Karla Kerlikowske, MD; Christopher G. Scott, MS; Amir P. Mahmoudzadeh, MScEng; Lin Ma, MS; Stacey Winham, PhD; Matthew R. Jensen, BS; Fang Fang Wu, BS; Serghei Malkov, PhD; V. Shane Pankratz, PhD; Steven R. Cummings, MD; John A. Shepherd, PhD; Kathleen R. Brandt, MD; Diana L. Miglioretti, PhD; Celine M. Vachon, PhD
The Breast Imaging Reporting and Data System (BI-RADS) density categories, estimated subjectively by radiologists, are the standard for reporting breast density in the United States. Variation in these clinical categories among and between radiologists has led to discussion about whether automated BI-RADS density should be reported instead. This case–control study examines whether breast cancer risk and detection are similar for automated and clinical BI-RADS density measures.
Ann Intern Med. 2018;168(11):757-765. doi:10.7326/M17-3008
Kelly L. Graham, MD, MPH; Andrew D. Auerbach, MD, MPH; Jeffrey L. Schnipper, MD, MPH; Scott A. Flanders, MD; Christopher S. Kim, MD, MBA; Edmondo J. Robinson, MD, MBA; Gregory W. Ruhnke, MD, MS, MPH; Larissa R. Thomas, MD, MPH; Sunil Kripalani, MD, MSc; Eduard E. Vasilevskis, MD, MPH; Grant S. Fletcher, MD, MPH; Neil J. Sehgal, PhD, MPH; Peter K. Lindenauer, MD, MSc; Mark V. Williams, MD; Joshua P. Metlay, MD, PhD; Roger B. Davis, ScD; Julius Yang, MD, PhD; Edward R. Marcantonio, MD, SM; Shoshana J. Herzig, MD, MPH
The Centers for Medicare & Medicaid Services requires that hospitals pay financial penalties when they have too many readmissions within 30 days of discharge. This 30-day window has little scientific basis, so others have proposed windows of 3, 7, or 14 days, but no direct evidence was given for these shorter periods. The aim of this study was to determine whether readmissions within 7 days of hospital discharge are more preventable than readmissions 8 to 30 days after discharge.
Ann Intern Med. 2018;168(11):766-774. doi:10.7326/M17-1724
Øyvind Holme, MD, PhD; Magnus Løberg, MD, PhD; Mette Kalager, MD, PhD; Michael Bretthauer, MD, PhD; Miguel A. Hernán, MD, DrPH; Eline Aas, PhD; Tor J. Eide, MD, PhD; Eva Skovlund, MSc, PhD; Jon Lekven, MD, PhD; Jörn Schneede, MD, PhD; Kjell Magne Tveit, MD, PhD; Morten Vatn, MD, PhD; Giske Ursin, MD, PhD; Geir Hoff, MD, PhD; for the NORCCAP Study Group†
Four randomized trials found that sigmoidoscopy screening reduces colorectal cancer incidence and mortality. Some also indicated that the effect might be smaller in women than men, but the differences varied by study and type of outcome (incidence or mortality). This population-based, randomized trial in Norway had longer follow-up and more events, and it reached a clear conclusion.
Ann Intern Med. 2018;168(11):775-782. doi:10.7326/M17-1441
David S. Fink, MPH; Julia P. Schleimer, BS; Aaron Sarvet, MPH; Kiran K. Grover, BA; Chris Delcher, PhD; Alvaro Castillo-Carniglia, PhD; June H. Kim, PhD; Ariadne E. Rivera-Aguirre, MPP; Stephen G. Henry, MD; Silvia S. Martins, MD, PhD; Magdalena Cerdá, DrPH
This systematic review examines whether implementation of prescription drug monitoring programs is associated with changes in nonfatal and fatal overdoses, identifies features of programs differentially associated with those outcomes, and investigates potential unintended consequences of these programs.
Ann Intern Med. 2018;168(11):783-790. doi:10.7326/M17-3074
Wendy L. Bennett, MD, MPH; Renee F. Wilson, MS; Allen Zhang, BS; Eva Tseng, MD, MPH; Emily A. Knapp, MHS; Hadi Kharrazi, MHI, MD, PhD; Elizabeth A. Stuart, PhD; Oluwaseun Shogbesan, MD; Eric B. Bass, MD, MPH; Lawrence J. Cheskin, MD
This systematic review identifies and describes the methodology of 294 studies that reported the effects of programs, policies, or built environment changes on obesity prevention and control.
Ann Intern Med. 2018;168(11):791-800. doi:10.7326/M18-0309
Risa B. Burns, MD, MPH; Harold Rosen, MD; Sarah Berry, MD; Gerald W. Smetana, MD
Two endocrinologists debate whether a 71-year-old woman with osteoporosis should have bone density monitoring during and after treatment with an antiresorptive agent. They also review management of osteoporosis and treatment recommendations for a patient whose bone density decreases during or after a 5-year course of alendronate.
Ann Intern Med. 2018;168(11):801-808. doi:10.7326/M18-0950
Karen M. Emmons, PhD; Chyke A. Doubeni, MD, MPH; Maria E. Fernandez, PhD; Diana L. Miglioretti, PhD; Jonathan M. Samet, MD, MS
This report of a National Institutes of Health Pathways to Prevention Workshop addresses methods of evaluating natural experiments to reduce obesity and research needs for advancing the field.
