Valerie M. Vaughn, MD, MSc; Scott A. Flanders, MD; Ashley Snyder, MS; Anna Conlon, PhD; Mary A.M. Rogers, PhD, MS; Anurag N. Malani, MD; Elizabeth McLaughlin, MS, RN; Sarah Bloemers, MPH; Arjun Srinivasan, MD; Jerod Nagel, PharmD, BCPS; Scott Kaatz, DO; Danielle Osterholzer, MD; Rama Thyagarajan, MD; Lama Hsaiky, PharmD, BCPS; Vineet Chopra, MD, MSc; Tejal N. Gandhi, MD
Randomized trials have demonstrated the safety of shorter courses of antibiotic treatment for pneumonia, but how often excess treatment durations are prescribed is not known. This large multicenter cohort study assessed how often patients hospitalized with pneumonia received excess durations of antibiotic treatment and whether this was associated with harm.
Ann Intern Med. 2019;171(3):153-163. doi:10.7326/M18-3640
Bella Mehta, MBBS, MS; Yiming Luo, MD; Jiehui Xu, MPH; Lisa Sammaritano, MD; Jane Salmon, MD; Michael Lockshin, MD; Susan Goodman, MD; Said Ibrahim, MD, MPH
Systemic lupus erythematosus (SLE) primarily affects women of child-bearing age. Recent diagnostic and treatment advances have resulted in improved overall survival in patients with SLE, but whether similar improvements in outcomes have occurred among pregnant women with SLE is unclear. This analysis compares trends in pregnancy outcomes over 17 years in a nationwide sample of pregnant women with and without SLE.
Ann Intern Med. 2019;171(3):164-171. doi:10.7326/M19-0120
Adam Gaffney, MD; Danny McCormick, MD; David H. Bor, MD; Anna Goldman, MD; Steffie Woolhandler, MD, MPH; David U. Himmelstein, MD
People who have more generous health insurance plans use more hospital days than those who are uninsured or have less generous coverage. Therefore, we would expect an increase in the overall number of hospital days in the United States after the introduction of Medicare and Medicaid in 1996 and again after the introduction of the Patient Protection and Affordable Care Act in 2014. Something else happened instead.
Ann Intern Med. 2019;171(3):172-180. doi:10.7326/M18-2806
Jeffrey T. Ha, MBBS; Brendon L. Neuen, MBBS(Hons); Lap P. Cheng, MBBS; Min Jun, PhD; Tadashi Toyama, PhD; Martin P. Gallagher, PhD; Meg J. Jardine, PhD; Manish M. Sood, MD; Amit X. Garg, PhD; Suetonia C. Palmer, PhD; Patrick B. Mark, PhD; David C. Wheeler, MD; Vivekanand Jha, MD; Ben Freedman, PhD; David W. Johnson, PhD; Vlado Perkovic, PhD; Sunil V. Badve, PhD
This meta-analysis of 45 trials compares the benefits and harms of vitamin K antagonists and non–vitamin K oral anticoagulants in patients with chronic kidney disease stages 3 to 5.
Ann Intern Med. 2019;171(3):181-189. doi:10.7326/M19-0087
Safi U. Khan, MD; Muhammad U. Khan, MD; Haris Riaz, MD; Shahul Valavoor, MD; Di Zhao, PhD; Lauren Vaughan, MD; Victor Okunrintemi, MD, MPH; Irbaz Bin Riaz, MD, MS; Muhammad Shahzeb Khan, MD; Edo Kaluski, MD; M. Hassan Murad, MD; Michael J. Blaha, MD, MPH; Eliseo Guallar, MD, DrPH; Erin D. Michos, MD, MHS
This umbrella review of 277 trials and 24 interventions summarizes evidence about the effects of nutritional supplements and dietary interventions on cardiovascular outcomes.
Ann Intern Med. 2019;171(3):190-198. doi:10.7326/M19-0341
Howard Libman, MD; Z. Gordon Jiang, MD, PhD; Elliot B. Tapper, MD; Eileen E. Reynolds, MD
Nonalcoholic fatty liver disease (NAFLD) is increasing in prevalence in the United States. However, identifying which patients with NAFLD will develop cirrhosis remains challenging, and management is controversial. In this Beyond the Guidelines, 2 gastroenterologists discuss the updated practice guidelines from the American Association for the Study of Liver Diseases regarding NAFLD screening; the use of noninvasive studies and liver biopsy for diagnosis; and approaches to clinical management, including weight loss, reduced alcohol consumption, and pharmacologic therapies.
