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.
Justin Barr, MD, PhD
Over the past 500 years, clinicians have applied contemporary medical knowledge in an effort to understand, diagnose, and treat aortic aneurysms through highly innovative yet largely unsuccessful interventions that have culminated in modern surgical cures.
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.
Venkataraman Palabindala, MD
Thomas DeLoughery, MD, MACP, FAWM
Bruce E. Johnson, MD; Elvis R. Pagan, MD
Simon O'Connor, MBBS, FRACP
Anna C. Juncadella, MD; Joseph D. Feuerstein, MD
Daniel I. Steinberg, MD
Eric R. Bates, MD
Richard G. Bach, MD
Steven M. Belknap, MD, FACP, FCP
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
Jennifer Meddings, MD, MSc; Laurence F. McMahon, Jr., MD, MPH
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.
Lion Shahab, PhD; Maciej L. Goniewicz, PhD; Benjamin C. Blount, PhD; Jamie Brown, PhD; Ann McNeill, PhD; K. Udeni Alwis, PhD; June Feng, PhD; Lanqing Wang, PhD; Robert West, PhD
E-cigarettes have been suggested as an alternative to nicotine replacement therapy (NRT) to reduce harms for persons who smoke combustible cigarettes. Whether toxin exposure is lower among combustible cigarette smokers who switch to e-cigarettes, however, has not been established. This study compared levels of carcinogens and nicotine among current and former combustible cigarette smokers, e-cigarette and NRT users, and those using combinations of these products.
John A. Harris, MD, MSc; Elena Byhoff, MD, MSc; Chithra R. Perumalswami, MD, MSc; Kenneth M. Langa, MD, PhD; Alexi A. Wright, MD, MPH; Jennifer J. Griggs, MD, MPH
Obesity complicates medical, nursing, and informal care in severe illness, but its effect on hospice use (a cornerstone of end-of-life care) and Medicare expenditures is unknown. In this retrospective cohort study of deceased Medicare fee-for-service beneficiaries in the Health and Retirement Study, the authors sought to describe the associations between body mass index and hospice use and Medicare expenditures in the last 6 months of life.
Hal C. Lawrence, MD; Debra L. Ness, MS
For more than 100 years, Planned Parenthood has served communities in need of affordable, safe, and accessible care. Despite trusted ties between Planned Parenthood health centers and communities across the nation, congressional leadership recently announced its intention to defund Planned Parenthood. Leaders from the American Congress of Obstetricians and Gynecologists and the National Partnership for Women and Families discuss the adverse consequences that defunding would have on the health of women in the United States.
Joan A. Reid, PhD; Tara N. Richards, PhD; Thomas A. Loughran, PhD; Edward P. Mulvey, PhD
Gun violence and psychological problems are often conflated in public discourse on gun safety. However, few studies have empirically assessed the effect of exposure to violence when exploring the association between gun carrying and psychological distress. This study of youths found guilty of a serious criminal offense found that the relationship between psychological distress and gun carrying seems to be influenced by exposure to violence.
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.
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 their increased use in clinical practice, it is not known whether in-home sleep studies lead to similar diagnostic and therapeutic decisions and similar patient outcomes compared with full laboratory polysomnography (PSG). 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 versus the more limited information available from in-home studies.
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 sleep apnea in patients with low pretest probability for obstructive sleep apnea (OSA) or in selecting therapies other than continuous positive airway pressure. The study by Chai-Coetzer and colleagues provides welcome insights. The editorialists discuss the findings and call for professional medical societies, payers, and other stakeholders to collaborate to ensure an economically viable strategy of replacing in-laboratory polysomnography with home testing in the routine evaluation of OSA.
Kelli D. Allen, PhD; Eugene Z. Oddone, MD, MHSc; Cynthia J. Coffman, PhD; Amy S. Jeffreys, MStat; Hayden B. Bosworth, PhD; Ranee Chatterjee, MD, MPH; Jennifer McDuffie, PhD; Jennifer L. Strauss; William S. Yancy, Jr., MD, MHS; Santanu K. Datta, PhD MHS; Leonor Corsino, MD, MHS; Rowena J. Dolor, MD, MHS
Gaps in the use of recommended strategies to manage osteoarthritis might be addressed by interventions aimed at health care providers or patients. This randomized trial evaluated the effects on physical function and symptoms of patient- and provider-targeted interventions aimed at increasing the use of recommended management strategies for hip or knee osteoarthritis.
Jessica Weiss, MD, MCR; Michele Freeman, MPH; Allison Low, BA; Rochelle Fu, PhD; Amy Kerfoot, MD; Robin Paynter, MLIS; Makalapua Motu'apuaka, BS; Karli Kondo, PhD; Devan Kansagara, MD, MCR
Although some guidelines recommend a systolic blood pressure target of less than 150 mm Hg for adults aged 60 years or older, results from a recent trial suggest a lower target may be optimal. This systematic review summarizes evidence from 21 trials and 3 observational studies about the benefits and harms of more versus less intensive blood pressure control in older adults.
Amir Qaseem, MD, PhD, MHA; Timothy J. Wilt, MD, MPH; Robert Rich, MD; Linda L. Humphrey, MD, MPH; Jennifer Frost, MD; Mary Ann Forciea, MD; for the Clinical Guidelines Committee of the American College of Physicians and the Commission on Health of the Public and Science of the American Academy of Family Physicians
This jointly developed guideline from the American College of Physicians and the American Academy of Family Physicians provides recommendations about the benefits and harms of higher versus lower blood pressure targets for the treatment of hypertension in adults aged 60 years or older.
Michael Pignone, MD, MPH; Anthony J. Viera, MD, MPH
The American College of Physicians and American Academy of Family Physicians report an evidence-based guideline for the pharmacologic management of hypertension in adults aged 60 years or older. The editorialists discuss the guidelines and provide advice for implementation of an office-based program to help achieve optimal outcomes for the treatment of hypertension.
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, this study assessed the association of screening with the size of detected tumors and estimated that a substantial proportion of breast tumors detected represent overdiagnosis—screening-detected tumors that would not become clinically relevant during a woman's lifetime.
Aaron Mendelson, BA; Karli Kondo, PhD; Cheryl Damberg, PhD; Allison Low, BA; Makalapua Motu'apuaka, 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.
In this opinion piece, the author discusses the plans of the incoming Trump administration and Republican-controlled Congress to repeal and replace the Patient Protection and Affordable Care Act and urges U.S. physicians to resist repeal and demand to see a replacement plan first.
Otis W. Brawley, MD
Jørgensen and colleagues compare 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.
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 assign penalties or rewards to 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.
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 conducted a thought experiment 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.
Sanjay Kaul, MD
Basu and coworkers present an innovative approach using microsimulation modeling to explore heterogeneous treatment effects. 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.
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.
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