Gi Hyeon Seo, MD; Tae Hyuk Kim, MD, PhD; Jae Hoon Chung, MD, PhD
Using a national database of nearly 3 million completed pregnancies, the authors analyzed the risk for congenital malformations associated with different antithyroid drugs used to treat Graves disease during the first trimester.
Divya Ravi, MD, MPH; Mehrnaz Ghasemiesfe, MD; Deborah Korenstein, MD; Thomas Cascino, MD; Salomeh Keyhani, MD, MPH
This systematic review of 24 observational studies examines the associations between marijuana use and vascular risk factors (hyperglycemia, diabetes, dyslipidemia, and obesity) and clinical outcomes (stroke, myocardial infarction, and cardiovascular mortality).
Robert M. Carey, MD; Paul K. Whelton, MB, MD, MSc; for the 2017 ACC/AHA Hypertension Guideline Writing Committee
In November 2017, the American College of Cardiology (ACC) and the American Heart Association (AHA) released a clinical practice guideline for the prevention, detection, evaluation, and treatment of high blood pressure in adults. This synopsis summarizes the major recommendations from the guideline.
Robert M. Carey, MD; Paul K. Whelton, MB, MD, MSc
The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults is the first comprehensive clinical practice guideline for hypertension since the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) in 2003. This commentary discusses the four ACC/AHA recommendations that differ substantially from those in JNC-7.
Timothy J. Wilt, MD, MPH; Devan Kansagara, MD, MCR; Amir Qaseem, MD, PhD; for the Clinical Guidelines Committee of the American College of Physicians
The recent hypertension guideline from the American College of Cardiology and the American Heart Association raises important questions about hypertension diagnosis and treatment but differs substantially from guidelines issued by other organizations. The editorialists discuss the ways in which the guideline falls short in weighing the potential benefits against potential harms, costs, and anticipated variation in individual-patient preferences, specifically for adults older than 60 years.
Steven M. Teutsch, MD, MPH; Timothy S. Naimi, MD, MPH
Despite decades of progress, more than 10 000 alcohol-related driving fatalities occur each year. To identify ways of reinvigorating efforts to stem these tragic events, the National Highway Traffic Safety Administration asked the National Academies of Sciences, Engineering, and Medicine to form a committee to do a rigorous study of the problem and make recommendations. This commentary highlights the recommendations.
Malin Hultcrantz, MD, PhD; Magnus Björkholm, MD, PhD; Paul W. Dickman, MSc, PhD; Ola Landgren, MD, PhD; Åsa R. Derolf, MD, PhD; Sigurdur Y. Kristinsson, MD, PhD; Therese M.L. Andersson, MSc, PhD
Patients with myeloproliferative neoplasms (MPNs) have been reported to be at increased risk for thrombotic events, but no population-based study has estimated this excess risk compared with matched control participants. In this cohort study, the authors analyzed data on patients reported to the Swedish Cancer Register between 1987 and 2009 to assess risk for arterial and venous thrombosis among patients with MPNs compared with matched control participants.
Per E. Lønning, MD, PhD; Elisabet O. Berge, PhD; Merete Bjørnslett, PhD; Laura Minsaas, PhD; Ranjan Chrisanthar, PhD; Hildegunn Høberg-Vetti, MD; Cécile Dulary, MSc; Florence Busato, MSc; Silje Bjørneklett, MSc; Christine Eriksen, MSc; Reidun Kopperud, PhD; Ulrika Axcrona, MD; Ben Davidson, MD, PhD; Line Bjørge, MD, PhD; D. Gareth Evans, MD, PhD; Anthony Howell, MD, PhD; Helga B. Salvesen, MD, PhD; Imre Janszky, MD, PhD; Kristian Hveem, MD, PhD; Pål R. Romundstad, PhD; Lars J. Vatten, MD, PhD; Jörg Tost, PhD; Anne Dørum, MD, PhD; Stian Knappskog, PhD
Women who carry germline BRCA1 mutations have an increased risk for ovarian cancer, particularly the high-grade serous type. The authors conducted 2 large case–control studies to examine the association between normal tissue BRCA1 methylation and the risk for ovarian cancer overall as well as for high-grade serous ovarian cancer, low-grade serous ovarian cancer, and nonserous ovarian cancer.
Alison R. Moliterno, MD; Elizabeth V. Ratchford, MD
In this issue, Hultcrantz and colleagues report a study that examined thrombosis patterns in Swedish patients with myeloproliferative neoplasms (MPNs) diagnosed between 1987 and 2009 compared with matched control participants. The editorialists discuss the implications of the study's findings and highlight the keys to a personalized, precision medicine approach to primary and secondary thrombosis prevention for patients with MPNs.
