Judith M. Poldervaart, MD, PhD; Johannes B. Reitsma, MD, PhD; Barbra E. Backus, MD, PhD; Hendrik Koffijberg, PhD; Rolf F. Veldkamp, MD, PhD; Monique E. ten Haaf, MD; Yolande Appelman, MD, PhD; Herman F.J. Mannaerts, MD, PhD; Jan-Melle van Dantzig, MD, PhD; Madelon van den Heuvel, MD; Mohamed el Farissi, MD; Bernard J.W.M. Rensing, MD, PhD; Nicolette M.S.K.J. Ernst, MD, PhD; Ineke M.C. Dekker, MD; Frank R. den Hartog, MD; Thomas Oosterhof, MD, PhD; Ghizelda R. Lagerweij; Eugene M. Buijs, MD, PhD; Maarten W.J. van Hessen, MD, PhD; Marcel A.J. Landman, MD; Roland R.J. van Kimmenade, MD, PhD; Luc Cozijnsen, MD; Jeroen J.J. Bucx, MD, PhD; Clara E.E. van Ofwegen-Hanekamp, MD, PhD; Maarten-Jan Cramer, MD, PhD; A. Jacob Six, MD, PhD; Pieter A. Doevendans, MD, PhD; Arno W. Hoes, MD, PhD
Relatively few patients with chest pain have an acute coronary syndrome that requires prompt admission and treatment. The HEART score, which provides the physician with a formal recommendation for admission, observation, or discharge in individual patients, has shown promising results in external validation studies in various countries and hospital settings. In this stepped-wedge, cluster randomized trial, the authors measured the effect of use of the HEART score on patient outcomes and use of health care resources.
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.
John W. Pickering, PhD; Martin P. Than, MBBS; Louise Cullen, MBBS, PhD; Sally Aldous, MBChB, PhD; Ewoud ter Avest, MD, PhD; Richard Body, MBChB, PhD; Edward W. Carlton, MBChB; Paul Collinson, MBBChir, MD; Anne Marie Dupuy, MD, PhD; Ulf Ekelund, MD, PhD; Kai M. Eggers, MD, PhD; Christopher M. Florkowski, MBBS, MD; Yonathan Freund, MD, PhD; Peter George, MBBS; Steve Goodacre, MB, ChB, MSc, PhD; Jaimi H. Greenslade, PhD; Allan S. Jaffe, MD; Sarah J. Lord, MBBS, MSc; Arash Mokhtari, MD; Christian Mueller, MD; Andrew Munro, MBChB; Sebbane Mustapha, MD, PhD; William Parsonage, MBBS, DM; W. Frank Peacock, MD; Christopher Pemberton, PhD; A. Mark Richards, MD, PhD; Juan Sanchis, MD, PhD; Lukas P. Staub, MD, PhD; Richard Troughton, MBChB, PhD; Raphael Twerenbold, MD; Karin Wildi, MD; Joanna Young, PhD
High-sensitivity assays for cardiac troponin T (hs-cTnT) are sometimes used to rule out myocardial infarction. This systematic review of 11 cohort studies examines whether a single hs-cTnT measurement below the limit of detection in combination with a nonischemic electrocardiogram can successfully rule out myocardial infarction in patients presenting to emergency departments with possible acute coronary syndrome.
Liselotte N. Dyrbye, MD, MHPE; Mickey Trockel, MD, PhD; Erica Frank, MD, MPH; Kristine Olson, MD; Mark Linzer, MD; Jane Lemaire, MD; Stephen Swensen, MD, MMM; Tait Shanafelt, MD; Christine A. Sinsky, MD
Physician burnout seems to be increasing. In 2016, the American Medical Association gathered 32 experts in the study of health professional burnout to develop a national research agenda for this field. This commentary summarizes the group's recommendations for methodologically rigorous research in 6 dimensions to help address physician burnout.
Caroline Weinberg, MD, MPH
Science in under threat. Our society faces a dramatic flood of challenges, including restrictions on communicating scientific work and promises of budget cuts at major scientific institutions. It is tempting to believe that attacks against science happened all at once. In truth, the crisis we face today is driven by the subtle and steady debasing of science over decades.
David Shulkin, MD
In 2014, media accounts reported an access crisis involving long waitlists for health care and, worse, suggested that some veterans were dying while waiting for care. The newly appointed secretary of the U.S. Department of Veterans Affairs (VA) describes the response to this crisis and his vision for a VA of the future that is based on how veterans want to receive care.
