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Original Research | 
Ali Rowhani-Rahbar, MD, MPH, PhD; Douglas Zatzick, MD; Jin Wang, PhD; Brianna M. Mills, MA; Joseph A. Simonetti, MD, MPH; Mary D. Fan, MPhil, JD; and Frederick P. Rivara, MD, MPH
Background:Risk for violent victimization or crime perpetration after firearm-related hospitalization (FRH) must be determined to inform the need for future interventions. Objective:To compare the risk for subsequent violent injury, death, or crime perpetration among patients with an FRH, those hospitalized for noninjury reasons, and the general population. Design:Retrospective cohort study. Setting:All hospitals in Washington. Patients:Patients with an FRH and a random sample of those with a non–injury-related hospitalization in 2006 to 2007 (index hospitalization). Measurements:Primary outcomes included subsequent FRH, firearm-related death, and the combined outcome of firearm- or violence-related arrest ascertained through 2011. Results:Among patients with an index FRH (n = 613), rates of subsequent FRH, firearm-related death, and firearm- or violence-related arrest were 329 (95% CI, 142 to 649), 100 (CI, 21 to 293), and 4221 (CI, 3352 to 5246) per 100 000 person-years, respectively. Compared with the general population, standardized incidence ratios among patients with an index FRH were 30.1 (CI, 14.9 to 61.0) for a subsequent FRH and 7.3 (CI, 2.4 to 22.9) for firearm-related death. In survival analyses that accounted for competing risks, patients with an index FRH were at greater risk for subsequent FRH (subhazard ratio [sHR], 21.2 [CI, 7.0 to 64.0]), firearm-related death (sHR, 4.3 [CI, 1.3 to 14.1]), and firearm- or violence-related arrest (sHR, 2.7 [CI, 2.0 to 3.5]) than those with a non–injury-related index hospitalization. Limitation:Lack of information on whether patients continued to reside in Washington during follow-up may have introduced outcome misclassification. Conclusion:Hospitalization for a firearm-related injury is associated with a heightened risk for subsequent violent victimization or crime perpetration. Further research at the intersection of clinical care, the criminal justice system, and public health to evaluate the effectiveness of interventions delivered to survivors of firearm-related injury is warranted. Primary Funding Source:Seattle City Council and University of Washington Royalty Research Fund.
Topics: crime, firearms, hospitalization
Medicine and Public Issues | 
Steven E. Weinberger, MD; David B. Hoyt, MD; Hal C. Lawrence III, MD; Saul Levin, MD, MPA; Douglas E. Henley, MD; Errol R. Alden, MD; Dean Wilkerson, JD, MBA; Georges C. Benjamin, MD; and William C. Hubbard, JD
Deaths and injuries related to firearms constitute a major public health problem in the United States. In response to firearm violence and other firearm-related injuries and deaths, an interdisciplinary, interprofessional group of leaders of 8 national health professional organizations and the American Bar Association, representing the official policy positions of their organizations, advocate a series of measures aimed at reducing the health and public health consequences of firearms. The specific recommendations include universal background checks of gun purchasers, elimination of physician “gag laws,” restricting the manufacture and sale of military-style assault weapons and large-capacity magazines for civilian use, and research to support strategies for reducing firearm-related injuries and deaths. The health professional organizations also advocate for improved access to mental health services and avoidance of stigmatization of persons with mental and substance use disorders through blanket reporting laws. The American Bar Association, acting through its Standing Committee on Gun Violence, confirms that none of these recommendations conflict with the Second Amendment or previous rulings of the U.S. Supreme Court.
Topics: firearms, health personnel, statutes and laws
Editorials | 
Darren B. Taichman, MD, PhD, Executive Deputy Editor; Christine Laine, MD, MPH, Editor in Chief, on behalf of the Annals editors
Includes: Supplemental Content
Health care professionals have been relatively silent on firearm-related harms compared with other public health crises. With the emergence of new research, the development of a national research agenda, and a united call for action from many physician professional organizations, the editors call on health care professionals to join in speaking up and demanding the resources and freedom to learn how to fix the public health crisis of firearm-related harms.
Topics: firearms
Original Research | 
Paul F. Pinsky, PhD; David S. Gierada, MD; William Black, MD; Reginald Munden, MD; Hrudaya Nath, MD; Denise Aberle, MD; and Ella Kazerooni, MD
Background:Lung cancer screening with low-dose computed tomography (LDCT) has been recommended, based primarily on the results of the National Lung Screening Trial (NLST). The American College of Radiology recently released Lung-RADS, a classification system for LDCT lung cancer screening. Objective:To retrospectively apply the Lung-RADS criteria to the NLST. Design:Secondary analysis of a group from a randomized trial. Setting:33 U.S. screening centers. Patients:Participants were randomly assigned to the LDCT group of the NLST, were aged 55 to 74 years, had at least a 30–pack-year history of smoking, and were current smokers or had quit within the past 15 years. Intervention:3 annual LDCT lung cancer screenings. Measurements:Lung-RADS classifications for LDCT screenings. Lung-RADS categories 1 to 2 constitute negative screening results, and categories 3 to 4 constitute positive results. Results:Of 26 722 LDCT group participants, 26 455 received a baseline screen; 48 671 screenings were done after baseline. At baseline, the false-positive result rate (1 minus the specificity rate) for Lung-RADS was 12.8% (95% CI, 12.4% to 13.2%) versus 26.6% (CI, 26.1% to 27.1%) for the NLST; after baseline, the false-positive result rate was 5.3% (CI, 5.1% to 5.5%) for Lung-RADS versus 21.8% (CI, 21.4% to 22.2%) for the NLST. Baseline sensitivity was 84.9% (CI, 80.8% to 89.0%) for Lung-RADS compared with 93.5% (CI, 90.7% to 96.3%) for the NLST, and sensitivity after baseline was 78.6% (CI, 74.6% to 82.6%) for Lung-RADS versus 93.8% (CI, 91.4% to 96.1%) for the NLST. Limitation:Lung-RADS criteria were applied retrospectively. Conclusion:Lung-RADS may substantially reduce the false-positive result rate; however, sensitivity is also decreased. The effect of using Lung-RADS criteria in clinical practice must be carefully studied. Primary Funding Source:National Institutes of Health.
Topics: lung, reactive airways dysfunction syndrome, nlst trial, false-positive results
Ideas and Opinions | 
Theodore G. Ganiats, MD
The chronic fatigue syndrome is often ignored or mismanaged by clinicians. The Institute of Medicine recently convened an expert committee to examine the evidence base for the condition, develop evidence-based clinical diagnostic criteria, and recommend whether new terminology should be adopted.
Topics: chronic fatigue syndrome, diagnosis
As the American College of Physicians celebrates its 100th anniversary in 2015, it is an appropriate time to reflect on the current challenges and opportunities that face internal medicine specialists and subspecialists, their patients, and American society. This commentary highlights 3 leading issues for internal medicine and for ACP as it enters its second century and strives to continue to meet the needs of internists and their patients.
Topics: internal medicine, job satisfaction, health care systems, health care cost containment, american college of physicians
Ideas and Opinions | 
David Satcher, MD, PhD
Some argue that changes in the U.S. Department of Health and Human Services and the U.S. Public Health Service have diminished the power of the U.S. Surgeon General over the years. In this commentary, former Surgeon General David Satcher contends that the Office of the Surgeon General has actually gained credibility and influence with the American people as the reporting structure has evolved.
Topics: health policy, united states dept. of health and human services, united states public health service, credibility, public health education, smoking, obesity, overweight, communicable diseases
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