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Peter J. Kaboli, MD, MS; Jorge T. Go, MD, MS; Jason Hockenberry, PhD; Justin M. Glasgow, BS, MS; Skyler R. Johnson, BS, MS; Gary E. Rosenthal, MD; Michael P. Jones, PhD; and Mary Vaughan-Sarrazin, PhD

Reducing hospital length of stay has been a priority for health care systems, but there is concern that overly aggressive reductions in length of stay could result in increased readmissions. In this study of patients admitted to Veterans Affairs hospitals for any of 5 common diagnoses from 1997 to 2010, the hospital length of stay and 30-day readmission and all-cause mortality rates decreased annually. These findings suggest that reductions in the length of hospitalizations were not accompanied by an increase in readmissions.

Topics: length of stay, patient readmission, hospitals, hospitals, veterans
  
Alexa B. Kimball, MD, MPH; Francisco Kerdel, MD; David Adams, MD, PharmD; Ulrich Mrowietz, MD; Joel M. Gelfand, MD, MSCE; Robert Gniadecki, MD; Errol P. Prens, MD, PhD; Joel Schlessinger, MD; Christos C. Zouboulis, MD, PhD; Hessel H. van der Zee, MD, PhD; Marie Rosenfeld, BA; Parvez Mulani, PhD; Yihua Gu, MS; Susan Paulson, PhD; Martin Okun, MD, PhD; and Gregor B.E. Jemec, MD, DMSc

Hidradenitis suppurativa (HS) is a chronic skin disease characterized by abscesses and draining fistulas in the axilla and groin. It is often refractory to antibiotic or surgical treatment. In this randomized, placebo-controlled trial, patients with moderate to severe HS who received weekly adalimumab had decreased pain and subjective improvement, as measured by a clinical scoring system at 16 weeks. Adalimumab may have a role in treating refractory HS.

Topics: hidradenitis suppurativa, adalimumab
  
María Elena Martínez*, PhD; Patricia Thompson, PhD; Karen Messer, PhD; Erin L. Ashbeck, MPH; David A. Lieberman, MD; John A. Baron, MD; Dennis J. Ahnen, MD; Douglas J. Robertson, MD; Elizabeth T. Jacobs, PhD; E. Robert Greenberg, MD; Amanda J. Cross, PhD; and Wendy Atkin*, PhD

Recommendations from the United States and the United Kingdom differ on risk stratification and monitoring after colonoscopic polypectomy. This pooled analysis of 4 prospective studies found that advanced neoplasia was detected 1 year after polypectomy in approximately 4% of patients classified as low-risk by either U.S. or U.K. criteria. Advanced neoplasia was detected in approximately 11% of patients classified as high-risk by U.S. criteria and 19% of those classified as high-risk by U.K. criteria. These observations suggest that, compared with the U.S. risk-stratification criteria, the U.K. criteria might better identify high-risk, postpolypectomy patients who warrant a 1-year clearing colonoscopy.

Topics: adenoma, colorectal neoplasms, guidelines, neoplasms, colonoscopy, surveillance, medical, stratification, polypectomy, colorectal cancer, ...
  
Rafael Zambelli Pinto, MSc; Chris G. Maher, PhD; Manuela L. Ferreira, PhD; Mark Hancock, PhD; Vinicius C. Oliveira, MSc; Andrew J. McLachlan, PhD; Bart Koes, PhD; and Paulo H. Ferreira, PhD

Therapeutic epidural injections for sciatica have become increasingly popular, but guidelines and systematic reviews on the efficacy of this approach have differing conclusions. This review assessed the efficacy of caudal, interlaminar, and transforaminal approaches to epidural corticosteroid injection for sciatica. Among 23 trials, high-quality evidence showed that epidural corticosteroid injections have small, short-term effects on leg pain and disability compared with placebo in patients with sciatica. However, corticosteroid injection seems to offer no benefit for low back pain and the observed reduction in leg pain did not persist over the long-term.

Topics: glucocorticoids, sciatica, epidural steroid injection, lower limb pain
  
Bradley C. Johnston, PhD; Stephanie S.Y. Ma, MD; Joshua Z. Goldenberg, BSc; Kristian Thorlund, PhD; Per O. Vandvik, MD, PhD; Mark Loeb, MD; and Gordon H. Guyatt, MD
Includes: CME | Audio/Video

Clostridium difficile–associated diarrhea (CDAD) occurs most often in patients who are exposed to broad-spectrum antibiotics. This review examined the efficacy and safety of probiotics (any strain or dose) for preventing CDAD in adults and children who were receiving antibiotics. It found moderate-quality evidence suggesting that probiotic prophylaxis reduces the risk for CDAD without an increase in clinically important adverse events.

