Cover photograph by Garrett M. Chinn, MD, MS
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IN THIS ISSUE
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The prevalence of diabetes in the United States has increased over the past 2 decades. The authors examined these trends using NHANES data and explored the roles of hemoglobin A1c and fasting plasma glucose measurements in diagnosing diabetes. The proportion of undiagnosed diabetes cases decreased over the course of NHANES and glycemic control improved overall. However, differences were noted in the prevalence of diabetes and prediabetes, as well as glycemic control, by age and race or ethnicity group.
Delirium is common among hospitalized older patients and is associated with poor outcomes. Reliable methods to quantify the severity of delirium are scarce, but this study validates a novel scale for delirium severity based on the Confusion Assessment Method. The authors describe the new scale and its relation to key clinical outcomes, including length of stay, functional decline, and nursing home placement or death at 90 days. The new scale may assist future research and treatments.
“Virtual” autopsy by postmortem computed tomography can replace medical autopsy to a certain extent but has limitations for cardiovascular diseases. This prospective cohort study compared findings from both types of autopsy in hospitalized patients who died unexpectedly or within 48 hours of an event necessitating cardiopulmonary resuscitation. The addition of angiography to postmortem computed tomography resulted in an ability to detect cardiovascular diagnoses similar to that of traditional medical autopsy.
Calcific and noncalcific tendinitis of the shoulder can be unresponsive to conventional therapies. This review assessed randomized, controlled trials comparing high-energy versus low-energy extracorporeal shock-wave therapy (ESWT) or placebo for treatment of calcific or noncalcific tendinitis of the shoulder. It found that high-energy ESWT is effective for improving pain and shoulder function in chronic calcific shoulder tendinitis and can result in complete resolution of calcifications.
Experts recommend that patients at risk for kidney disease be screened for albuminuria, which is typically assessed using the urinary albumin–creatinine ratio. This systematic review suggests that semiquantitative tests are not sufficiently accurate to rule out albuminuria in such patients but that quantitative tests meet diagnostic accuracy requirements and can be used.
The U.S. Preventive Services Task Force found that evidence on the benefits and harms of multivitamins and most single- or paired-nutrient supplements was insufficient to recommend for or against their use to prevent cardiovascular disease or cancer but recommended against use of β-carotene or vitamin E supplements.
The Physician Value-Based Payment Modifier (PVBPM) is the first national value-based purchasing program for physicians in fee-for-service Medicare. The concept of shifting from volume- to value-based payment embodied by the PVBPM is a radical change for the Medicare program. The authors discuss the implementation challenges associated with this reform and what they mean for the future of the PVBPM.
Starting in 2011, a cluster of infections caused by carbapenem-resistant Enterobacteriaceae (CRE) occurred at the National Institutes of Health Clinical Center. The authors of this commentary reflect on the experience and discuss ways to manage CRE and other multidrug-resistant organisms.
In September 2013, the American Board of Obstetrics and Gynecology revised its definition of “obstetrician-gynecologist,” which explicitly prohibited gynecologists from performing anoscopy (on men) and vasectomy. After intense pressure, it fully reversed its stance in early 2014. This commentary discusses the flaws in its initial decision.
In this issue, Selvin and colleagues assess the trends in diabetes, prediabetes, and glycemic control in the United States between 1988 and 2010. The editorialists discuss the findings and express the need for policies that focus on prevention to reduce prevalence of diabetes and obesity and the costs associated with them.
In this issue, Inouye and colleagues describe and validate a new scale for measuring delirium severity based on the existing Confusion Assessment Method. The editorialists discuss the value of the new scale and assert that it should facilitate future research about the effect of delirium on patient outcomes and can lead to earlier recognition and treatment.
I was sitting at the computer, reviewing a note in the electronic health record, when suddenly the software froze. I felt immediate frustration and anger.
It was a cloudy Monday morning in September, and Helen was my first patient. The hint of blush against her cheekbones provided contrast to the black-green bruise above her left eye.
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