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Vincent Lo Re III, MD, MSCE; Michael J. Kallan, MS; Janet P. Tate, ScD; A. Russell Localio, PhD; Joseph K. Lim, MD; Matthew Bidwell Goetz, MD; Marina B. Klein, MD, MS; David Rimland, MD; Maria C. Rodriguez-Barradas, MD; Adeel A. Butt, MD, MS; Cynthia L. Gibert, MD, MS; Sheldon T. Brown, MD; Lesley Park, MPH; Robert Dubrow, MD, PhD; K. Rajender Reddy, MD; Jay R. Kostman, MD; Brian L. Strom, MD, MPH; and Amy C. Justice, MD, PhD

During the era of antiretroviral therapy, few studies have examined the incidence of hepatic decompensation among patients co-infected with HIV and hepatitis C virus (HCV) and few have compared incidence among these patients with that among patients infected with HCV alone. The authors conducted a retrospective cohort study of HIV-infected patients receiving care at Veterans Affairs medical facilities and found that, despite receiving antiretroviral therapy, co-infected patients had higher rates of hepatic decompensation than those infected only with HCV.

Topics: hiv, acquired immunodeficiency syndrome, antiretroviral therapy, highly active, hepatitis c, chronic, hepatitis ...
Michael B. Rothberg, MD, MPH; Penelope S. Pekow, PhD; Aruna Priya, MA, MSc; and Peter K. Lindenauer, MD, MSc

Measures of hospital risk-standardized mortality rates for pneumonia exclude more severe cases, which are coded as sepsis or respiratory failure with pneumonia as a secondary diagnosis. This cross-sectional study of adults hospitalized for pneumonia between 2007 and 2010 examined the effect of coding on hospital mortality rates. The authors found that variation in use of the principal diagnosis of sepsis or respiratory failure may bias efforts to compare hospital performance regarding outcomes of pneumonia.

Topics: systemic infection, hospital mortality, pneumonia, respiratory insufficiency, septicemia, medical coding
Yaseen M. Arabi, MD; Ahmed A. Arifi, MD; Hanan H. Balkhy, MD; Hani Najm, MD; Abdulaziz S. Aldawood, MD; Alaa Ghabashi, MD; Hassan Hawa, MD; Adel Alothman, MB; Abdulaziz Khaldi, MD; and Basel Al Raiy, MD

In a study of patients hospitalized with suspected Middle East respiratory syndrome coronavirus infection, those with confirmed disease had preexisting comorbid conditions and required mechanical ventilation. Mortality was high, hospitalization was prolonged, and some exposed health care workers became infected.

Topics: critical illness, disease progression, middle east respiratory syndrome coronavirus, middle east respiratory ...
Rajiv Chowdhury, MD, PhD; Samantha Warnakula, MPhil; Setor Kunutsor, MD, MSt; Francesca Crowe, PhD; Heather A. Ward, PhD; Laura Johnson, PhD; Oscar H. Franco, MD, PhD; Adam S. Butterworth, PhD; Nita G. Forouhi, MRCP, PhD; Simon G. Thompson, FMedSci; Kay-Tee Khaw, FMedSci; Dariush Mozaffarian, MD, DrPH; John Danesh, FRCP; and Emanuele Di Angelantonio, MD, PhD

Nutritional guidelines encourage consumption of fatty acids to improve cardiovascular health. The authors summarize evidence about associations between fatty acids and coronary disease, concluding that guidelines promoting high consumption of polyunsaturated fatty acids and low consumption of total saturated fats may need to be reexamined.

Topics: fatty acids, monounsaturated fatty acids, saturated fatty acids, diet, dietary fats, unsaturated, ...
Susan J. Curry, PhD; David C. Grossman, MD, MPH; Evelyn P. Whitlock, MD, MPH; and Adelita Cantu, PhD, RN

This article, written on behalf of the U.S. Preventive Services Task Force (USPSTF), explores development of evidence-based recommendations for behavioral counseling interventions in primary care, which need rigorous synthesis of high-quality intervention trials. The authors discuss challenges in synthesizing trial findings to relate to study design and reporting and how USPSTF recommendations can be enhanced by consensus-based terminology for intervention components and intensity and for measures of behavioral and clinical outcomes.

Topics: behavior therapy, evidence-based practice, behavioral change
Virginia A. Moyer, MD, MPH, on behalf of the U.S. Preventive Services Task Force

This updated recommendation from the USPSTF addresses screening for gestational diabetes mellitus in pregnant women who have not previously been diagnosed with type 1 or type 2 diabetes. The Task Force recommends screening for gestational diabetes mellitus in asymptomatic pregnant women after 24 weeks of gestation and concludes that evidence is insufficient to assess the balance of benefits and harms of screening before that time.