Marleen Smits, PhD; Martijn Rutten, MD; Ellen Keizer, MSc; Michel Wensing, PhD; Gert Westert, PhD; Paul Giesen, MD, PhD
In the United States, some patients have difficulty receiving treatment because of overcrowding in emergency departments and limited access to other forms of care after regular office hours. Other countries have addressed this problem by integrating emergency care with other forms of after-hours care. This article describes how the approach is working in the Netherlands.
Florian Bruns, MD, MA; Tessa Chelouche, MD
Although Nazi medical authorities are often assumed to have spurned ethics, Nazi-influenced medical ethics became an important part of the curriculum at all German medical schools between 1939 and 1945. This suggests that medical ethics itself can be corrupted and that a political and public realm of reason and humanity may be more vital in preventing immoral medical conduct than formal instruction in medical ethics.
Christine Laine, MD, MPH; Darren B. Taichman, MD, PhD
On 22 April 2017, science supporters will take to the streets in the first March for Science. Progress toward improved health may be impaired when the politicization of science interferes with the pursuit of knowledge or the use of what has been learned. The authors decry such an approach and explain why it is imperative that we stand up for science.
David Dunt, MBBS, PhD; Rosemary McKenzie, PhD, MPH
In this issue, Smits and colleagues describe the arrival of a new era in the delivery of after-hours care in the Netherlands. The editorialists discuss the experience in the Netherlands and why it should inspire other countries to invest in high-quality after-hours services.
William G. Kussmaul III, MD
The editorialist discusses his experience with high-sensitivity cardiac troponin T testing and its paradoxical effect on hospital admissions, in light of Pickering and colleagues' study.
Stephen E. Wilkinson, MD
Alena Shantsila, MD; Gregory Y.H. Lip, MD
René Rodriguez-Gutierrez, MD; Victor M. Montori, MD
Donald A. Smith, MD, MPH
Dennis G. Maki, MD, MACP
Matthew Thompson, MBChB, MPH, DPhil; Terry Scott, MPA, PA-C
Angela Lowenstern, MD; L. Kristin Newby, MD, MHS
Christopher R. Carpenter, MD, MSc
Micelle Haydel, MD, FACEP
Sina Jasim, MD, MPH; Steven A Smith, MD
Nicholas Talley, MD, PhD, FRACP; Michael Potter, MBBS (Hons)
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
Lauren Clack, MSc; Hugo Sax, MD
Jason E. Goldstick, PhD; Patrick M. Carter, MD; Maureen A. Walton, MPH, PhD; Linda L. Dahlberg, PhD; Steven A. Sumner, MD, MSc; Marc A. Zimmerman, PhD; Rebecca M. Cunningham, MD
Emergency departments are an important setting for identifying youths and younger adults who are at increased risk for future firearm violence. This paper describes the development and initial validation of a brief measure that could be used to identify at-risk younger individuals in the emergency room setting.
Lisa M. Wilson, ScM; Casey M. Rebholz, PhD, MPH, MS; Ermias Jirru, MD, MPH; Marisa Chi Liu, MD, MPH; Allen Zhang, BS; Jessica Gayleard, BS; Yue Chu, MSPH; Karen A. Robinson, PhD
This systematic review of 13 trials addresses benefits and harms of osteoporosis medications, including bisphosphonates, teriparatide, raloxifene, and denosumab, for patients with chronic kidney disease.
Unjali P. Gujral, PhD; Eric Vittinghoff, PhD; Morgana Mongraw-Chaffin, PhD; Dhananjay Vaidya, PhD; Namratha R. Kandula, MD, MPH; Matthew Allison, MD, MPH; Jeffrey Carr, MD; Kiang Liu, PhD; K.M. Venkat Narayan, MD; Alka M. Kanaya, MD
The relationship between body weight and cardiometabolic abnormalities may vary by race and ethnicity. Some data on the prevalence of metabolic abnormality but normal weight (MAN) are available for certain U.S. racial/ethnic groups but not for others. This study presents data on the prevalence and correlates of MAN in members of 5 ethnic groups in the United States, including the relatively understudied South Asian and Chinese American populations.
Edward Yu, MS; Sylvia H. Ley, PhD, RD; JoAnn E. Manson, MD, DrPH; Walter Willett, MD, DrPH; Ambika Satija, ScD; Frank B. Hu, MD, PhD, MPH; Andrew Stokes, PhD
The relationship between body mass index (BMI) and all-cause mortality has been a focus of research and debate, with several studies showing a paradoxical association (lower mortality among persons who are overweight at baseline). In this study, the authors examined the relationship between maximum BMI over a 16-year period and all-cause and cause-specific mortality.