Alexander Dobrovic, PhD
In their current Annals article, Lønning and colleagues report substantially increased BRCA1 promoter region methylation in patients with ovarian cancer relative to a control population in 2 independent case–control studies. The editorialist believes that this and previous studies make it clear that BRCA1 constitutional methylation is strongly associated with the same tumor types as BRCA1 mutation and thus may be seen as an alternate mechanism of BRCA1 inactivation, leading to an increased risk for breast or ovarian cancer in which tumors are methylated for BRCA1.
Michael J. Barry, MD
Part of being a doctor these days involves dealing with conflicts of interest in the health care system. I've always worried about my own conflicts of interest, whether in clinical care, education, or research.
Tejas Patel, MD, FASN; Vihas Patel, MD
Timothy S. Carey, MD, MPH; Alan Kinlaw, PhD
Alexander W. Chessman, MD
Calvin Hirsch, MD
Bruce E. Johnson, MD, FACP; Cynda Ann Johnson, MD, MBA
Martin R. Stockler, MBBS, MSc, FRACP
Mark J. Alberts, MD
Natalia Genere, MD; Victor M. Montori, MD, MSc
Thomas Fekete, MD, MACP
Darren B. Taichman, MD, PhD
David H. Wesorick, MD; Vineet Chopra, MD, MSc
Jason Stein, MD; Susan Shapiro, PhD, RN
How can we elevate the quality and efficiency of inpatient care? The authors of this commentary explain why it is time for radical, disruptive change in how we organize our patients and how we round on them.
Andrea Trombetti, MD; Mélany Hars, PhD; Fang-Chi Hsu, PhD; Kieran F. Reid, PhD; Timothy S. Church, MD, PhD; Thomas M. Gill, MD; Abby C. King, PhD; Christine K. Liu, MD; Todd M. Manini, PhD; Mary M. McDermott, MD; Anne B. Newman, MD; W. Jack Rejeski, PhD; Jack M. Guralnik, MD, PhD; Marco Pahor, MD; Roger A. Fielding, PhD; for the LIFE Study Investigators
Studies suggest that exercise-based interventions may improve physical functioning and prevent disability among frail older adults. This secondary analysis of a large multicenter randomized controlled trial involving sedentary older adults compared the effects of a structured physical activity program with those of health education on the risk for frailty. The authors also examined whether the participants' baseline frailty status modified the positive effects of the physical activity intervention on reducing major mobility disability.
Rahman Shah, MD; Mannu Nayyar, MD; Ion S. Jovin, MD, ScD; Abdul Rashid, MD; Beatrix R. Bondy, MD; Tai-Hwang M. Fan, MD, PhD; Michael P. Flaherty, MD, PhD; Sunil V. Rao, MD
This meta-analysis of recent landmark trials examines the benefits and harms of percutaneous closure of patent foramen ovale compared with medical therapy alone in patients with cryptogenic stroke.
Salvatore De Rosa, MD, PhD; Horst Sievert, MD; Jolanda Sabatino, MD; Alberto Polimeni, MD; Sabato Sorrentino, MD, PhD; Ciro Indolfi, MD
This meta-analysis of recent landmark trials examined the benefits and harms of percutaneous closure of patent foramen ovale compared with medical therapy alone in patients with cryptogenic stroke.
David L. Brody, MD, PhD
Chronic traumatic encephalopathy (CTE) has recently been the focus of extensive attention. To date, CTE has been found exclusively in persons with a history of head injuries, although not all have been diagnosed with concussions. This commentary addresses CTE diagnosis, prevention, treatment, and financial compensation for patients with a history of head trauma and their families.
Michael L. Cheng, MD; David B. Solit, MD
Cancer is defined by diverse somatic and germline alterations that promote aberrant cell growth. Tumor genomic profiling to guide therapy is now part of standard management in several solid tumor types. The authors discuss how recent technical advances in next-generation sequencing technology, coupled with decreasing costs, present a transformative opportunity to improve patient outcomes through implementation of routine, prospective tumor and germline genomic profiling.
Kenneth G. Castro, MD; Dabney P. Evans, PhD, MPH; Carlos Del Rio, MD; James W. Curran, MD, MPH
Recently, it was reported that Centers for Disease Control and Prevention (CDC) staff were advised to avoid using the following 7 words in budget documents: “vulnerable,” “entitlement,” “diversity,” “transgender,” “fetus,” “evidence-based,” and “science-based.” This commentary discusses the implications of such censorship on the work and credibility of the CDC and other U.S. government health organizations.
