Cover photographer/subject: Jason Williams, MD
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Variability in blood pressure measurements across outpatient visits is frequently viewed as random fluctuation without clear prognostic importance. This study found that higher visit-to-visit variability of systolic blood pressure readings is associated with an increased risk for cardiovascular disease and mortality. Further studies are warranted to assess whether reducing such variation will alter the risk for adverse cardiovascular outcomes.
Among persons at average risk for colorectal cancer, several screening methods are recommended equally, with no evidence-based preference. In this cross-sectional study, the authors developed an index to stratify risk for advanced neoplasia among average-risk persons by identifying lower-risk groups for which noncolonoscopy screening strategies may be effective and efficient and a higher-risk group for which colonoscopy may be preferred.
This study examined associations between use of low-dose aspirin or non-aspirin nonsteroidal antiinflammatory drugs (NSAIDs) and colorectal cancer risk. Continuous use of low-dose aspirin for 5 years or longer and long-term, high-intensity use of nonaspirin NSAIDs were associated with decreased risk for colorectal cancer. Nonaspirin NSAIDs with the highest cyclooxygenase-2 selectivity were associated with the largest risk reductions.
Experts debate whether written informed consent from participants is ethically necessary for pragmatic trials that evaluate standard care interventions whose true comparative effectiveness is unknown. This national survey involving 2130 adults reports their opinions on the need for written consent, verbal consent, or general notification only.
Systematic differences in placebo interventions for osteoarthritis may substantially affect interpretation of the results of placebo-controlled trials. This network meta-analysis of 149 randomized trials in adults with knee osteoarthritis focuses on effects of 4 placebo types (oral, intra-articular, topical, and oral plus topical) on pain outcomes.
Epidural corticosteroids are commonly and increasingly being used to treat radiculopathy and spinal stenosis. This systematic review of 30 placebo-controlled trials examines the short- and long-term effects of these agents on pain, function, and risk for surgery.
Direct oral anticoagulants are making anticoagulation simpler for patients with atrial fibrillation who need protection from strokes. However, clinicians still have an important role to play in patient monitoring to ensure that these drugs are used as safely and effectively as possible. The authors of this guide provide a framework for monitoring patients receiving these drugs.
Because of concerns about the emergence of highly antibiotic-resistant bacteria, legislation was recently proposed to permit approval of new antibiotics on the basis of preliminary studies. In contrast, when staphylococci developed widespread resistance to penicillin in the 1950s, infectious disease experts argued strongly against similar proposals.
Blood pressure variation is the topic of this issue's discussion from the Annals archive.
In this issue, Imperiale and colleagues' cross-sectional study evaluates whether the odds of detecting advanced colorectal adenomas can be predicted using a simple algorithm among “average-risk” patients aged 50 to 80 years who are having their first screening colonoscopy. The editorialist views risk prediction as the Holy Grail of colorectal cancer prevention and screening and discusses scientific and policy issues that this study raises.
In this issue, Bannuru and colleagues' network metaanalysis examines the relative efficacy of different placebos given for knee osteoarthritis. The editorialists discuss how patient expectancy and contextual factors influence the placebo effect. They believe that randomized, placebo-controlled trial reports need to better recognize and account for placebo effects when comparing interventions.
In an odd turn of events, I recently had some free time, and my husband, an internist, suddenly lost his secretary. Thus, I became the secretary for his solo practice of internal medicine staffed by two.
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—whether they be poignant, thought-provoking, or just plain entertaining.