Ann Intern Med. 2019;171(3):199-207. doi:10.7326/M19-1125
Howard H. Weitz, MD
This commentary discusses the lessons of Sir William Osler's time in Philadelphia with regard to how the medical profession values modern-day clinician-educators.
Ann Intern Med. 2019;171(3):208-209. doi:10.7326/M19-0665
Brad Spellberg, MD; Louis B. Rice, MD
Vaughn and colleagues reported a study of antibiotic prescriptions for the treatment of nearly 6500 adults with community-acquired pneumonia from 2017 to 2018 and found that more than two thirds of antibiotic regimens were longer than necessary. The editorialists discuss how the findings contribute to the growing body of evidence supporting shorter antibiotic courses.
Ann Intern Med. 2019;171(3):210-211. doi:10.7326/M19-1509
Megan E.B. Clowse, MD, MPH
Using the National Inpatient Sample database, Mehta and colleagues identified improvements over 18 years in both maternal and fetal mortality among pregnant women with systemic lupus erythematosus. The editorialist discusses the findings and notes that although great advances have occurred, the use of recommended therapy during pregnancy remains suboptimal.
Ann Intern Med. 2019;171(3):212-213. doi:10.7326/M19-1667
Ainslie Hildebrand, MD, MSc; Christine Ribic, MD, MSc; Deborah Zimmerman, MD, MSc
Badve and colleagues' systematic review evaluated the benefits and harms of oral anticoagulant therapy in patients with stage 3 to 5 chronic kidney disease, including those receiving dialysis. The editorialists discuss the findings and why they believe that, until the results of ongoing trials become available, anticoagulant therapy in patients with end-stage kidney disease will continue to require an individualized approach that balances potential risks and benefits.
Ann Intern Med. 2019;171(3):214-215. doi:10.7326/M19-1504
Amitabh C. Pandey, MD; Eric J. Topol, MD
Khan and colleagues reported an evidence review to identify supplements and dietary interventions associated with improved cardiovascular outcomes. The editorialists discuss the findings and limitations of testing diets or supplements in a broad population without acknowledging interindividual variability.
Ann Intern Med. 2019;171(3):216-217. doi:10.7326/M19-1498
Catriona M. McNeil, MBBS, PhD
“Make sure you take care of Robbie,” was the last thing she said. Sometimes she acted like she'd only had one child.
Ann Intern Med. 2019;171(3):218-219. doi:10.7326/M18-2403
Ann Intern Med. 2019;171(3):220-222. doi:10.7326/M18-3698
Ann Intern Med. 2019;171(3):222-224. doi:10.7326/M18-3081
Ann Intern Med. 2019;171(3):224-225. doi:10.7326/L19-0158
Ann Intern Med. 2019;171(3):225. doi:10.7326/L19-0202
Ann Intern Med. 2019;171(3):225. doi:10.7326/L19-0203
Ann Intern Med. 2019;171(3):226. doi:10.7326/L19-0204
Ann Intern Med. 2019;171(3):226. doi:10.7326/L19-0205
Ann Intern Med. 2019;171(3):227. doi:10.7326/L19-0206
Ann Intern Med. 2019;171(3):227-228. doi:10.7326/L19-0207
Ann Intern Med. 2019;171(3):228. doi:10.7326/L19-0208
Daniel Katz, MD; Michael C. Gavin, MD, MPH
Ann Intern Med. 2019;171(3):ITC17-ITC32. doi:10.7326/AITC201908060
Darren B. Taichman, MD, PhD
Ann Intern Med. 2019;171(3):ED3. doi:10.7326/AWED201908060
Robert M. Centor, MD; Katherine Tuttle, MD
In this episode of Annals On Call, Dr. Centor discusses the risks and benefits of using SGLT2 inhibitors to treat patients with type 2 diabetes with Dr. Katherine Tuttle, an endocrinologist and nephrologist at Washington State University.
Ann Intern Med. 2019;171(3):OC1. doi:10.7326/A19-0011
Grace E. Farris, MD
Dr. Mom explores the challenges and ups and downs of juggling life as a hospitalist and mother. The feature appears monthly in Annals Graphic Medicine at Annals.org.
Ann Intern Med. 2019;171(3):W9-W10. doi:10.7326/G18-0048
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