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Jennifer A. Meddings, MD, MSc; Heidi Reichert, MA; Tim Hofer, MD, MSc; and Laurence F. McMahon Jr., MD, MPH

Value-based purchasing programs use administrative data to compare rates of hospital-acquired pressure ulcers among hospitals for public reporting and financial penalties, but validation of these data is lacking. Investigators compared the rates of hospital-acquired pressure ulcers as assessed by administrative data with those derived from direct surveillance and found that administrative data frequently misclassified hospitals as having high or low rates relative to others. The findings suggest that administrative data may not be appropriate for comparing hospital performance with respect to pressure ulcers.

Topics: decubitus ulcer, performance measurement
Ming-Hua Li, MD, PhD; Shi-Wen Chen, MD, PhD; Yong-Dong Li, MD, PhD; Yuan-Chang Chen, MD; Ying-Sheng Cheng, MD, PhD; Ding-Jun Hu, MD; Hua-Qiao Tan, MD, PhD; Qian Wu, MD; Wu Wang, MD; Zhen-Kui Sun, MD; Xiao-Er Wei, MD; Jia-Yin Zhang, MD, PhD; Rui-Hua Qiao, MS; Wen-Hong Zong, MD; Yin Zhang, MD; Wei Lou, MD; Zhi-Yuan Chen, MD; Yu Zhu, MD; De-Rong Peng, MD; Sui-Xin Ding, MD; Xue-Fan Xu, MD; Xu-Hong Hou, MD, PhD; and Wei-Ping Jia, MD, PhD

The prevalence and typical characteristics of unruptured cerebral aneurysms are unclear. This cross-sectional study used 3-dimensional time-of-flight magnetic resonance angiography to determine the prevalence of unruptured cerebral aneurysms in Chinese adults aged 35 to 75 years. Overall prevalence was 7.0%, was higher in women than men, and increased with age in both sexes. Only 8.7% of the aneurysms were deemed potentially risky for rupture based on their size, shape, and location. Unruptured cerebral aneurysms may be common but their clinical significance remains unclear.

Topics: magnetic resonance angiography, aneurysm, china, cerebral aneurysm, cerebral aneurysm, unruptured
Faouzi Saliba, MD; Christophe Camus, MD; François Durand, MD; Philippe Mathurin, MD, PhD; Alexia Letierce, PhD; Bertrand Delafosse, MD; Karl Barange, MD; Pierre François Perrigault, MD; Magali Belnard; Philippe Ichaï, MD; and Didier Samuel, MD, PhD

Extracorporeal liver support (or liver dialysis) might serve as a bridge to transplantation for patients with acute liver failure. Uncontrolled studies of an albumin dialysis system suggest possible decreased encephalopathy and increased survival. This randomized, controlled trial examined the effect of this system on mortality and adverse events, but many patients had transplantation before receiving the intervention; thus, the findings were inconclusive. Further study of albumin liver dialysis systems is necessary to determine effectiveness as well as the safety of extracorporeal liver support in improving outcomes of acute liver failure.

Topics: hemodialysis, albumins, liver failure, acute, liver transplantation, extracorporeal albumin hemodialysis
Nancy Greer, PhD; Neal A. Foman, MD, MS; Roderick MacDonald, MS; James Dorrian, MD; Patrick Fitzgerald, MPH; Indulis Rutks, BS; and Timothy J. Wilt, MD, MPH

Nonhealing ulcers affect patient quality of life and impose a substantial financial burden on the health care system. This review examined the benefits and harms of advanced wound care therapies for nonhealing diabetic, venous, and arterial ulcers compared with standard care. Reviewers found that advanced wound care therapies may improve the proportion of healed diabetic and venous ulcers compared with standard care in adults with nonhealing ulcers. Some therapies may reduce the time to ulcer healing, but evidence is limited.

Topics: ulcer, skin ulcer, wound care, diabetic ulcer, diabetes mellitus
Elizabeth Sumamo Schellenberg, BSc, MPH; Donna M. Dryden, PhD; Ben Vandermeer, MSc; Christine Ha, BSc; and Christina Korownyk, MD, CCFP

Many reviews report the effectiveness of exercise and dietary interventions in preventing diabetes, but how multifaceted lifestyle interventions affect clinically oriented outcomes across metabolic risk factors and abnormal glucose is unclear. This review found that comprehensive lifestyle interventions (including exercise, dietary changes, and ≥1 other component) decrease the risk for type 2 diabetes. The evidence that these interventions improve cardiovascular and microvascular outcomes among patients diagnosed with type 2 diabetes is less clear.