Gillian J. Buckley, PhD, MPH; Brian L. Strom, MD, MPH
This commentary describes the consensus report from the National Academies of Sciences, Engineering, and Medicine that proposes an innovative strategy to eliminate hepatitis B and C as public health problems in the United States.
Harlan M. Krumholz, MD, SM; Jeanie Kim, JD
The International Committee of Medical Journal Editors and others have proposed requiring trialists to share individual patient–level data from clinical trials with other researchers, but the logistics of data sharing are complicated. This commentary proposes data escrow as a mechanism in which researchers deposit data with a neutral third party that safeguards the data to facilitate sharing agreements.
Sachin Patel, MD, PhD; John W. Williams, Jr., MD, MHS; Robert B. Wallace, MD
The National Academies of Sciences, Engineering, and Medicine recently released a report on the health effects of cannabis and cannabinoids. In this commentary, Patel and colleagues highlight the major findings of that report.
Jean-Pierre Després, PhD
In an analysis of 3 prospective cohort studies, Yu and colleagues explore the relationship between maximum body mass index (BMI) over 16 years and subsequent mortality. The editorialist discusses the importance of moving beyond a single BMI measurement to refine the assessment of risk for death, especially among patients with a BMI in the overweight category who may receive mixed messages about their risk.
Robert J. Rushakoff, MD; Mary M. Sullivan, DNP; Heidemarie Windham MacMaster, PharmD; Arti D. Shah, MD; Alvin Rajkomar, MD; David V. Glidden, PhD; Michael A. Kohn, MD, MPP
Diabetes mellitus or uncontrolled hyperglycemia is common among inpatients and is associated with adverse outcomes. This study assessed the effect of a virtual glucose management service on inpatient glycemic control. The virtual service involved automated detection of uncontrolled blood glucose levels in inpatients and remote clinical review by diabetes clinical specialists who inserted treatment recommendations into the patients' electronic health record.
Ryan Crowley, BSJ; Neil Kirschner, PhD; Andrew S. Dunn, MD; Sue S. Bornstein, MD; for the Health and Public Policy Committee of the American College of Physicians
Substance abuse disorders involving illicit and prescription drugs pose a heavy societal burden, and access to care for these conditions is limited. In this position paper, the American College of Physicians provides policy recommendations aimed at decreasing the burden of substance abuse disorders in the United States.
Shari M. Erickson, MPH; Brooke Rockwern, MPH; Michelle Koltov, MPH; Robert McLean, MD; for the Medical Practice and Quality Committee of the American College of Physicians
The growing number of administrative tasks imposed on physicians, their practices, and their patients adds unnecessary costs to the U.S. health care system. Excessive administrative tasks also divert time and focus from more clinically important activities of physicians and their staff members, such as providing actual care to patients and improving quality. In this position paper, the American College of Physicians provides a framework for evaluating administrative tasks and proposes recommendations to reduce excessive administrative tasks in health care.
Dawn E. DeWitt, MD, MSc
The author contrasts her experience practicing general internal medicine in Australia and the United States and explains why she felt more joy in practice in Australia.
David A. Fleming, MD; Walter J. McDonald, MD
In these challenging times, physicians and health care organizations may need guidance to help stabilize their moral compass in response to a disruptive political and economic environment. The authors discuss The Charter on Professionalism for Health Care Organizations, a recently released document outlining tenets of professional behavior as well as behavior that supports professionalism. It is intended for use by hospitals and health care systems to create a more inclusive, welcoming, and healing environment of care; alleviate burnout; and provide ethical guidance for model hospital operations.
Christine A. Sinsky, MD
To address the growing number of administrative tasks in health care, as well as the direct and indirect costs of these tasks to patients, professionals, and the U.S. health care system, the American College of Physicians (ACP) has put forth a bold set of recommendations aimed at technology vendors, payers, measure developers, regulators, and other accountability organizations. The editorialist discusses the negative consequences of excessive administrative tasks and views the ACP recommendations as a timely call for greater evidence-based regulation and for a shared responsibility to create better value in health care.
Gerry Rayman, MD
Rushakoff and colleagues report improvements in inpatient glycemic control with use of a novel approach in which the electronic health record generated daily reports of out-of-range glucose values for review by a diabetes specialist, who then remotely reviewed the patients' glucose/insulin charts and recommended medication changes via an electronic note in the electronic health record. The editorialist discusses the strengths of this novel approach but speculates that a combination of virtual management with selected bedside care by diabetes specialists may lead to even better control.
Grace E. Farris, MD
Annals Graphic Medicine brings together original graphic narratives, comics, animation/video, and other creative forms by those who provide or receive health care. They address medically relevant topics##mdash;whether they be poignant, thought-provoking, or just plain entertaining.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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