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Observational studies suggest that biliopancreatic diversion with duodenal switch may lead to greater weight loss than gastric bypass. This study randomly assigned patients with a body mass index of 50 to 60 kg/m2 to undergo one or the other of these procedures. After 2 years, duodenal switch resulted in significantly greater reduction in body mass index and improved lipid measures, but nearly twice as many patients had adverse events. Because patients benefited from both types of bariatric surgery, the choice should consider patient preferences about benefits and harms associated with each option.
Although the relationships of individual lifestyle factors with type 2 diabetes are well-described, the risk that combinations of risk factors confer is not. This study collected information on diet, body size, exercise, smoking, and alcohol use in more than 200 000 adults without known cardiovascular disease, cancer, or diabetes at baseline and followed them for a decade. Results suggest that combinations of favorable lifestyle factors powerfully reduce the risk for diabetes and that addressing the full range of lifestyle factors will have the largest effect on population rates of diabetes.
Few studies have addressed associations between mild cognitive impairment and mortality. This study used the Short Portable Mental Status Questionnaire to screen for cognitive impairment in patients aged 60 to 102 years during primary care visits. Over about 15 years of follow-up and after comorbid conditions were controlled for, patients with moderate to severe cognitive impairment had the highest mortality, but even patients with mild impairment had higher mortality risk than those with normal cognition.
This systematic review identified 39 studies of variable quality that compared care during the housestaff transition at the start of the academic year with a control period or group. Studies with higher-quality designs and larger sample sizes more often showed increased mortality and decreased efficiency during changeover. Studies examining morbidity and medical errors were of lower quality and produced inconsistent results. Current evidence suggests that housestaff changeover is associated with some unfavorable outcomes in the hospital. Evidence is insufficient to determine whether particular staffing models during changeover are more or less problematic.
In this study, the investigators measured how long research participants took to review a 2833-word online informed consent document before indicating consent and whether they identified a masked hyperlink near the end of the document. A total of 23% of participants consented within 10 seconds, and 93% consented in less than the minimal predicted reading time; only 2.5% identified the masked hyperlink. These data suggest that we should reassess the value of current informed consent documents in protecting research participants.
When established ward patients are unexpectedly transferred to an intensive care unit, the ward team often ceases to follow them. This commentary argues that the advantages of following patients after such transfers outweigh the obstacles and that this sort of behavior undergirds professionalism.
The increase in opioid prescribing by primary care physicians in the past 20 years has outpaced the evidence regarding this practice. Greater opioid availability has been accompanied by an epidemic of misuse, abuse, and serious adverse events. Opioid-related risks may increase with dose, and cautious dosing may reduce both diversion potential and risks for adverse effects. Limiting long-term opioid therapy to patients for whom it provides decisive benefits could also reduce risks. The authors propose that greater caution and selectivity are needed in prescribing long-term opioid therapy.
In this issue, Søvik and colleagues report that patients who had duodenal switch surgery lost more weight and had greater improvements in cholesterol levels than those who had gastric bypass. Complication rates were substantial in both groups but were twice as high with duodenal switch. The editorialist explores the implications of these findings and concludes that we should seriously question whether duodenal switch has a role in the treatment of severely obese patients.
In this issue, Young and colleagues' systematic review suggests that housestaff changeover is associated with some adverse outcomes. The editorialists discuss these findings and argue that efficient, safe patient care throughout the year requires an approach that both recognizes the value of immersing trainees in the clinical environment and the need for seasoned mentorship, close supervision, and graduated clinical responsibilities.
Jane was 39 years old but didn't look it. Her tracheostomy prevented her from speaking, and her bed was surrounded by notebooks, pens, and the odd scraps of paper that she used when communicating with the rest of the world.
Like many physicians, I believed that belonging to the profession conferred some sort of immunity to disease—illness only happened to patients.