Topics: diarrhea, probiotics, diarrhea, clostridium difficile, clostridium difficile (bacteria)
  
Sherilyn K.D. Houle, BSP; Finlay A. McAlister, MD, MSc; Cynthia A. Jackevicius, MSc, PharmD; Anderson W. Chuck, PhD, MPH; and Ross T. Tsuyuki, PharmD, MSc

Pay-for-performance (P4P) has gained popularity as a strategy to promote high-quality health care. This review identified 30 studies that compared P4P programs with other remuneration models for individual clinicians. Uncontrolled studies suggested that P4P improves quality of care, but higher-quality studies with contemporaneous controls did not confirm these findings. Four large U.K. analyses found that quality scores for incentivized indicators that were increasing for patients with target conditions before P4P did not increase at a faster rate after P4P. Whether P4P targeting individual clinicians improves quality of care and outcomes remains uncertain.

Topics: hypertension, quality of care, diabetes mellitus, type 2, chronic disease, fee for ...
  
Virginia A. Moyer, MD, MPH, on behalf of the U.S. Preventive Services Task Force*

This U.S. Preventive Services Task Force recommendation reaffirms its 2004 recommendation statement on screening for ovarian cancer. The USPSTF recommends against screening for ovarian cancer in women. The recommendation applies to asymptomatic women but does not apply to women with known genetic mutations that increase their risk for ovarian cancer.

Topics: ovarian cancer, screening, united states preventive services task force, women
  
Robert J. Ursano, MD; David M. Benedek, MD; and Charles C. Engel, MD, MPH

Posttraumatic stress disorder and depression are common after traumatic events in military or civilian life, but routine assessment for trauma-related disorders is not standard practice in emergency departments or in outpatient settings where many patients affected by trauma present. This commentary discusses “trauma-informed care”—the recognition, detection, and treatment of disorders that result from traumatic events.

Topics: primary health care, post-traumatic stress disorder, wars, combat trauma, combat-related post-traumatic stress ...
  
Nancy A. Rigotti, MD; and Melanie Wakefield, PhD
Includes: Audio/Video

This commentary discusses the Centers for Disease Control and Prevention's (CDC's) Tips From Former Smokers campaign, the first federally funded, nationwide mass media effort to encourage smokers to quit. The author discusses the CDC's goals and efforts to assess the impact of the campaign.

Topics: smoking, smoking cessation, advertising, mass media
  
Eugene Z. Oddone, MD, MHSc; and Morris Weinberger, PhD

In this issue, Kaboli and colleagues examined the relationship among hospital length of stay, readmission rates, and mortality for more than 4 million veterans hospitalized in Veterans Affairs acute care facilities. The editorialists discuss the study and what we know about hospital readmission as a quality indicator.

Topics: hospitals, patient readmission
  

In this issue, Houle and colleagues report that the effect of P4P on the quality of care of individual physicians remains uncertain. The editorialist discusses the P4P system and concludes that, while it likely has a role yet to be defined in our armamentarium, it is not a magic bullet.

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Patricio A. Pazmiño, MD, PhD
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Ryan P. Radecki, MD
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James Webster, MD, MS
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William C. Becker, MD; and David A. Fiellin, MD
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Hiroki Matsubara, BSc; Kyosuke Takeshita, MD, PhD; Shigeo Nakamura, MD, PhD; Toyoaki Murohara, MD, PhD; and Shigeru Miyachi, MD, PhD
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Holly Geyer, MD; Robyn Emanuel, MD; and Lynette Scherber
Includes: Audio/Video
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Topics: aspirin, clopidogrel, hemorrhage, infarction, lacunar, ischemic stroke
  
Topics: asthma, pulmonary function tests, tiotropium
  
Topics: asthma
  
Topics: omega-3 fatty acids, cardiovascular event
  
Topics: antihypertensive agents, hypertension
  
Topics: atrial fibrillation, warfarin, renal function, ischemic stroke, embolism, apixaban
  
Topics: pancreatitis, triglycerides, statins
  
Topics: heart failure, systole, hospital admission
  
Topics: aldosterone antagonists, mortality, eplerenone
  
Topics: myocardial infarction, acute, intra-aortic balloon pumping, cardiogenic shock, mortality
  
Topics: heat (physical force), pain, jellyfish sting
  
Topics: cardiovascular event, framingham risk calculator
  
Topics: hidradenitis suppurativa, adalimumab
  
Topics: ovarian cancer, screening
  
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