MD, MPH
In a population-based study of adults aged 66 to 75 years, the authors examined whether the risk of developing interval colorectal cancer after a colonoscopy differed by race/ethnicity, location of cancer, and physician polyp detection rate.
Aïda Bafeta, PhD; Amelie Yavchitz, MD, PhD; Carolina Riveros, MSc; Rui Batista, PharmD; Philippe Ravaud, MD, PhD
Fecal microbiota transplantation is a novel treatment option for some chronic diseases with altered gut microbiota. This analysis of 85 published reports examines studies in humans that assessed the efficacy or safety of fecal microbiota transplantation.
Jean P. Hall, PhD
High-risk pools are included as a state option in the American Health Care Act recently passed by the U.S. House of Representatives. These plans segregate persons with preexisting conditions from the broader insurance pool to a much smaller pool with others who have potentially high costs. This commentary discusses what we know about the past performance of high-risk pools and why reinstituting them would constitute a huge step backward for American health care policy.
Vincent B. Young, MD, PhD
Research on the human microbiome has opened new avenues to understanding the pathogenesis of a variety of conditions and to pursuing novel therapeutics that change the microbiome to restore health. Bafeta and colleagues report a systematic review that examined the methods described in 85 studies of fecal microbiota transplantation (FMT). The editorialist discusses the findings and proposes strategies for establishing standards for FMT research that will help ensure that we realize the potential effect that an understanding of the microbiome will have on health.
Emily P. Hyle, MD, MSc; Sowmya R. Rao, PhD; Emily S. Jentes, PhD, MPH; Amy Parker Fiebelkorn, MSN, MPH; Stefan H.F. Hagmann, MD, MSc; Allison Taylor Walker, PhD, MPH; Rochelle P. Walensky, MD, MPH; Edward T. Ryan, MD; Regina C. LaRocque, MD, MPH
Measles outbreaks in the United States are mostly due to index infections occurring in returning U.S. travelers. In a study of more than 40 000 travelers presenting to U.S. pretravel clinics, the authors assessed why those eligible for measles vaccination were not offered it or, if it was offered, why they refused it.
Krishna K. Patel, MD; Glen B. Taksler, PhD; Bo Hu, PhD; Michael B. Rothberg, MD, MPH
Guidelines differ regarding when to begin cholesterol screening in younger adults. Understanding the distribution of cardiovascular risks in this population may help identify the groups for whom cholesterol screening likely will not be beneficial. The authors analyzed data from the National Health and Nutrition Examination Survey to describe the prevalence of increased cardiovascular risk among young adults in the United States.
Valerie M. Vaughn, MD, MSc; Dmitry Shuster, MD; Mary A.M. Rogers, PhD; Jason Mann, MSA; Marisa L. Conte, MLIS; Sanjay Saint, MD, MPH; Vineet Chopra, MD, MSc
Hospitalizations for acute pancreatitis are common and costly. This systematic review of 11 randomized trials evaluates whether early feeding of adults hospitalized with acute pancreatitis affects length of hospital stay, mortality, and readmission rates.
J. Michael McWilliams, MD, PhD
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) aims to improve health care by rewarding clinicians providing higher-quality and lower-cost care who would receive increases in their Medicare reimbursement rates. Poorer performers would receive reductions in their rates. The author discusses how the design of MACRA will, however, result in unintended consequences and incentives that will increase health care disparities without reducing costs.
Kristen M. Roberts, PhD, RD, LD; Darwin Conwell, MD
Early enteral nutrition, defined as the provision of nutrients within 48 hours of hospitalization, has been associated with reduced mortality and complications compared with delayed enteral nutrition in patients with acute pancreatitis. Vaughn and colleagues report a systematic review of early versus delayed enteral nutrition. The editorialists discuss the results, why they should be interpreted with caution, and the evidence gaps in defining when and how to best feed patients with acute pancreatitis.
Paul M Ridker, MD, MPH; Nancy R. Cook, ScD
In this issue, Patel and colleagues estimate the prevalence of elevated atherosclerotic risk among nondiabetic adults younger than 50 years, with the stated aim of identifying subgroups for whom cholesterol screening would not provide actionable information. The authors thus suggest that their findings support delayed screening until age 40 years for men and 50 years for women. The editorialists discuss the limitations of the study and why they think the primary prevention of cardiovascular disease should include early-life evaluation of low-density lipoprotein cholesterol, not a delayed approach.
Lori K. Handy, MD, MSCE; Paul A. Offit, MD
In this issue, Hyle and colleagues report that only 47% of adults eligible for measles vaccine at a pretravel clinic visit were vaccinated. The editorialists note that efforts to increase measles immunization rates are focused mainly on young children and that the need to immunize unvaccinated travelers at risk for transmitting measles within the United States after international travel often is overlooked. They argue that vigilance is needed to ensure that travelers do not bring the virus back from overseas.
Michael A. LaCombe, MD
Lawrence J. Hergott, MD
Brenda Butka, MD
Shirin Shafazand, MD, MS, FAASM
Henry S. Sacks, PhD, MD
Matthew B. Stanbrook, MD, PhD
Fred Arthur Zar, MD
Nick Fitterman, MD; Varinder Singh, MD
Peter W. de Leeuw, MD
Calvin Hirsch, MD
Clare J. Lee, MD, MHS; Lawrence J. Cheskin, MD, FACP, FTOS
Daniel I. Steinberg, MD
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
Dana P. Edelson, MD, MS; Matthew M. Churpek, MD, MPH, PhD
Michael Silverman, MD; Marcus Povitz, MDCM, MSc; Jessica M. Sontrop, PhD; Lihua Li, PhD; Lucie Richard, MA; Sonny Cejic, MD; Salimah Z. Shariff, PhD
Reduction of inappropriate prescribing of antibiotics for acute upper respiratory tract infections has proven difficult and a more granular understanding of factors that lead to such prescribing is needed. This retrospective administrative database study examined physician level variables that predicted inappropriate prescribing of antibiotics to older adults with acute upper respiratory tract infections in Canada. Background:
Kathleen N. Ly, MPH; Ruth B. Jiles, PhD, MPH; Eyasu H. Teshale, MD; Monique A. Foster, MD, MPH; Rick L. Pesano, MD, PhD; Scott D. Holmberg, MD, MPH
Hepatitis C virus (HCV) infection is a critical public health threat to young U.S. adults who use drugs. Using 2 large databases, the authors estimated the number of U.S. women of reproductive age with HCV infection from 2011 to 2014, as well as the number of HCV-infected babies to whom they gave birth.
