David S. Weinberg, MD, MSc; Ronald E. Myers, PhD; Eileen Keenan, MA; Karen Ruth, MS; Randa Sifri, MD; Barry Ziring, MD; Eric Ross, ScM, PhD; Sharon L. Manne, PhD
Genetic and environmental risk assessment (GERA) uses genetic and environmental information to identify an individual's risk for a disease, and it has been suggested as a means to motivate adherence to recommended cancer screening. This 2-group, randomized, controlled trial evaluated whether individualized GERA of colorectal cancer susceptibility improves adherence to screening in average-risk persons and found that screening uptake was not positively associated with feedback from a single personalized GERA.
Ann Intern Med. 2014;161(8):537-545. doi:10.7326/M14-0765
Shan Liu, PhD; Daena Watcha, MD, MS; Mark Holodniy, MD; Jeremy D. Goldhaber-Fiebert, PhD
More than 500 000 incarcerated persons in the United States have chronic hepatitis C virus (HCV) infection. The recent availability of short-duration, highly efficacious treatments may enable incarcerated patients to receive a full course of treatment while in prison. The authors analyzed the cost-effectiveness of sofosbuvir for HCV treatment in incarcerated populations. Their results suggest that sofosbuvir-based treatment is cost-effective for this population, although affordability may be an issue.
Ann Intern Med. 2014;161(8):546-553. doi:10.7326/M14-0602
Edward R. Marcantonio, MD, SM; Long H. Ngo, PhD; Margaret O'Connor, PhD; Richard N. Jones, ScD; Paul K. Crane, MD, MPH; Eran D. Metzger, MD; Sharon K. Inouye, MD, MPH
Delirium occurs regularly among hospitalized patients and is associated with adverse outcomes but often goes unrecognized. The Confusion Assessment Method (CAM) is the most widely used diagnostic tool for delirium. This study validated a 3-minute version of the CAM (called 3D-CAM) against a reference standard and found it to be a sensitive and specific diagnostic tool in hospitalized patients, including those with and without dementia.
Ann Intern Med. 2014;161(8):554-561. doi:10.7326/M14-0865
Vineet Chopra, MD, MSc; Sushant Govindan, MD; Latoya Kuhn, MPH; David Ratz, MS; Randy F. Sweis, MD; Natalie Melin, BA; Rachel Thompson, MD; Aaron Tolan, MD; James Barron, MD; Sanjay Saint, MD, MPH
Complications associated with central venous catheters (CVCs) increase over time, and the extent to which clinicians are aware that their patients have a CVC is unknown. This multicenter, cross-sectional study assessed how often clinicians were aware of the presence of triple-lumen or peripherally inserted central catheters in hospitalized patients and found that many interns, residents, and attending physicians were unaware that their patients had indwelling catheters.
Ann Intern Med. 2014;161(8):562-567. doi:10.7326/M14-0703
Jennifer S. Lin, MD, MCR; Elizabeth O'Connor, PhD; Corinne V. Evans, MPP; Caitlyn A. Senger, MPH; Maya G. Rowland, MPH; Holly C. Groom, MPH
This systematic review of 74 trials for the U.S. Preventive Services Task Force assesses benefits of lifestyle counseling interventions for persons with cardiovascular risk factors. Intensive interventions that promoted healthy diets and physical activity helped persons lose weight and reduce their lipid levels, blood pressure, and glucose levels.
Ann Intern Med. 2014;161(8):568-578. doi:10.7326/M14-0130
Kurt Kroenke, MD
Physical symptoms lead to more than half of all outpatient visits, yet the current disease-focused model of care inadequately addresses this problem. This narrative review discusses 4 common epidemiologic questions about a clinical condition (cause, diagnosis, prognosis, and therapy) to promote an evidence-based and practical approach to handling common symptoms.
Ann Intern Med. 2014;161(8):579-586. doi:10.7326/M14-0461
Michael L. LeFevre, MD, MSPH; on behalf of the U.S. Preventive Services Task Force
This updated U.S. Preventive Services Task Force recommen-dation applies to adults aged 18 years or older in primary care settings who are overweight or obese and have known risk factors for cardiovascular disease. It recommends offering or referring such patients to intensive behavioral counseling interventions to promote a healthful diet and physical activity for prevention of cardiovascular disease.
Ann Intern Med. 2014;161(8):587-593. doi:10.7326/M14-1796
Steven H. Lipstein, MHA; W. Claiborne Dunagan, MD, MS
The National Quality Forum recently convened on whether to risk-adjust health care performance measures for sociodemographic factors in addition to clinical factors present at the initiation of care. This commentary discusses why the panel chose to recommend such adjustment and why the topic is so hotly debated.