Topics: diabetes mellitus, type 2, diet, exercise, lifestyle changes

In a recommendation that applies to school-aged children and adolescents, the U.S. Preventive Service Task Force recommends that primary care clinicians provide these groups with education or brief counseling to prevent initiation of tobacco use.

Topics: smoking, smoking cessation, primary health care, tobacco, tobacco use cessation, tobacco use, ...
Michael B. Steinberg, MD, MPH; and Cristine D. Delnevo, PhD, MPH

A critical aspect of tobacco control is to prevent young people from ever becoming smokers. Toward this aim, New York City has proposed to increase the legal age of sale for tobacco products from 18 to 21 years. This commentary discusses the proposal and other efforts to reduce smoking in young people.

Topics: tobacco use cessation, smoking prevention, teenage smoking, public smoking laws, smoking, smoking ...
Miguel A. Hernán, MD; Sonia Hernández-Díaz, MD; and James M. Robins, MD

Randomized trials are not always free of confounding and selection bias. This commentary posits that randomized trials with long follow-up are similar to observational studies and that “intention-to-treat” analysis of such studies may be inadequate. The authors propose use of g-methods to adjust for postrandomization confounding and selection bias.

Topics: confounding factors (epidemiology), randomized controlled trial, selection bias, observational studies, intention to ...

Synthetic cannabinoid use has increased in the United States. The consequences are dangerous, and public health concern about these products has led to international control efforts. This commentary discusses the difficulties associated with regulating use and the need for research to aid efforts to slow the trend.

Topics: cannabinoid, designer drugs

In 1905, soon-to-be president William Howard Taft hired English diet expert Nathaniel E. Yorke-Davies to treat him for obesity. This article analyzes the letters exchanged as part of his clinical weight management. The correspondence offers a unique opportunity to examine the history of the obesity experience in the United States and the challenges of creating and maintaining long-term treatment courses.

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Barbara Pieper, PhD, RN; and Robert S. Kirsner, MD, PhD

In this issue, Meddings and colleagues evaluated the frequency of hospital-acquired pressure ulcers reported in administrative data and active surveillance data from a California hospital collaborative and found deficiencies in the ability to identify highly and poorly performing institutions. The editorialists discuss the study and its findings, which they believe challenge us to think about clinical grading in terms of pressure ulcers.

Topics: decubitus ulcer, performance measurement

I never expected that I would have a lesson in disaster medicine or be thrust into a resource-limited setting in midtown Manhattan, but on 29 October 2012, Super-Storm Sandy came to New York City, bringing massive flooding and power outages to most of the city.

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Julia H. Hayes, MD; Michael J. Barry, MD; and Pamela M. McMahon, PhD
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Houman Farzin, MD; Mai Takematsu, MD; and Robert S. Hoffman, MD
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Sonja Gandhi, BSc; and Amit X. Garg, MD, PhD
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Thomas E. Cowling, MPH; Matthew J. Harris, MBBS, DPhil; and Azeem Majeed, MD
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Michael N. Dohn, MD, MSc; and Anita L. Dohn, MD, MSc
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Topics: enoxaparin, warfarin, apixaban, venous thromboembolism
Topics: obesity, diabetes mellitus, type 2, weight reduction, glucose control, bariatric surgery
Topics: obesity, diabetes mellitus, type 2, diet, exercise, life style, lifestyle changes, cardiovascular ...
Topics: aspirin, clopidogrel, transient ischemic attack, hemorrhage, cerebrovascular accident
Topics: intracranial hemorrhages, cerebral hemisphere hemorrhage, blood pressure, disability
Topics: antibiotics, diarrhea, probiotics, diarrhea, clostridium difficile, clostridium difficile (bacteria)
Topics: hepatic encephalopathy, lactulose, rifaximin
Topics: antibiotic prophylaxis, urinary tract infection, urinary catheter
Topics: obstructive sleep apnea, continuous positive airway pressure, treatment with mandibular advancement device ...
Topics: beta-blocker, migraine disorders, off-label use, migraine prophylaxis
Topics: anti-inflammatory agents, non-steroidal, cyclooxygenase-2 inhibitors, cardiovascular event, disorder of upper gastrointestinal tract ...
Topics: back pain, low back pain, yoga, disability
Geno J. Merli, MD; and Howard H. Weitz, MD

The Consult Guys bring a new perspective to the art and science of medicine with lively discussion and analysis of real-world cases and situations.

Topics: consultation, urine
Topics: smoking cessation, primary health care, tobacco, tobacco use cessation, tobacco use, smoking ...
Topics: magnetic resonance angiography, aneurysm, china, cerebral aneurysm, cerebral aneurysm, unruptured
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