Topics: diabetes mellitus, type 2, gestational diabetes, mothers, pregnancy, diabetes mellitus
Kristen A. Feemster, MD, MPH, MSHP; and Paul Offit, MD

Since 22 March 2013, 8 cases of confirmed Neisseria meningitidis serogroup B (MenB) meningitis have occurred among students and visitors at Princeton University. The only vaccine in production that protects against MenB is being distributed in response to the outbreak. This distribution is the first time the “compassionate use” mechanism has been granted to allow a group of healthy persons access to a nontherapeutic biological drug. The authors discuss the ethical implications of this decision.

Topics: public health medicine, compassionate use, vaccines
Ryan A. Crowley, BSJ; and William Golden, MD

The Medicaid program provided health insurance for more than 62 million low-income persons and families in 2013. Before passage of the Patient Protection and Affordable Care Act (ACA), few states provided comprehensive Medicaid coverage to low-income, childless adults. The ACA sought to mend this gap by expanding Medicaid to nearly all persons with incomes up to 138% of the federal poverty level starting in January 2014. However, in June 2012, the U.S. Supreme Court ruled that state expansion of their Medicaid programs would be optional. This article discusses this expansion and how it will affect patients and physicians.

Topics: medicaid, health policy

More than 30 years ago, Medicare began paying hospitals by diagnosis-related group (DRG), arguably the most influential innovation in health care financing. The author discusses the history and importance of DRGs and current debate on improving value in health care. He concludes that provider incentives can change delivery systems better than regulation and that sensible policy need not be the domain of any single political party or other entity.

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In this issue, Rothberg and colleagues evaluate how variability of in-hospital coding of patients with pneumonia affects the risk-standardized mortality rates of these patients. The editorialists discuss the unintended consequences of using administrative data to compare hospitals. They also examine ways to improve value-based purchasing.

Topics: hospital mortality, pneumonia, medical coding, pay for performance
Trish M. Perl, MD, MSc; Allison McGeer, MD; and Connie Savor Price, MD

In this issue, Arabi and colleagues report a case series of severely ill patients infected with the Middle East respiratory syndrome coronavirus. The editorialists comment on the report and emphasize the need for transparency and collaboration in the scientific community to identify optimum management and prevent a pandemic.

Topics: critical illness, disease outbreaks, international cooperation, public health medicine, severe acute respiratory ...
Alok A. Khorana, MD
Includes: Audio/Video

You walk into the clinic room, your lab coat sleeves rolled up, your stethoscope askew. However, one look at the patient as he hunches over a basin, trying not to heave, and you know this is the real deal.

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Carolyn Kanter, BA
Includes: Audio/Video

Although it is said that physicians make the worst patients, there is compelling evidence that medical students set the bar: They know just enough to be terrified of everything.

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Rahman Shah, MD; and M. Rehan Khan, MD
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Hitinder S. Gurm, MD; Carrie Hosman, PhD; and Ben B. Hansen, PhD
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Caroline Poplin, MD, JD
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Stephen Harvey, MD
Includes: Audio/Video
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Brian Devitt, MD
Includes: Audio/Video
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Topics: 5-alpha reductase inhibitors, adrenergic alpha1-antagonists, lower urinary tract symptoms
Topics: proteinuria, lisinopril, losartan, hyperkalemia, diabetes mellitus, type 2, renal failure, acute
Topics: stent, ischemic stroke, angioplasty, arterial stenosis, intracranial, medical management
Topics: pharmaceutical preparations, multiple sclerosis, relapsing-remitting, recurrence
Topics: atrial fibrillation, obesity, weight reduction, overweight
Topics: atrial fibrillation, warfarin, cerebrovascular accident, ischemic stroke, embolism, edoxaban
Topics: atrial fibrillation, warfarin, genotype, venous thromboembolism, coag trial
Topics: atrial fibrillation, warfarin, genotype, venous thromboembolism
Topics: atrial fibrillation, acenocoumarol, genotype, phenprocoumon, venous thromboembolism
Topics: myocardial infarction, acute, chest pain
Topics: shoulder pain, rotator cuff injury
Topics: acute coronary syndromes, heart, troponin i
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: surgical procedures, operative, npo - nothing by mouth
Topics: gestational diabetes
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