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IN THIS ISSUE
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Involvement of large arteries is well-documented in giant-cell arteritis (GCA), but the risk for cardiovascular events is not well-understood. In this study, patients with incident GCA were compared with age- and sex-matched controls without baseline cardiovascular disease to evaluate risk for incident myocardial infarction, cerebrovascular accident, and peripheral vascular disease. These outcomes were increased in patients with GCA.
After determining the type of health insurance coverage (private, Medicare, Medicaid, or uninsured) for patients discharged alive from U.S. acute care hospitals, this study evaluated whether type of insurance was associated with the likelihood of interhospital transfer for patients with 5 common diagnoses. In adjusted analyses, uninsured patients were significantly less likely to be transferred than privately insured patients for 4 of the 5 disorders.
In rural Africa, the annual mortality rate of human rabies is 3.6 deaths per 100 000 persons. Prompt postexposure prophylaxis can prevent rabies deaths, but is costly and often inaccessible. Because 99% of human exposures occur through rabid dogs, canine vaccination also prevents transmission of rabies to humans. After studying the cost-effectiveness of annual rabies vaccination in 2 areas of rural Africa, the authors found that annual canine rabies vaccination campaigns conferred value and reduced the health burden of rabies.
Debate surrounds whether access to firearms in the home increases the risk for violent death. This systematic review identified and evaluated studies that compared suicide and homicide victimization between participants with and without firearm access. Although some misclassification may have occurred because most studies determined firearm accessibility through participant survey, access to firearms was associated with risk for completed suicide and homicide victimization.
Previous systematic reviews of implantable cardioverter defibrillators (ICDs) used for primary prevention of sudden cardiac death (SCD) from sustained ventricular arrhythmias concluded that ICDs are less effective in women and the elderly. Researchers screened articles for studies comparing ICD versus no ICD for primary prevention of SCD. They found that weak evidence fails to show differences in all-cause mortality in subgroups of sex, age, and QRS interval. Available evidence is indeterminate for all-cause mortality in the other subgroups and for SCD.
The net reclassification improvement (NRI) is an increasingly popular measure for evaluating improvements in risk predictions. After a review of 67 high-impact publications that considered the NRI, the authors found incomplete reporting of methods, incorrect calculations, and commonmisinterpretations. They discuss limitations and controversies, including the effect of miscalibration of prediction models and the relation with decision analytic measures, and propose a systematic approach to presenting NRI analysis.
In this issue, Fitzpatrick and colleagues discuss the dramatic reduction in the health burden of rabies in 2 rural areas of Africa through vaccination of domestic dogs. The editorialist discusses the authors' novel approach as well as the study's implications beyond the realm of rabies control.
This issue contains a systematic review and meta-analysis that finds that access to firearms is associated with risk for both completed suicide and being the victim of homicide. Although the results are consistent with previous literature reviews, the editorialist believes that this review provides a conservative estimate of the true relationship of guns to suicide and homicide at a societal level.
In this issue, Leening and colleagues discuss limitations and controversies surrounding the NRI and propose a systematic approach for presenting NRI analysis. The editorialists recommend that researchers exercise caution when using the NRI and consider statistical methods that allow for presenting results in more straightforward clinical terms.
In this era of increasingly cost-conscious health care, end-of-life care has been the focus of much discussion. Although this analysis has provided insight into the problem, it neglects to take into account an essential barrier for avoiding unnecessary care: humans.
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.