Ann Intern Med. 2014;161(8):594-596. doi:10.7326/M14-1601
Linda S. Kinsinger, MD, MPH; David Atkins, MD, MPH; Dawn Provenzale, MD, MS; Charles Anderson, MD, PhD; Robert Petzel, MD
This commentary describes the Veterans Health Administration's demonstration project that aims to assess initial experience in implementing lung screening programs at select sites. It will assess the results to inform whether, and how, to proceed with broader implementation.
Ann Intern Med. 2014;161(8):597-598. doi:10.7326/M14-1070
Ilana Graetz, PhD; Cameron M. Kaplan, PhD; Erin K. Kaplan, PhD; James E. Bailey, MD, MPH; Teresa M. Waters, PhD
The Affordable Care Act aims to expand health care coverage in part by providing subsidies to individuals with low incomes. This study assessed the cost of purchasing the least expensive health insurance plans after accounting for these subsidies. It found that the penalty for not buying health insurance would be lower than buying the least expensive insurance for many individuals and some young persons would pay more than older ones.
Ann Intern Med. 2014;161(8):599-604. doi:10.7326/M14-0757
J.S. Blumenthal-Barby, PhD, MA; Amy L. McGuire, JD, PhD; Peter A. Ubel, MD
In this issue, Weinberg and colleagues conclude that colorectal cancer screening uptake in average-risk persons was not positively associated with feedback from a single personalized GERA. The editorialists explore the difficulties of using personalized genomics to improve health and evaluate how to use risk estimates to motivate positive behaviors.
Ann Intern Med. 2014;161(8):605-606. doi:10.7326/M14-2074
Darren B. Taichman, MD, PhD, Executive Deputy Editor
In this issue, Chopra and colleagues determined that clinicians are often unaware of the presence of central venous catheters in hospitalized patients. The editorialist discusses the complications associated with devices that might no longer be needed and the role of programmatic interven-tions aimed at fostering a culture of safety-mindedness.
Ann Intern Med. 2014;161(8):607-608. doi:10.7326/M14-2005
Deborah Cotton, MD, MPH, Deputy Editor
Recently revealed safety lapses in U.S. government facilities that work with deadly pathogens suggest another grave bioterror threat: the risk emanating from biocontainment laboratories themselves. This commentary discusses possible factors contributing to the safety lapses and strategies to prevent future incidents.
Ann Intern Med. 2014;161(8):609-610. doi:10.7326/M14-1668
Elizabeth Lawrence, MD
Ann Intern Med. 2014;161(8):611-612. doi:10.7326/M14-0690
Ann Intern Med. 2014;161(8):613. doi:10.7326/L14-5020-4
Ann Intern Med. 2014;161(8):613-614. doi:10.7326/L14-5020-5
Ann Intern Med. 2014;161(8):614-615. doi:10.7326/L14-5020-6
Ann Intern Med. 2014;161(8):615. doi:10.7326/L14-5020-7
Jenna Thomason, MD, MPH
Ann Intern Med. 2014;161(8):606. doi:10.7326/M14-1695
Ann Intern Med. 2014;161(8):JC2. doi:10.7326/0003-4819-161-8-201410210-02002
Ann Intern Med. 2014;161(8):JC3. doi:10.7326/0003-4819-161-8-201410210-02003
Ann Intern Med. 2014;161(8):JC4. doi:10.7326/0003-4819-161-8-201410210-02004
Ann Intern Med. 2014;161(8):JC5. doi:10.7326/0003-4819-161-8-201410210-02005
Ann Intern Med. 2014;161(8):JC6. doi:10.7326/0003-4819-161-8-201410210-02006
Ann Intern Med. 2014;161(8):JC7. doi:10.7326/0003-4819-161-8-201410210-02007
Ann Intern Med. 2014;161(8):JC8. doi:10.7326/0003-4819-161-8-201410210-02008
Ann Intern Med. 2014;161(8):JC9. doi:10.7326/0003-4819-161-8-201410210-02009
Ann Intern Med. 2014;161(8):JC10. doi:10.7326/0003-4819-161-8-201410210-02010
Ann Intern Med. 2014;161(8):JC11. doi:10.7326/0003-4819-161-8-201410210-02011
Ann Intern Med. 2014;161(8):JC12. doi:10.7326/0003-4819-161-8-201410210-02012
Ann Intern Med. 2014;161(8):JC13. doi:10.7326/0003-4819-161-8-201410210-02013
Geno J. Merli, MD; 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.
Ann Intern Med. 2014;161(8):CG10. doi:10.7326/G14-3010
Ann Intern Med. 2014;161(8):I-36. doi:10.7326/P14-9037
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