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Guidelines recommend that adults at low risk for group A streptococcal pharyngitis be neither tested nor treated. Researchers developed a new disease prediction model that patients with sore throat could use to decide whether they need medical evaluation. The model uses historical features and real-time information about the local incidence of streptococcal pharyngitis. Widespread implementation of this new method could reduce unnecessary patient visits to clinicians for management of sore throat.

Topics: pharyngitis, sore throat, streptococcal, therapeutics
Cécilia Samieri, PhD; Qi Sun, MD, ScD; Mary K. Townsend, ScD; Stephanie E. Chiuve, ScD; Olivia I. Okereke, MD; Walter C. Willett, MD, DrPH; Meir Stampfer, MD, DrPH; and Francine Grodstein, ScD

Healthy eating is associated with lower mortality and lower incidence of some chronic diseases, but the relationship of diet to healthy aging is less well-defined. This large observational study found that women with healthier dietary patterns at midlife were more likely to survive past age 70 years without major chronic disease or major physical or cognitive impairment. Better diet quality at midlife seems to be linked to greater health and well-being in persons surviving to older ages.

Topics: aging, diet, chronic disease
Ingrid A. Binswanger, MD, MPH; Patrick J. Blatchford, PhD; Shane R. Mueller, MSW; and Marc F. Stern, MD

Former prisoners are at increased risk for death, particularly from drug-related causes. Researchers documented that, in Washington state from 1999 to 2009, the leading cause of death after prison release was overdose, especially from pharmaceutical opioids. Female former prisoners were at greater risk for overdose and opioid-related death than men. Interventions to reduce drug overdose, including overdose from pharmaceutical opioids, are needed for released prisoners.

Topics: opioid analgesics, cause of death, overdose, prisoners, opioid intoxication, correctional facilities, trend, ...
Jennifer S. Lin, MD, MCR; Elizabeth O’Connor, PhD; Rebecca C. Rossom, MD, MCR; Leslie A. Perdue, MPH; and Elizabeth Eckstrom, MD, MPH

This review examined the diagnostic accuracy of brief cognitive screening instruments and the benefits and harms of pharmacologic and nonpharmacologic interventions for early cognitive impairment. Several brief instruments were reasonably accurate tools to screen for cognitive impairment or dementia, but no evidence that screening improves decision making or outcomes was found. Whether interventions for patients or their caregivers have a clinically significant effect in persons with earlier detected cognitive impairment is still unclear.

Topics: dementia, caregiver, cognitive impairment, elderly, minimal cognitive impairment, cognitive ability
Virginia A. Moyer, MD, MPH, on behalf of the U.S. Preventive Services Task Force

The U.S. Preventive Services Task Force concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for primary hypertension in asymptomatic children and adolescents to prevent subsequent cardiovascular disease.

Topics: hypertension, essential, hypertension, cardiovascular diseases, hypertension, childhood
Robert B. Doherty; Ryan A. Crowley, for the Health and Public Policy Committee of the American College of Physicians*

The U.S. health care system is undergoing a shift from individual clinician practice toward team-based care. In this position paper, the American College of Physicians (ACP) presents its position on clinical care teams. The ACP believes that the principles of professionalism should guide the development of team-based and collaborative care models that are organized in ways that put patients' health and interests first.

Topics: health personnel, nurses, patient care team, primary health care, professionalism, physician assistant, ...
G. Stuart Mendenhall, MD

This commentary discusses how many words, particularly racial identifiers, used in patient presentations have been removed from the lexicon because of unacceptable connotations and how the relative medical and social importance of the racial identifier changes in the context of society.

Topics: cystic fibrosis, racial group, genetics, hydralazine-isosorbide dinitrate, social history, isosorbide dinitrate, hydralazine, ...

This commentary discusses 4 issues in measuring hospital readmissions—the denominator of the readmission rate, the observation period, risk adjustment, and hospital-associated mortality—that show how hospital- and population-based measures differ and why both perspectives are important.

Topics: patient readmission, accountability
Thomas R. Talbot, MD, MPH; Dale W. Bratzler, DO, MPH; Ruth M. Carrico, PhD, RN; Daniel J. Diekema, MD; Mary K. Hayden, MD; Susan S. Huang, MD, MPH; Deborah S. Yokoe, MD, MPH; Neil O. Fishman, MD, for the Healthcare Infection Control Practices Advisory Committee

The Healthcare Infection Control Practices Advisory Committee assessed the challenges of using health care–associated infection (HAI) surveillance data for external quality reporting. It formulated standards for the use of such data in external facility assessment to ensure valid comparisons. The recommendations advocate for consistent, objective, and independent application of accepted definitions with concomitant validation of HAIs and surveillance processes and discourages clinician veto and adjudication.

Topics: surveillance, medical, infectious disease prevention / control

In this issue, Fine and colleagues add to the debate on whether to treat or test patients with sore throat. The editorialist discusses the factors that should be considered before examining, testing, or treating these patients.

Topics: sore throat, pharyngitis

In this issue, Fine and colleagues retrospectively analyzed data from patients presenting with pharyngitis to derive a “home score” algorithm to identify whether further evaluation was needed. The editorialist discusses certain aspects of the home score that are concerning.

Topics: sore throat, streptococcal
Anna Reisman, MD

In this issue, the ACP outlines its position on dynamic clinical care teams. The editorialist, who is a general internist, discusses the ACP position and notes that a deep understanding of the roles and skills of all team members is essential to effective team-based care.

Topics: nurse practitioner, nurses, health personnel, primary health care, veterans, medical residencies, consensus, ...
Angela Golden, DNP, FNP-C; and Kenneth P. Miller, PhD, FNP-BC

In this issue, the ACP outlines its position on dynamic clinical care teams. The editorialists, who are nurse practitioners, take issue with the ACP's position that physicians are the most appropriate team leaders in most cases.

Topics: patient care team, health care systems, accountability, health personnel, nurse practitioner, nurses, ...

In this issue, the ACP outlines its position on dynamic clinical care teams. The editorialist discusses the challenges of team-based care to internal medicine and concludes that the principles offered by the ACP are a useful step toward addressing the problems that internal medicine will face.

Topics: internal medicine
Evan Bilstrom, MD
Includes: Audio/Video
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E. Anne MacGregor, MB, MD
Includes: CME
Topics: migraine disorders, headache
Topics: sore throat, streptococcal
Topics: hypertension
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