Ann Intern Med. 2018;168(11):809-814. doi:10.7326/M18-0501
Aubrey C. Chan, MD, PhD; Christopher A. Burke, MD; Ellen M. Coffey, MD; David R. Hilden, MD, MPH; Diego L. Coira, MD; Jessy Warner-Cohen, PhD, MPH; Margaret Grady, MSN, APN-C; Philip R. Muskin, MD, MA; Gen Shinozaki, MD
Some hospitalized patients with comorbid, chronic medical and psychiatric illnesses may benefit from admission to an integrated unit that can provide care for both conditions. This commentary describes integrated medical–psychiatric inpatient care units implemented in 5 U.S. institutions, the facilitators of and barriers to this model, and the benefits in terms of patient outcomes and provider satisfaction.
Ann Intern Med. 2018;168(11):815-817. doi:10.7326/M17-3186
Katrina Armstrong, MD, MSCE
The quest to eliminate uncertainty in clinical decision making has become central to biomedical research over the past 50 years, driving the emergence of evidence-based medicine, precision medicine, and most recently biomedical artificial intelligence. This commentary discusses how, despite being a source of discomfort, the handling of uncertainty can also have an important positive effect on medical care.
Ann Intern Med. 2018;168(11):818-819. doi:10.7326/M18-0445
Gianna Zuccotti, MD; Lipika Samal, MD, MPH; Francine L. Maloney, MPH; Angela Ai, BA; Adam Wright, PhD
The authors observe that their hospital performed approximately equal numbers of screening mammograms and Pap smears each year. Follow-up was appropriate for more than 99% of abnormal mammograms but only 91% of abnormal Pap smears. They examine the reasons for these differences and propose improvements for follow-up of abnormal results from other diagnostic tests.
Ann Intern Med. 2018;168(11):820-821. doi:10.7326/M17-2425
Joann G. Elmore, MD, MPH; Jill Wruble, DO
Kerlikowske and colleagues have evaluated whether, given the variability of radiologists' subjective assessment of breast density, machine measurements should be introduced. The editorialists discuss the findings and what we need to know before deciding whether machine measurement of breast density provides health care value.
Ann Intern Med. 2018;168(11):822-823. doi:10.7326/M18-0941
Kirsten Bibbins-Domingo, PhD, MD, MAS; John Inadomi, MD
Holme and colleagues offer the latest evidence that adds to and challenges our understanding of the optimal screening approach for colorectal cancer. The study confirms the effectiveness of screening sigmoidoscopy to reduce colorectal cancer incidence and mortality among men but not among women. The editorialist discusses the findings and why more research is needed.
Ann Intern Med. 2018;168(11):824-825. doi:10.7326/M18-0963
Wilson M. Compton, MD, MPE; Eric M. Wargo, PhD
All 50 states and the District of Columbia have prescription drug monitoring programs (PDMPs), but their implementation varies and research assessing their effect on opioid misuse, diversion, and overdose is sparse. Thus, the systematic review by Fink and colleagues is a welcome contribution. The editorialists discuss the review, the challenge of assessing PDMP effectiveness, and the reason PDMPs should be viewed as 1 component of a complex strategy to address the opioid crisis.
Ann Intern Med. 2018;168(11):826-827. doi:10.7326/M18-0883
A. Russell Localio, PhD; Steven N. Goodman, MD, PhD; Anne Meibohm, PhD; John E. Cornell, PhD; Catharine B. Stack, PhD; Eric A. Ross, PhD, ScM; Cynthia D. Mulrow, MD, MSc
Assel and Vickers report the shortcomings of statistical code supporting research reports in high-impact medical journals. In this editorial, Annals' statistical editors argue that clearly presented and transparently reported statistical code is a sine qua non for reproducible research. They describe the attributes of code that communicates clearly to readers the path that researchers took to arrive at their findings.
Ann Intern Med. 2018;168(11):828-829. doi:10.7326/M17-3431
James S. Kahn, MD
He is one of my most memorable patients. Despite his passion and outrage, he recognized his own limitations and helplessness to right the wrongs he witnessed and endured.
Ann Intern Med. 2018;168(11):830-831. doi:10.7326/M18-0691
Ann Intern Med. 2018;168(11):832-833. doi:10.7326/M17-2863
Ann Intern Med. 2018;168(11):833-834. doi:10.7326/L18-0079
Ann Intern Med. 2018;168(11):833. doi:10.7326/L18-0080
Ann Intern Med. 2018;168(11):834. doi:10.7326/L18-0078
Ann Intern Med. 2018;168(11):834. doi:10.7326/L18-0081
Ann Intern Med. 2018;168(11):834. doi:10.7326/L18-0082
Ann Intern Med. 2018;168(11):834-835. doi:10.7326/L18-0083
Ann Intern Med. 2018;168(11):836-837. doi:10.7326/L18-0015
Ann Intern Med. 2018;168(11):836. doi:10.7326/L18-0016
Ann Intern Med. 2018;168(11):837. doi:10.7326/L18-0017
Ann Intern Med. 2018;168(11):837. doi:10.7326/L18-0190
Rebekka E. DePew
Ann Intern Med. 2018;168(11):831. doi:10.7326/M17-2754
Audrey Wu, MD
Ann Intern Med. 2018;168(11):ITC81-ITC96. doi:10.7326/AITC201806050
Darren B. Taichman, MD, PhD
Ann Intern Med. 2018;168(11):ED11. doi:10.7326/AFED201806050
Jade R. Blue, BA(Hons)
Laugh, cry, and reflect with your learners at the messages in this series of cartoons by a patient who reflects on her experiences with chemotherapy for breast cancer.
Ann Intern Med. 2018;168(11):W24-W30. doi:10.7326/G17-0018
Ann Intern Med. 2018;168(11):I-24. doi:10.7326/P18-0006
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