Austin B. Frakt, PhD; Craig Garthwaite, PhD
Through mergers and acquisitions, health care organizations are making large bets about the future of the U.S. medical landscape and the types of organizations that can ultimately succeed in it. There's been a recent uptick in vertical integration, such as hospitals buying physician practices and insurers buying providers. This commentary discusses the recently announced merger of CVS and Aetna and whether it will benefit consumers.
Rebecca T. Brown, MD, MPH; Kenneth E. Covinsky, MD, MPH
Studies suggest that exercise-based interventions may improve physical functioning and prevent disability among frail older adults. This secondary analysis of a large multicenter randomized controlled trial involving sedentary older adults compared the effects of a structured physical activity program versus health education on the risk of frailty. The authors also examined whether the participants' baseline frailty status modified the positive effects of the physical activity intervention on reducing major mobility disability.
William G. Kussmaul III, MD
Two meta-analyses in the current Annals make a case that the totality of available data favors patent foramen ovale (PFO) closure to prevent recurrent stroke in patients who, after work-up, are found to have a PFO and no other apparent cause. The editorialist discusses the findings and how they should be incorporated into clinical practice.
Vaibhav Kumar, MD; Joshua T. Cohen, PhD; David van Klaveren, PhD; Djøra I. Soeteman, PhD; John B. Wong, MD; Peter J. Neumann, ScD; David M. Kent, MD, MS
Lung cancer screening with low-dose computed tomography has been recommended for current and former smokers selected on the basis of criteria that approximate those that were used in a large randomized trial that demonstrated a mortality benefit. This study assessed whether being more specific in choosing patients with the highest predicted risk for lung cancer improves the performance of a population screening program.
Angela K. Green, MD, MSc; Peter Bach, MD, MAPP
In this issue, Cheung and colleagues argue for moving from lung cancer screening based on the National Lung Screening Trial eligibility criteria toward risk-based testing, and Kumar and colleagues examine the cost-effectiveness of risk-based screening. The editorialists discuss the findings of these studies and note that regardless of the criteria used to identify persons for testing, lung cancer screening remains woefully underused.
John Weiser, MD, MPH; Alejandro Perez, MPH; Heather Bradley, PhD; Hope King, PhD, MSPH; R. Luke Shouse, MD, MPH
Persons with HIV infection are at increased risk for hepatitis B virus infection. In this study, the authors used a nationally representative cross-sectional survey to estimate the prevalence of hepatitis B vaccination among U.S. patients receiving medical care for HIV infection.
Jefferson G. Williams, MD, MPH; Michael W. Bachman, MHS, EMT-P; Michael D. Lyons, BA, EMT-P; Benjamin B. Currie, EMT-P; Lawrence H. Brown, PhD; A. Wooten Jones, MPH, EMT-P; Jose G. Cabanas, MD, MPH; Alan K. Kronhaus, MD; J. Brent Myers, MD, MPH
Falling is a frequent problem for residents of assisted living facilities. The problem is aggravated when institutional policy requires transport to an emergency department after every fall, even when there is minimal injury or no injury. The paramedics who provide emergency medical services and some of the primary care physicians who provide care in 1 geographic area worked together to address this problem. The result was a remarkable improvement.
Neda Laiteerapong, MD, MS; Jennifer M. Cooper, MPH; M. Reza Skandari, PhD; Philip M. Clarke, PhD; Aaron N. Winn, PhD; Rochelle N. Naylor, MD; Elbert S. Huang, MD, MPH
Intensive glycemic control (glycated hemoglobin level <7%) is an established, cost-effective standard of care for patients with type 2 diabetes, but guidelines recommend individualizing glycemic goals on the basis of age, comorbidity, diabetes duration, and complications. In this study, the authors sought to estimate the cost-effectiveness of individualized control versus uniform intensive control for U.S. adults with diabetes diagnosed at age 30 years or older.
Matthew E. Growdon, MD, MPH; Sharon K. Inouye, MD, MPH
Williams and colleagues present the results of a prospective cohort study of an intervention to avoid unnecessary transport to the emergency department for residents in assisted living facilities residents who fall. The editorialists discuss the findings and conclude that the study provides an example of a much-needed health care innovation pushing our health system toward the triple aim of improving patient experience, population health, and costs of care.
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