Amir Qaseem, MD, PhD, MHA; Mary Ann Forciea, MD; Robert M. McLean, MD; Thomas D. Denberg, MD, PhD; for the Clinical Guidelines Committee of the American College of Physicians
This guideline updates the American College of Physicians' recommendations on treatment of low bone density and osteoporosis to prevent fractures in men and women. Recommendations focus on the comparative benefits and risks of short- and long-term pharmacologic treatments for low bone density, including pharmaceutical prescriptions, calcium, vitamin D, and estrogen.
Barbara E. Jones, MD, MSc; Matthew H. Samore, MD
Silverman and colleagues report that among a low-risk cohort of elderly Canadian patients seen by primary care providers for acute upper respiratory infections, almost half received an inappropriate prescription for antibiotics. The editorialists discuss the study's findings and why they believe that the tipping point to a culture of judicious antibiotic use is within reach and clinicians are at the forefront of change.
Eric S. Orwoll, MD
The editorialist discusses the ACP guideline on treatment of low bone density or osteoporosis to prevent fractures and believes that the recommendations provide a solid foundation for informed clinical decisions about individual patients.
Alfred DeMaria Jr., MD
In this issue, Ly and colleagues explore the implications of the current hepatitis C virus (HCV) epidemic in reproductive-aged women and their babies. The editorial discusses the consequences of the opioid epidemic on HCV and the need to recognize infection in pregnant women and neonates if HCV is to be eliminated.
Sara Vogrin, MBBS, MBiostat; Richard Harper, MBBS; Elizabeth Paratz, MBBS; Andrew MacIsaac, MBBS; Jodie Burchell, PhD; Belinda Smith, MBBS; Anthony Scott, PhD; Jongsay Yong, PhD; Vijaya Sundararajan, MD, MPH
Current guidelines recommend routine invasive coronary angiography for patients with acute non–ST-segment elevation myocardial infarction. However, experts do not agree about adopting the same recommendation for patients with unstable angina. This study identified the outcomes of 33 901 patients hospitalized with unstable angina. The investigators compared outcomes of patients who had angiography during their first hospitalization with those of other patients by using advanced statistical methods to adjust for differences in patient characteristics. They found that it was the risk stratification of diagnostic angiography, not revascularization, that was associated with a survival benefit.
David Blumenthal, MD, MPP
As clinicians click and tap at their electronic health records, they may be unaware that they are fueling a huge public and private enterprise that will turn their patients' digitized health data into enormously valuable—and potentially profitable—new products. This commentary discusses the special circumstances associated with the creation of a vast pool of electronic patient information. These circumstances must be understood and addressed so that all parties contributing to this unparalleled resource are treated fairly.
Sanjit S. Jolly, MD, MSc; P.J. Devereaux, MD, PhD
In this issue, Vogrin and colleagues report a retrospective, observational study that reidentified the importance of the question regarding the effects of an invasive strategy in patients with unstable angina. The editorialists explain why this observational study is not sufficient to answer this question and advocate for a large, definitive randomized trial to evaluate the effects of a routine invasive strategy in patients with a diagnosis of unstable angina and a negative high-sensitivity troponin measurement.
Susan J. Bersoff-Matcha, MD; Kelly Cao, PharmD; Mihaela Jason, PharmD; Adebola Ajao, PhD; S. Christopher Jones, PharmD, MS, MPH; Tamra Meyer, PhD, MPH; Allen Brinker, MD, MS
Use of direct-acting antivirals (DAAs) to treat patients with hepatitis C virus (HCV) infection has become the standard of care. This report from the U.S. Food and Drug Administration focuses on an important safety concern when using DAAs in patients with HCV who are co-infected with hepatitis B.
Dennis Anheyer, MA; Heidemarie Haller, MSc; Jürgen Barth, PhD; Romy Lauche, PhD; Gustav Dobos, MD; Holger Cramer, PhD
Mindfulness-based interventions are forms of complementary therapy that are often used to treat chronic pain. In this systematic review and meta-analysis, the authors examined the effect of mindfulness-based stress reduction and mindfulness-based cognitive therapy programs on pain intensity, pain-related disability, quality of life, and other outcomes among patients with low back pain.
Andrew H. Talal, MD, MPH; Dave L. Thomas, MD; Jessica L. Reynolds, PhD; Jag H. Khalsa, MS, PhD
New direct-acting antiviral drugs for hepatitis C virus (HCV) infection are as effective in persons with substance use disorders (SUDs) as in others with this condition. However, HCV eradication rates among persons with SUDs are low and barriers specific to this population are present at each step of the HCV care cascade.
Camilla S. Graham, MD, MPH
In this issue, authors from the U.S. Food and Drug Administration (FDA) describe data submitted to the FDA Adverse Event Reporting System on 29 patients receiving hepatitis C virus treatment with direct-acting antiviral–based regimens who had reactivation of hepatitis B virus. The editorialist discusses the clinical implications of the findings regarding safety reporting after a drug's approval.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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