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Evidence to guide the choice of therapy for acute and subacute neck pain is lacking. This randomized, controlled trial aimed to determine the short- and long-term relative efficacy of spinal manipulation therapy, medication, and home exercise with advice for acute and subacute neck pain. For pain, spinal manipulation therapy had a statistically significant advantage over medication after 8, 12, 26, and 52 weeks, and home exercise was superior to medication at 26 weeks. However, no statistically or clinically significant differences in pain were found between spinal manipulation and home exercise at any time point.
The Centers for Disease Control and Prevention's BioSense program uses only the chief complaint field of an electronic health record encounter note for biosurveillance for emerging diseases and bioterrorist attacks. This study found that a predictive model using data extracted from the whole encounter note of patients with influenza missed substantially fewer cases of influenza than a model that relied only on the chief complaint field. Incorporating data from the full encounter note into biosurveillance systems should be considered.
In-hospital mortality measures are widely used to assess hospital quality but may systematically favor hospitals with shorter lengths of stay. This study compared hospital performance for acute myocardial infarction, heart failure, and pneumonia by using 2 measures: in-hospital mortality and 30-day mortality. Performance classifications differed between the in-hospital and 30-day models of risk-standardized mortality rate for many hospitals, and mean length of stay was positively correlated with in-hospital mortality for all 3 conditions. These data suggest that performance measures based on in-hospital mortality favor hospitals with shorter lengths of stay.
Little is known about the quality of clinical practice guidelines in terms of choosing among medications to treat type 2 diabetes mellitus. This systematic review of 11 guidelines found that quality scores for the rigor of development and editorial independence varied greatly across the guidelines. Guidelines that received higher quality scores contained more recommendations that were consistent with the available evidence about the effectiveness of type 2 diabetes medications.
Researchers use the labels “case series” and “cohort study” inconsistently and sometimes incorrectly. This article reviews the differences between case series and cohort studies to help readers distinguish between the 2 study types.
Ten years ago, the United States experienced a deliberate act of bioterrorism, when anthrax spores were disseminated through the postal service. What transpired during the following difficult weeks, including how public health and federal government agencies performed, received both praise and criticism. In this article, 2 physicians involved in diagnosing the index case of anthrax and alerting authorities offer their perspective on these events and assert the critical role of clinicians in surveillance.
In this issue, Bronfort and colleagues report that spinal manipulation therapy was more effective than medication for neck pain but was similar in effectiveness to home exercise and advice. The editorialists discuss possible reasons for the marginally different effectiveness of the therapies and explore what this study tells primary care providers confronted with a patient with neck pain whose profile matches that of the study participants.
The articles by Bush and Perez and by Elkin and colleagues in this issue concern the role of clinicians and biosurveillance systems in detecting bioterrorism and emerging infections. The editorialists note that Bush and Perez's account of the anthrax attacks reminds us that “fortune favors the prepared mind.” Elkin and colleagues' study reminds us that the challenges for the next decade include learning how to select optimal biosurveillance systems and translate the information from these tools into concrete actions that improve public health.
The American College of Physicians Ethics Manual, published as a supplement to this issue, is an integral part of an ancient tradition. The editorialist highlights certain clear and specific recommendations in the Manual and praises it for taking a stand on current issues related to the practice environment.
This article outlines the current understanding of advanced dementia and identifies research priorities for the next decade. Opportunities for improvement include greater recognition of advanced dementia as a terminal illness, better treatment of distressing symptoms, increased access to hospice and palliative care services, and less use of costly and aggressive treatments that may be of limited clinical benefit. Priority areas include interventions that promote high-quality, goal-directed care; health policy research to identify strategies that incentivize cost-effective and evidence-based care; implementation studies of promising interventions and policies; and further development of disease-specific outcome measures.